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As we recognize National Folic Acid Awareness Week (September 8-14, 2025), it is vital to discuss innovations, research, and evolving care strategies that will influence folic acid management. From its influence on birth defects to increased use in gestation diabetes patients, groundbreaking folic acid research has emerged throughout 2025.

In this roundup, Contemporary OB/GYN highlights some of the most notable folic acid-related developments so far this year, including supplement use before pregnancy and improved child development. These stories highlight an ongoing effort to highlight the benefits of folic acid supplementation and increase use in the general population.

Click on each title below for more information on each news item.

A multicenter randomized clinical trial evaluated the impact of 3 surgical approaches for vaginal vault prolapse repair on body image and sexual function: native tissue repair, sacrocolpopexy, and transvaginal mesh. The study included 335 women, with a mean age of 66 years, most of whom had stage 3 prolapse.

Using the Body Image in Pelvic Organ Prolapse questionnaire and sexual function measures, investigators found significant improvements in body image and sexual function across all surgical methods over 36 months. No significant differences emerged between approaches, nor between mesh vs non-mesh or vaginal vs abdominal procedures.

Women who remained or became sexually active post-surgery reported greater gains in sexual function, with improvements closely tied to better body image. However, 37% experienced surgical failure by 36 months, which was associated with poorer body image. Overall, findings highlight that prolapse repair enhances body image and sexual health regardless of surgical technique.

A national analysis published in the American Journal of Preventive Medicine found that two-thirds of US women of reproductive age present with at least 1 modifiable risk factor for birth defects. Among 5,374 nonpregnant, nonlactating women studied from 2007 to 2020, 19.5% had low red blood cell folate levels, 33.8% were obese, 4.8% had diabetes, and nearly 1 in 5 had tobacco exposure.

Supplement use was low, with only 12.6% meeting recommended folic acid intake, and nearly all participants fell below 400 µg/day without supplements. Over time, obesity, diabetes, prediabetes, and very low food security increased, while active tobacco use and adequate folic acid intake declined.

Disparities were noted, with non-Hispanic Black and Hispanic women more likely than White women to have risk factors. Investigators emphasized that addressing these preventable factors through improved nutrition, health care access, and preconception counseling could significantly reduce the risk of birth defects and improve pregnancy outcomes.

A national survey conducted by the Annenberg Public Policy Center in April 2025 revealed persistent gaps in US adults’ knowledge of pregnancy-related health recommendations, despite broad recognition of maternal health’s importance. Among 1,653 respondents, 91% acknowledged pregnancy health affects infants, yet knowledge of specific guidelines was inconsistent and declining in some areas.

Only 46% correctly identified the recommended weight gain of 25 to 35 pounds during pregnancy, and understanding of folic acid supplementation dropped from 76% in 2023 to 71%. Awareness of iron use, alcohol abstinence prior to conception, and secondhand smoke risks also showed significant gaps, particularly among women of childbearing age.

Knowledge of vaccine recommendations declined, with just 37% recognizing Tdap as recommended and only 11% aware that MMR is contraindicated in pregnancy. These findings highlight the need for stronger, targeted public health messaging to address misconceptions and support healthier pregnancies, especially among reproductive-aged women and their families.

A study presented at the American Academy of Neurology’s 77th Annual Meeting found that higher maternal folic acid intake during the first trimester is linked to improved verbal and behavioral outcomes in children at age 6 years. The analysis included 345 children, most born to women with epilepsy, and compared outcomes based on maternal folic acid doses ranging from none to more than 4 mg per day.

Children whose mothers took folic acid scored higher in verbal skills (mean 108 vs 96) and behavior (102 vs 82) compared with those whose mothers took none. Among folic acid users, verbal scores averaged 110 for high-dose vs 108 for low-dose groups, with behavioral scores similar at 103.

These findings suggest that folic acid intake, regardless of dose, benefits neurodevelopment, while higher doses appear safe. Investigators emphasized the importance of early supplementation for child brain health, particularly in women at higher risk, such as those with epilepsy.

A study published in Gynecological Endocrinology suggests that a multi-layer perceptron (MLP) deep learning model may improve prediction of gestational diabetes mellitus (GDM) compared with traditional logistic regression approaches. GDM affects 5% to 30% of pregnancies worldwide, varies by region and ethnicity, and poses serious risks for both mothers and infants.

Investigators conducted a retrospective cohort study of pregnant women delivering between 2008 and 2018, analyzing 32 prenatal variables, including age, prepregnancy body mass index (BMI), folic acid supplementation, family history, and laboratory biomarkers. Women with GDM were more likely to be older, have higher BMI, lower education, earlier menarche, and distinct hematological, renal, and liver profiles.

