{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T06:12:23Z","timestamp":1773295943795,"version":"3.50.1"},"reference-count":17,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2013,2,4]],"date-time":"2013-02-04T00:00:00Z","timestamp":1359936000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Objectives: To evaluate the effects of folic acid supplementation on isolated oral cleft recurrence and fetal growth. Patients and Methods: The study included 2,508 women who were at-risk for oral cleft recurrence and randomized into two folic acid supplementation groups: 0.4 and 4 mg per day before pregnancy and throughout the first trimester. The infant outcome data were based on 234 live births. In addition to oral cleft recurrence, several secondary outcomes were compared between the two folic acid groups. Cleft recurrence rates were also compared to historic recurrence rates. Results: The oral cleft recurrence rates were 2.9% and 2.5% in the 0.4 and 4 mg groups, respectively. The recurrence rates in the two folic acid groups both separately and combined were significantly different from the 6.3% historic recurrence rate post the folic acid fortification program for this population (p = 0.0009 when combining the two folic acid groups). The rate of cleft lip with palate recurrence was 2.9% in the 0.4 mg group and 0.8% in the 4 mg group. There were no elevated fetal growth complications in the 4 mg group compared to the 0.4 mg group. Conclusions: The study is the first double-blinded randomized clinical trial (RCT) to study the effect of high dosage folic acid supplementation on isolated oral cleft recurrence. The recurrence rates were similar between the two folic acid groups. However, the results are suggestive of a decrease in oral cleft recurrence compared to the historic recurrence rate. A RCT is still needed to identify the effect of folic acid on oral cleft recurrence given these suggestive results and the supportive results from previous interventional and observational studies, and the study offers suggestions for such future studies. The results also suggest that high dosage folic acid does not compromise fetal growth.<\/jats:p>","DOI":"10.3390\/ijerph10020590","type":"journal-article","created":{"date-parts":[[2013,2,4]],"date-time":"2013-02-04T11:10:35Z","timestamp":1359976235000},"page":"590-605","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["High Dosage Folic Acid Supplementation, Oral Cleft Recurrence and Fetal Growth"],"prefix":"10.3390","volume":"10","author":[{"given":"George","family":"Wehby","sequence":"first","affiliation":[{"name":"Department of Health Management and Policy, University of Iowa, Iowa City, IA 52242, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T\u00eamis","family":"F\u00e9lix","sequence":"additional","affiliation":[{"name":"Hospital de Cl\u00ednicas de Porto Alegre, Porto Alegre, Rio Grande do Sul 90035-903, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Norman","family":"Goco","sequence":"additional","affiliation":[{"name":"RTI International, Research Triangle Park, NC 27709, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Richieri-Costa","sequence":"additional","affiliation":[{"name":"Hospital de Reabilita\u00e7\u00e3o de Anomalias Craniofaciais, Bauru, Sao Paulo 17.043-900, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hrishikesh","family":"Chakraborty","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC 29208, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josiane","family":"Souza","sequence":"additional","affiliation":[{"name":"Centro de Atendimento Integral ao Fissurado L\u00e1bio Palatal, Curitiba, Paran\u00e1 81.050-000, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rui","family":"Pereira","sequence":"additional","affiliation":[{"name":"Instituto Materno Infantil Prof. Fernando Figueira-CADEFI\/IMIP, Recife, Pernambuco 50070-550, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carla","family":"Padovani","sequence":"additional","affiliation":[{"name":"Hospital Santo Ant\u00f4nio: Obras Sociais Irm\u00e3 Dulce, Salvador, Bahia 40.415-000, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danilo","family":"Moretti-Ferreira","sequence":"additional","affiliation":[{"name":"Genetic Counseling Service, S\u00e3o Paulo State University, Botucatu, Sao Paulo 18618-000, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey","family":"Murray","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Iowa, Iowa City, IA 52242, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2013,2,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1773","DOI":"10.1016\/S0140-6736(09)60695-4","article-title":"Cleft lip and palate","volume":"374","author":"Mossey","year":"2009","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Wehby, G.L., Nyarko, K.A., Castilla, E.E., and Lopez-Camelo, J. 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