title: Population-wide folic acid fortification and preterm birth: testing the folate depletion hypothesis.
abstract: OBJECTIVE
  We assess whether population-wide folic acid fortification policies were followed by a reduction of preterm and early-term birth rates in Québec among women with short and optimal interpregnancy intervals.
  
  
  METHODS
  We extracted birth certificate data for 1.3 million births between 1981 and 2010 to compute age-adjusted preterm and early-term birth rates stratified by short and optimal interpregnancy intervals. We used Joinpoint regression to detect changes in the preterm and early term birth rates and assess whether these changes coincide with the implementation of population-wide folic acid fortification.
  
  
  RESULTS
  A change in the preterm birth rate occurred in 2000 among women with short (95% confidence interval [CI] = 1994, 2005) and optimal (95% CI = 1995, 2008) interpregnancy intervals. Changes in early term birth rates did not coincide with the implementation of folic acid fortification.
  
  
  CONCLUSIONS
  Our results do not indicate a link between folic acid fortification and early term birth but suggest an improvement in preterm birth rates after implementation of a nationwide folic acid fortification program.
authors.affiliation: Ashley I. Naimi is with the Department of Obstetrics and Gynecology, McGill University, Montreal, Quèbec. Nathalie Auger is with the Institute National de Santé Publique du Quèbec, Montreal.
authors.forename: Ashley I
authors.initials: AI
authors.lastname: Naimi
authors.forename: Nathalie
authors.initials: N
authors.lastname: Auger
mesh_terms: D005492:Folic Acid; D005527:Food, Fortified / Q000706:statistics & numerical data*; D006801:Humans; D047928:Premature Birth / Q000453:epidemiology*; D011792:Quebec
chemical_list: D005492:Folic Acid