The MLP model, structured with 3 neural network layers, demonstrated superior predictive performance with an area under the receiver operating characteristic curve of 0.943, average precision of 0.855, and F1 score of 0.879, compared to weaker results from logistic regression models. Investigators noted that incorporating genetic data could further refine prediction and support personalized prevention and treatment strategies for GDM.

Even healthy, full-term infants often develop severe respiratory syncytial virus (RSV) infections, particularly in the first 3 months of life, Swedish researchers reported yesterday in The Lancet Regional Health-Europe.

A team from Karolinska Institutet and the University of Helsinki analyzed national registry data on all children born in Sweden from 2001 to 2022 on RSV diagnoses, sociodemographic factors, underlying diseases, RSV deaths, intensive care unit (ICU) admissions, and hospital stays of 7 days or longer.

“Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory tract infections (LRTIs) in young children, with the highest burden of disease in low- and middle-income countries,” the study authors wrote. “In 2019 there were globally 33 million cases of RSV in children younger than 5 years, leading to 3.6 million hospitalizations and over 100,000 RSV-related deaths.”

12% of kids with RSV severely ill

Of 2.4 million children, 1.7% were diagnosed as having RSV, corresponding to an incidence of 1,406 cases per 100,000 person-years in children younger than 1 year and 36 per 100,000 person-years in older children. Of children with RSV, 11.9% had severe illness. The median age of children admitted to an ICU was 1.9 months, 41.3% had an underlying medical condition, and the median length of ICU stay was 46.0 hours. 

Among these children, 36.1% required supplemental oxygen with a high-flow nasal cannula for a median of 18.9 hours, 25.2% received non-invasive ventilation for a median of 25.3 hours, and 32.1% needed mechanical ventilation for a median of 65.8 hours. The median age of children who died was 6.6 months.

Among all children, risk factors for ICU admission or death included birth in winter (hazard ratio [HR], 2.96), small for gestational age (adjusted HR [aHR], 3.91), twins (aHR, 3.43), having siblings aged 3 years or younger (aHR, 2.92), having a sibling hospitalized for lower respiratory tract infection before age 4 years (aHR, 2.40), and having severe chronic conditions (aHRs, greater than 4).

Underlying diseases were seen in 52.3% of children admitted to the ICU, 42.6% of those with a prolonged hospitalization, and 77.8% of those who died.

In children with RSV infection, risk factors for poor outcomes included small for gestational age (aHR, 2.74), prematurity (very preterm aHR, 3.74; extremely preterm aHR, 5.70), and severe underlying illnesses.

Targeting more children for immunization

In the full cohort, 3,766 children were hospitalized for at least 7 days after RSV infection. The risk factors for prolonged hospitalization were similar to those for ICU admission or death, including winter birth (HR, 3.13), small for gestational age (aHR, 2.22), twins (aHR, 3.63), having older siblings aged 0 to 3 years (aHR, 2.91), and prematurity (very preterm aHR, 10.85; extremely preterm aHR, 19.19). 

The study highlights that a large proportion of children who require intensive care due to their RSV infection were previously healthy.

Chronic conditions were tied to an elevated risk of prolonged hospitalization, particularly severe congenital heart disease (aHR, 7.18), Down syndrome (aHR, 7.53), and other severe underlying illnesses (aHR, 9.08). Underlying conditions were less common in seriously ill children younger than 3 months than in their older counterparts (40.3% vs 71.6%).

The authors said the findings strengthen the evidence supporting universal RSV immunization in children. “In settings where universal immunization is not yet feasible, our study provides crucial evidence to guide the prioritization of high-risk groups, not only based on underlying conditions, but on age and other risk factors,” they wrote.

In the United States, infants can be protected against RSV through maternal vaccination or infant immunization with a monoclonal antibody injection.

In a Karolinska press release, senior author Samuel Rhedin, MD, PhD, of Karolinska, said, “We know that several underlying diseases increase the risk of severe RSV infection, and it is these children who have so far been targeted for protection with the preventive treatment that has been available. However, the study highlights that a large proportion of children who require intensive care due to their RSV infection were previously healthy.”

When formulating treatment strategies, it’s important to consider that even healthy infants can be severely affected by RSV, first author Giulia Dallagiacoma, MD, of Karolinska Institutet, said in the release: “The good news is that there is now preventive treatment that can be given to newborns, and a vaccine that can be given to pregnant women.”