Maternal Folate Levels during Pregnancy and Offspring Brain Development in Late Childhood
Open accessAbstract
Background Cumulative evidence shows that low maternal folate levels during pregnancy are associated with offspring neuropsychiatric disorders even in the absence of neural tube defects. However, the relationship between prenatal exposure to folate and brain development in late childhood has been rarely investigated. Methods In 2095 children from a prospective population-based cohort in Rotterdam, the Netherlands, we examined the association of maternal folate levels during pregnancy with downstream brain development in offspring. Maternal folate concentrations were measured from venous blood in early gestation. Child structural neuroimaging data were measured at age 9-11 years. In addition, measures of child head circumference using fetal ultrasound in the third trimester and total brain volume using magnetic resonance imaging at age 6-8 years were used for analyses with repeated assessments of brain development. Results Maternal folate deficiency (i.e., <7 nmol/L) during pregnancy was associated with smaller total brain volume (B = -18.7 cm 3, 95% CI -37.2 to -0.2) and smaller cerebral white matter (B = -7.2 cm 3, 95% CI -11.8 to -2.6) in children aged 9-11 years. No differences in cortical thickness or surface area were observed. Analysis of the repeated brain assessments showed that children exposed to deficient folate concentrations in utero had persistently smaller brains compared to controls from the third trimester to childhood (β = -0.4, 95% CI -0.6 to -0.1). Conclusions Low maternal folate levels during pregnancy are associated with altered offspring brain development in childhood, suggesting the importance of essential folate concentrations in early pregnancy.
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Emerging data demonstrate an association between inadequate maternal folate status during gestation and aberrant neurodevelopmental trajectories in offspring, with implications extending to long-term neuropsychiatric outcomes.
“Emerging data from contemporary investigations demonstrate an association between inadequate maternal folate status during gestation and aberrant neurodevelopmental trajectories in offspring, with implications extending to long-term neuropsychiatric outcomes.”
From Maternal Overnutrition and Fetal Programming: Long-Term Metabolic, Cognitive, and Epigenetic Consequences (2026) · cites this paper as [113]
Offspring exposed to suboptimal intrauterine folate environments exhibit distinctive neuroanatomical alterations, including diminished cerebral white matter and subcortical gray matter volumes, increased cortical thickness in left frontal regions, and reduced surface area bilaterally across frontal and temporal cortices.
“Offspring exposed to suboptimal intrauterine folate environments exhibit distinctive neuroanatomical alterations, including diminished cerebral white matter and subcortical gray matter volumes, increased cortical thickness in left frontal regions, and reduced surface area bilaterally across frontal and temporal cortices.”
From Maternal Overnutrition and Fetal Programming: Long-Term Metabolic, Cognitive, and Epigenetic Consequences (2026) · cites this paper as [113]
Adequate maternal folate status protects against neural tube defects and supports proper brain development, while deficiency is associated with persistent alterations in offspring neurodevelopment and an increased risk of obesity and insulin resistance later in life.
“Adequate maternal folate status protects against neural tube defects and supports proper brain development, while deficiency is associated with persistent alterations in offspring neurodevelopment and an increased risk of obesity and insulin resistance later in life [112,113,114].”
From Maternal Overnutrition and Fetal Programming: Long-Term Metabolic, Cognitive, and Epigenetic Consequences (2026) · cites this paper as [113]
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- Authors
- Zou, R., El Marroun, H., Cecil, C., Jaddoe, V. W. V., Hillegers, M., Tiemeier, H., & White, T.
- Affiliations
- Erasmus MC (NL)
- Leiden University Medical Center (NL)
- Harvard University (US)
- Corresponding author
- White, Tonya
- ORCID
- Venue
- Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2021-05
- Volume
- 40
- Issue
- 5
- Pages
- 3391-3400
- ISSN
- 0261-5614 (ISSN-L)
- OpenAlex
- W3109715309
- Cited by
- 44
- References
- 69
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 14 · 2023: 6 · 2022: 7 · 2021: 6
- FWCI
- 3.57
- Type
- journal article
- Language
- en
- Open access
- green
- pure.eur.nl
- Licence
- Locations
- Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, cc-by-nc-nd)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, cc-by-nc-nd)
- Utrecht University Repository (Utrecht University) (submittedVersion)
- Funders
- China Scholarship Council (201606100056)
- Dutch Brain Foundation (GH2016.2.01)
- Stichting Volksbond Rotterdam
- Brain & Behavior Research Foundation NARSAD Young Investigator Grant (27853)
- European Union's Horizon 2020 research and innovation program (707404)
- Netherlands Organization for Health Research and Development ZonMw Vici Grant (016.VICI.170.200)
- Netherlands Organization for Health Research and Development ZonMw TOP project (91211021)
- Topics
- Health Sciences › Medicine › Rheumatology › Folate and B Vitamins Research
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
- Keywords
- maternal folate, pregnancy, offspring neurodevelopment, head circumference, cortical thickness, cortical surface area, neuroimaging, neuropsychiatric disorders, neural tube defects
- MeSH terms
- Adult, Brain, Child, Child Development, Female, Folic Acid, Folic Acid Deficiency, Humans, Magnetic Resonance Imaging, Male, Netherlands, Pregnancy, Pregnancy Complications, Prenatal Exposure Delayed Effects, Prospective Studies, Dietary Supplements, Young Adult
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