Maternal folic acid supplementation and the risk of ankyloglossia
(tongue-tie) in infants; a systematic review
Abstract
Background: Maternal folic acid supplementation is protective
against the development of neural tube defects (NTDs) in babies.
However, recent public-facing communications have raised concerns about
a causal relationship between folic acid supplementation, particularly
after the first trimester, and ankyloglossia (tongue-tie) in infants.
Non-evidence-based communications are potentially harmful because they
could adversely affect adherence to folic acid supplementation,
increasing NTD occurrence. Objectives: To review evidence on
the relationships between maternal folic acid supplementation during
preconception and/or pregnancy and the risk of ankyloglossia in infants.
Search Strategy: We searched online bibliographic databases for
studies investigating the effect of maternal folic acid supplementation
during preconception or pregnancy on the occurrence of ankyloglossia in
offspring. Selection Criteria: Observational, interventional
studies, and systematic reviews assessing the relationships between
folic acid and ankyloglossia. Data Collection and Analysis: The
database searches yielded 93 articles. After removing duplicates and
screening titles and abstracts, 26 remained. One article was judged
relevant for inclusion in analyses; a case-control study that directly
mentions the relationship between folic acid supplementation and
ankyloglossia Main Results: One case-control study reported
that regular intake of folic acid supplements was higher in women with
infants with ankyloglossia. However, this study has limitations
regarding design, selection bias, and confounding, calling the findings
into question. Conclusions: Insufficient evidence exists for a
relationship between folic acid supplementation and ankyloglossia.
Currently, the benefits of folic acid supplementation far outweigh the
risks. This must be clearly communicated to patients by their clinicians
during preconception and antenatal care.