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Association Between Maternal 2nd Trimester Plasma Folate Levels and Infant Bronchiolitis

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Abstract

Objectives Viral bronchiolitis is the most common cause of infant hospitalization. Folic acid supplementation is important during the periconceptional period to prevent neural tube defects. An area of investigation is whether higher prenatal folate is a risk factor for childhood respiratory illnesses. We investigated the association between maternal 2nd trimester plasma folate levels and infant bronchiolitis. Methods We conducted a retrospective cohort analysis in a subset of mother-infant dyads (n = 676) enrolled in the Conditions Affecting Neurocognitive Development and Learning in Early Childhood study and Tennessee Medicaid. Maternal folate status was determined using 2nd trimester (16–28 weeks) plasma samples. Bronchiolitis diagnosis in the first year of life was ascertained using International Classification of Diagnosis-9 codes from Medicaid administrative data. We used multivariable logistic regression to assess the adjusted association of prenatal folate levels and infant bronchiolitis outcome. Results Half of the women in this lower-income and predominately African-American (84%) study population had high levels of folate (median 2nd trimester level 19.2 ng/mL) and 21% of infants had at least one bronchiolitis healthcare visit. A relationship initially positive then reversing between maternal plasma folate and infant bronchiolitis was observed that did not reach statistical significance (poverall = .112, pnonlinear effect = .088). Additional adjustment for dietary methyl donor intake did not significantly alter the association. Conclusions for Practice Results did not confirm a statistically significant association between maternal 2nd trimester plasma folate levels and infant bronchiolitis. Further work is needed to investigate the role of folate, particularly higher levels, in association with early childhood respiratory illnesses.

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Acknowledgements

We acknowledge the vital contributions of the CANDLE study research staff and the families that are enrolled in the Conditions Affecting Neurocognitive Development and Learning in Early Childhood study. We thank the Tennessee Bureau of TennCare (Department of Finance and Administration) and the Tennessee Department of Health (Office of Policy, Planning, and Assessment) for providing data needed for this study. This work was supported by the National Institutes of Health, National Heart, Blood, and Lung Institute (Grant R01 HL109977-KNC), the Urban Child Institute (FT) and the National Institutes of Health, National Center for Research Resources (Vanderbilt CTSA Grant UL1 RR024975).

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Author notes

  1. Shanda Vereen and Tebeb Gebretsadik have contributed equally to this work.

Authors and Affiliations

  1. Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA

    Shanda Vereen, Sreenivas P. Veeranki, William O. Cooper & Kecia N. Carroll

  2. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA

    Tebeb Gebretsadik & William D. Dupont

  3. Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA

    Edward F. Mitchel

  4. Divisions of General Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA

    Shanda Vereen, Sreenivas P. Veeranki, William O. Cooper & Kecia N. Carroll

  5. Center for Asthma Health Research, Vanderbilt University Medical Center, Nashville, TN, USA

    Shanda Vereen, Tebeb Gebretsadik, Sreenivas P. Veeranki, William D. Dupont & Kecia N. Carroll

  6. Fisk University, Nashville, TN, USA

    Nia Johnson

  7. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Terryl J. Hartman

  8. Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA

    Chandrika Piyathilake

  9. Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA

    Mehmet Kocak & Frances Tylavsky

  10. Vanderbilt University School of Medicine, 313 Oxford House, 1313 21st Avenue South, Nashville, TN, 37232-4313, USA

    Kecia N. Carroll

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  1. Shanda Vereen
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Correspondence to Kecia N. Carroll.

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Vereen, S., Gebretsadik, T., Johnson, N. et al. Association Between Maternal 2nd Trimester Plasma Folate Levels and Infant Bronchiolitis. Matern Child Health J 23, 164–172 (2019). https://doi.org/10.1007/s10995-018-2610-2

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