1. Children of mothers who supplemented with folic acid (FA) during the second and third trimesters demonstrated greater processing speed at 11 years of age.
2. FA supplementation in later pregnancy resulted in stronger verbal comprehension skills among females.
Evidence Rating Level: 2 (Good)
Folic acid (FA) has been shown to prevent neural tube defects (NTD) when supplementation occurs before and during early pregnancy. This study investigated the benefits of continued FA supplementation through the second and third trimesters and its impact on neurocognitive performance in children. Included participants were followed up at 11 years of age from the randomized trial of Folic Acid Supplementation in the Second and Third Trimesters (FASSTT) in pregnancy. They were randomly assigned to be given 400 μg/day FA or placebo beginning in the 14th gestational week. Cognitive performance was measured with the Wechsler Intelligence Scale for Children in the following domains: Full Scale IQ, Verbal Comprehension, Perceptual Reasoning, Working Memory, and Processing Speed. Magnetoencephalographic (MEG) brain imaging was used to assess neuronal function. Of 119 mother-child pairs in the FASSTT trial, the cognitive performance of 68 children was assessed at the 11-year follow-up. A total of 31 were in the placebo group (M age = 28.1 years, 95% CI 26.6 to 29.6, 52% female) and 37 were in the FA group (M age = 29.7 years, 95% CI 28.5 to 30.8, 59.8% female). Children of mothers in the FA group scored significantly higher on two Processing Speed tests: Symbol Search (mean difference 2.9, 95% CI 0.3 to 5.5, p = 0.03) and Cancellation (mean difference 11.3, 95% CI 2.5 to 20.1, p = 0.04). Verbal Comprehension was higher in the FA group as well, but only for females (mean difference 6.5, 95% CI 1.2 to 11.8, p = 0.03). MEG assessment with a language tasks demonstrated more efficient semantic processing based on increased power at the High Gamma (49-70 Hz, p = 0.04) and Beta (13-30 Hz, p = 0.01) bands in children from the FA group. Overall, this study found that FA supplementation continues to benefit children when undergone in the second and third trimesters, with cognitive abilities proving stronger in multiple domains into the eleventh year of life.
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