Higher maternal folic acid intake linked to improved child development

Higher maternal folic acid intake linked to improved child development | Image Credit: © Myst - © Myst - stock.adobe.com.

Introduction

Verbal abilities and behavior skills are improved in children at the age of 6 years when mothers take higher doses of folic acid during the first trimester of pregnancy, according to a recent study that will be presented at the American Academy of Neurology’s 77th Annual Meeting, San Diego, California, from April 5 to April 9, 2025.¹

The study highlighted increased mean verbal scores among children of mothers who took high doses of folic acid during pregnancy vs low doses, at 110 vs 108, respectively. In comparison, both groups had an average behavioral score of 103.

“Folic acid during pregnancy has been shown to reduce deformities and improve intellectual abilities in children, but the best dose of folic acid is unknown,” said study author Kimford J. Meador, MD, PhD, of Stanford University. “Our study provides new information showing a positive connection between taking folic acid during early pregnancy and brain health outcomes in children.”

Low folic acid in pregnancy has been linked to multiple adverse outcomes.² One study reported preterm delivery in 16.94% of patients with folic acid levels below 8.6 ng/mL vs 7.53% of those with levels above 8.6 ng/mL. Fetal growth restriction was reported in 27.11% and 13.38%, respectively.

Study overview

There were 345 children aged 6 years included in the recent analysis, 262 of whom were children of women with epilepsy and 83 of women without epilepsy.¹ These patients were classified based on the recorded doses of folic acid their mothers took in the first 12 weeks of pregnancy.

Categories included no folic acid, folic acid up to 0.4 mg per day, more than 0.4 to 1 mg per day, more than 1 to 4 mg per day, and more than 4 mg per day. Currently, a daily dose of 0.4 mg is recommended in the general population, with increased doses often recommended among women with epilepsy.

Verbal skills were evaluated through multiple tests. This included being asked to describe objects, actions, or concepts displayed in an image using a single word. Scores of 70 to 130 were reported for the general population, with a mean score of 100. Higher scores indicated improved verbal skills.

Children’s behavior was also measured through questionnaires completed by parents. This included social skills, communication skills, and daily living skills. Scores also ranged from 70 to 130 for a mean of 100 when assessing these characteristics.

Impact of folic acid intake on child development

Adjustments were made for mother’s IQ, pregnancy complications, and epilepsy medications. Following these adjustments, children of mothers who took folic acid reported a mean verbal score of 108, vs 96 for those whose mothers did not take folic acid. For behavioral scores, the means were 102 and 82, respectively.

Similar scores were reported regardless of folic acid dose among women taking folic acid during pregnancy. For high vs low doses, children aged 6 years reported mean verbal skill scores of 110 and 108, respectively, while both groups reported mean behavioral scores of 103.

Safety and conclusion

Safety was also reported from taking higher doses of folic acid during pregnancy. However, the study was limited by not assessing other factors influencing folic acid intake and absorption such as genetics and other vitamins taken.

“While previous studies have found risks with higher doses, these findings are reassuring for people who are pregnant or planning to have children that taking a higher dose of folic acid early in pregnancy may still positively impact the brain health of their child,” said Meador.

References:

1. Are higher doses of folic acid in pregnancy safe? American Academy of Neurology. March 4, 2025. Accessed March 5, 2025. https://www.eurekalert.org/news-releases/1074752
2. Krewson C.Impact of low folic acid levels on pregnancy. Contemporary OB/GYN. February 27, 2024. March 6, 2025. https://www.contemporaryobgyn.net/view/impact-of-low-folic-acid-levels-on-pregnancy