Association between preconception folic acid intake and behavioural problems in children aged 2–8 years: a prospective cohort study

PURPOSE: While maternal folic acid intake during periconception is well-known for preventing neural tube defects, its association with childhood behavioural outcomes remains understudied. This study examined the association between preconception folic acid intake and behavioural problems in children aged 2-8 years. METHODS: We analysed data from 646 children and their 563 mothers participating in the Mothers' and their Children's Healthcare Experience Study, a sub-study of the 1989-95 cohort of the Australian Longitudinal Study on Women's Health. Mothers reported preconception folic acid intake and rated their child's behaviours using the Strengths and Difficulties Questionnaire. Analyses were conducted using Poisson regression with robust standard error. RESULTS: Nearly two-thirds (63%) of mothers reported taking FA supplements prior to the child's birth. Overall, 64% of children were reported to experience at least one behavioural problem across the behaviour difficulties subscales. After adjusting for potential confounders, children of mothers who reported taking FA supplements before conception had a 34% lower risk of peer relationship problems than those whose mothers did not (RR = 0.66; 95% CI 0.49-0.87). No associations were found between preconception folic acid intake and the total behavioural difficulties, emotional, conduct, or hyperactivity problem subscales. CONCLUSIONS: While large prospective studies are required to confirm these associations, our findings suggest that preconception folic acid intake may lower the risk of peer relationship problems in offspring. Supporting mothers to become more aware of the benefits of folic acid intake may contribute to optimal peer relationship outcomes in their offspring.