Prenatal exposure to tobacco and adverse birth outcomes: effect modification by folate intake during pregnancy

Adrienne T Hoyt; Anna V Wilkinson; Peter H Langlois; Carol E Galeener; Nalini Ranjit; Katherine A Sauder; Dana M Dabelea; Brianna F Moore

doi:10.1186/s40748-022-00141-1

Prenatal exposure to tobacco and adverse birth outcomes: effect modification by folate intake during pregnancy

Matern Health Neonatol Perinatol. 2022 Sep 12;8(1):6. doi: 10.1186/s40748-022-00141-1.

Authors

Adrienne T Hoyt¹, Anna V Wilkinson², Peter H Langlois², Carol E Galeener³, Nalini Ranjit¹, Katherine A Sauder⁴, Dana M Dabelea⁵, Brianna F Moore⁶

Affiliations

¹ Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health - Austin Regional Campus, Austin, TX, USA.
² Department of Epidemiology, UTHealth School of Public Health - Austin Regional Campus, Human Genetics, and Environmental Sciences, Austin, TX, USA.
³ Department of Management, Policy and Community Health, UTHealth School of Public Health- Houston Regional Campus, Fleming Center Health for Care Management, Houston, TX, USA.
⁴ Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) CenterDepartment of PediatricsSchool of Medicine, Colorado School of Public Health, University of Colorado, Denver, USA.
⁵ Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, Department of Pediatrics, Department of Epidemiology, University of Colorado School of Medicine, Colorado School of Public Health, Aurora, CO, USA.
⁶ Department of Epidemiology, UTHealth School of Public Health - Austin Regional Campus, Human Genetics, and Environmental Sciences, Austin, TX, USA. brianna.f.moore@cuanschutz.edu.

Abstract

Background: Fetal exposure to tobacco increases the risk for many adverse birth outcomes, but whether diet mitigates these risks has yet to be explored. Here, we examined whether maternal folate intake (from foods and supplements) during pregnancy modified the association between prenatal exposure to tobacco and with preterm delivery, small-for-gestational age (SGA) births, or neonatal adiposity.

Methods: Mother-child pairs (n = 701) from Healthy Start were included in this analysis. Urinary cotinine was measured at ~ 27 weeks gestation. Diet was assessed using repeated 24-h dietary recalls. Neonatal adiposity (fat mass percentage) was measured via air displacement plethysmography. Interaction was assessed by including a product term between cotinine (< / ≥ limit of detection [LOD]) and folate (< / ≥ 25^th percentile [1077 µg/day]) in separate logistic or linear regression models, adjusting for maternal age, race, ethnicity, education, pre-pregnancy body mass index, and infant sex.

Results: Approximately 26% of women had detectable levels of cotinine. Folate intake was significantly lower among women with cotinine ≥ LOD as compared to those with cotinine < LOD (1293 µg/day vs. 1418 µg/day; p = 0.01). Folate modified the association between fetal exposure to tobacco with neonatal adiposity (p for interaction = 0.07) and SGA (p for interaction = 0.07). Among those with lower folate intake, fetal exposure to tobacco was associated with lower neonatal adiposity (mean difference: -2.09%; 95% CI: -3.44, -0.74) and increased SGA risk (OR: 4.99; 95% CI: 1.55, 16.14). Conversely, among those with higher folate intake, there was no difference in neonatal adiposity (mean difference: -0.17%; 95% CI: -1.13, 0.79) or SGA risk (OR: 1.15; 95% CI: 0.57, 2.31).

Conclusions: Increased folate intake during pregnancy (from foods and/or supplements) may mitigate the risk of fetal growth restriction among those who are unable to quit smoking or cannot avoid secondhand smoke during pregnancy.

Keywords: Cotinine; Diet; Folate; Healthy start; Neonatal adiposity; Preterm Births; Small-for-gestational age births; Smoking; Tobacco.

Abstract

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