Preconception Folic Acid Supplementation Associated with Attenuated Effects of Air Pollution on Birthweight Outcomes.
6 affiliations
- 1Nicholas School of the Environment, Duke University, Durham, North Carolina 27708, United States.
- 2Department of Clinical Epidemiology & Clinical Trial Unit, Children's Hospital of Fudan University, National Children's Medical Center & Shanghai Key Laboratory of Birth Defects, Shanghai 201102, China.
- 3Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, United States.
- 4Duke Global Health Institute, Duke University, Durham, North Carolina 27708, United States.
- 5Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York 10032, United States.
- 6State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing 100012, China.
Abstract
Gestational exposure to ambient air pollution has been linked to adverse birth outcomes. Folic acid (FA) supplementation supports fetal development, but the optimal timing for protective effects remains uncertain. This study aims to determine whether maternal FA supplementation prior to conception modifies the association between gestational air pollution exposure and birthweight-related outcomes in a population where most women also took FA during pregnancy. We analyzed data from 10,579 mother-child pairs from a preconception cohort in Shanghai, China. Ambient concentrations of PM2.5, PM₁₀, NO₂, and ozone were estimated at a residential level using spatiotemporal models for the preconception period and each trimester. We assessed whether preconception FA supplementation modified the association between air pollution exposure and birth outcomes, including birthweight, birthweight Z-score, small-for-gestational age (SGA), and low birthweight (LBW). Linear and logistic regression models with interaction terms, as well as stratified analyses by FA supplementation status, were applied. Children's sex-specific associations were also explored. Significant interactions between preconception FA supplementation and air pollution exposures were observed for birthweight and SGA. A 10 μg/m³ increase in PM2.5 exposure during pregnancy was associated with a -62.8 g (95% CI: -97.0, -28.6) change in birthweight and a 1.78 (95% CI: 1.16, 2.73) odds ratio for SGA among women without preconception FA supplementation. No such significant associations were found among women receiving preconception FA supplementation, with an estimated change of -1.7 g in birthweight (95% CI: -65.7 to 62.4) and an odds ratio of 0.70 for SGA (95% CI: 0.32-1.44). The protective effect appeared more pronounced for male infants than females. Maternal preconception FA supplementation can attenuate the adverse effects of gestational air pollution exposure on birthweight and SGA risk in women who also received FA supplementation during pregnancy. These findings support the importance of incorporating preconception FA supplementation as a protective measure against gestational exposure to air pollution.
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BibTeX
@article{ge2026preconception,
title = {{Preconception Folic Acid Supplementation Associated with Attenuated Effects of Air Pollution on Birthweight Outcomes.}},
author = {Yihui Ge and Yi Zhang and Jiawen Liao and Yan Lin and Zhenchun Yang and Kiros Berhane and Zhipeng Bai and Bin Han and Jia Xu and Frank Gilliland and Zhanghua Chen and Weili Yan and Guoying Huang and Junfeng Jim Zhang},
journal = {Environment \& health (Washington, D.C.)},
year = {2026},
month = jun,
doi = {10.1021/envhealth.5c00779},
url = {https://europepmc.org/article/MED/42903402},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Preconception Folic Acid Supplementation Associated with Attenuated Effects of Air Pollution on Birthweight Outcomes.
AU - Yihui Ge
AU - Yi Zhang
AU - Jiawen Liao
AU - Yan Lin
AU - Zhenchun Yang
AU - Kiros Berhane
AU - Zhipeng Bai
AU - Bin Han
AU - Jia Xu
AU - Frank Gilliland
AU - Zhanghua Chen
AU - Weili Yan
AU - Guoying Huang
AU - Junfeng Jim Zhang
PY - 2026
DA - 2026/06/27
JO - Environment & health (Washington, D.C.)
DO - 10.1021/envhealth.5c00779
UR - https://europepmc.org/article/MED/42903402
AB - Gestational exposure to ambient air pollution has been linked to adverse birth outcomes. Folic acid (FA) supplementation supports fetal development, but the optimal timing for protective effects remains uncertain. This study aims to determine whether maternal FA supplementation prior to conception modifies the association between gestational air pollution exposure and birthweight-related outcomes in a population where most women also took FA during pregnancy. We analyzed data from 10,579 mother-child pairs from a preconception cohort in Shanghai, China. Ambient concentrations of PM2.5, PM₁₀, NO₂, and ozone were estimated at a residential level using spatiotemporal models for the preconception period and each trimester. We assessed whether preconception FA supplementation modified the association between air pollution exposure and birth outcomes, including birthweight, birthweight Z-score, small-for-gestational age (SGA), and low birthweight (LBW). Linear and logistic regression models with interaction terms, as well as stratified analyses by FA supplementation status, were applied. Children's sex-specific associations were also explored. Significant interactions between preconception FA supplementation and air pollution exposures were observed for birthweight and SGA. A 10 μg/m³ increase in PM2.5 exposure during pregnancy was associated with a -62.8 g (95% CI: -97.0, -28.6) change in birthweight and a 1.78 (95% CI: 1.16, 2.73) odds ratio for SGA among women without preconception FA supplementation. No such significant associations were found among women receiving preconception FA supplementation, with an estimated change of -1.7 g in birthweight (95% CI: -65.7 to 62.4) and an odds ratio of 0.70 for SGA (95% CI: 0.32-1.44). The protective effect appeared more pronounced for male infants than females. Maternal preconception FA supplementation can attenuate the adverse effects of gestational air pollution exposure on birthweight and SGA risk in women who also received FA supplementation during pregnancy. These findings support the importance of incorporating preconception FA supplementation as a protective measure against gestational exposure to air pollution.
SN - 2833-8278
ER -