Children of mothers who reported taking folic acid supplements before conception had a 34% lower risk of peer relationship problems, but preconception folic acid intake was not associated with total behavioural difficulties, emotional, conduct, or hyperactivity problems.
Key Findings
Results
Preconception folic acid supplement intake was associated with a 34% lower risk of peer relationship problems in children aged 2-8 years.
Poisson regression with robust standard error was used, adjusting for potential confounders.
RR = 0.66; 95% CI 0.49-0.87 for peer relationship problems among children whose mothers took folic acid supplements before conception compared to those who did not.
Sample included 646 children and 563 mothers from the Mothers' and their Children's Healthcare Experience Study.
Nearly two-thirds (63%) of mothers reported taking folic acid supplements prior to the child's birth.
Results
No statistically significant associations were found between preconception folic acid intake and total behavioural difficulties, emotional problems, conduct problems, or hyperactivity subscales.
Behavioural outcomes were assessed using the Strengths and Difficulties Questionnaire (SDQ), rated by mothers.
The null findings applied across four of the five SDQ behavioural difficulties subscales.
Analyses controlled for potential confounders using Poisson regression with robust standard error.
Results
A substantial proportion of children in this cohort were reported to experience at least one behavioural problem.
Overall, 64% of children were reported to experience at least one behavioural problem across the behaviour difficulties subscales.
Behavioural problems were assessed across emotional, conduct, hyperactivity, and peer relationship subscales of the SDQ.
Children were aged 2-8 years at the time of assessment.
Methods
The study population was drawn from a sub-study of the Australian Longitudinal Study on Women's Health (ALSWH), specifically the 1989-95 birth cohort.
The Mothers' and their Children's Healthcare Experience Study is a sub-study of the ALSWH 1989-95 cohort.
The analytic sample comprised 646 children and their 563 mothers, indicating some mothers had more than one child in the study.
Mothers self-reported preconception folic acid intake and rated their children's behaviours using the Strengths and Difficulties Questionnaire.
The study design was a prospective cohort.
Conclusions
The authors conclude that preconception folic acid intake may lower the risk of peer relationship problems in offspring, while calling for larger prospective studies to confirm these findings.
Authors note that while large prospective studies are required to confirm these associations, findings suggest a potential benefit of preconception folic acid on peer relationship outcomes.
The authors suggest that supporting mothers to become more aware of the benefits of folic acid intake may contribute to optimal peer relationship outcomes in their offspring.
The periconception period was the exposure window of interest, distinct from the commonly studied prenatal period.
What This Means
This research suggests that mothers who took folic acid supplements before becoming pregnant had children with fewer peer relationship problems during early childhood (ages 2-8), compared to children whose mothers did not take folic acid before conception. Specifically, children of mothers who took preconception folic acid supplements were about 34% less likely to experience peer relationship difficulties. However, folic acid supplementation before pregnancy was not linked to differences in overall behavioral problems, emotional difficulties, conduct issues, or hyperactivity in children.
The study followed 646 children and 563 Australian mothers, with mothers reporting their own supplement use and rating their children's behavior using a standardized questionnaire called the Strengths and Difficulties Questionnaire. About 63% of mothers reported taking folic acid before conception, and 64% of all children showed at least one type of behavioral problem across the categories measured. Folic acid is already well-known for reducing the risk of neural tube defects like spina bifida, but this study adds to a smaller body of research exploring whether it might also influence children's social and behavioral development.
This research suggests that preconception folic acid supplementation could have benefits for children's social development beyond its established role in preventing birth defects, though the authors caution that the findings need to be confirmed in larger studies. The results highlight a specific window — before pregnancy — as potentially important for influencing childhood peer relationship outcomes, which matters because many pregnancies are unplanned and women may not start supplements until after conception is confirmed.
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Mekonnen A, Gete D, Doust J, Mishra G. (2026). Association between preconception folic acid intake and behavioural problems in children aged 2-8 years: a prospective cohort study.. European journal of nutrition. https://doi.org/10.1007/s00394-026-04094-5