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Trial details imported from ClinicalTrials.gov

For full trial details, please see the original record at https://clinicaltrials.gov/ct2/show/NCT03981029




Registration number
NCT03981029
Ethics application status
Date submitted
3/06/2019
Date registered
10/06/2019
Date last updated
10/06/2019

Titles & IDs
Public title
FACT Biomarker Subgroup Analysis
Scientific title
Folic Acid Clinical Trial (FACT): Biomarker Subgroup Analysis
Secondary ID [1] 0 0
2011649-01H
Universal Trial Number (UTN)
Trial acronym
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Pre-Eclampsia 0 0
Condition category
Condition code
Reproductive Health and Childbirth 0 0 0 0
Fetal medicine and complications of pregnancy
Cardiovascular 0 0 0 0
Hypertension

Intervention/exposure
Study type
Observational
Patient registry
Target follow-up duration
Target follow-up type
Description of intervention(s) / exposure
Other interventions - 4.0mg Folic Acid received through participation in FACT (NCT01355159)
Other interventions - Placebo received through participation in FACT

FACT High-dose folic acid treatment group - Consenting study participants who, through their participation in FACT (NCT01355159) are randomized to receive daily high-dose folic acid supplementation during pregnancy.

FACT Placebo treatment group - Consenting study participants who, through their participation in FACT (NCT01355159) are randomized to receive daily placebo supplementation during pregnancy.


Other interventions: 4.0mg Folic Acid received through participation in FACT (NCT01355159)
Participants in this study received either daily high-dose folic acid supplementation during pregnancy OR placebo through their participation in FACT (NCT01355159). Details of the FACT Folic Acid intervention are provided below:
Folic Acid 1.0 mg x 4 tablets will be taken daily by oral administration. The majority of women in the study will routinely take 1.0 mg folic acid in a prenatal vitamin supplement, as recommended by their primary obstetrical provider; the study requirements do not require that participants change their practice. Therefore the actual total daily dose may be up to 5.1 mg of folic acid

Other interventions: Placebo received through participation in FACT
Participants in this study received either daily high-dose folic acid supplementation during pregnancy OR placebo through their participation in FACT (NCT01355159). Details of the FACT Folic Acid placebo are provided below:
Placebo x 4 tablets will be taken daily by oral administration.
Intervention code [1] 0 0
Other interventions
Comparator / control treatment
Control group

Outcomes
Primary outcome [1] 0 0
Folate Status
Timepoint [1] 0 0
From FACT randomization at 8-16 weeks gestation to date of sample collection taken at one time point between 24 and 26 completed weeks gestation.
Secondary outcome [1] 0 0
Homocysteine Status
Timepoint [1] 0 0
From FACT randomization at 8-16 weeks gestation to date of sample collection taken at one time point between 24 and 26 completed weeks gestation.
Secondary outcome [2] 0 0
Status of modifiers of folate metabolism
Timepoint [2] 0 0
Taken at one time point between 24 and 26 completed weeks gestation.
Secondary outcome [3] 0 0
Angiogenic potential
Timepoint [3] 0 0
From FACT randomization at 8-16 weeks gestation to date of sample collection taken at one time point between 24 and 26 completed weeks gestation.

Eligibility
Key inclusion criteria
Individuals participating in FACT (NCT01355159) will be eligible to participate. FACT
eligibility criteria are as follows:

INCLUSION criteria

1. Capability of subject to comprehend and comply with study requirements

2. = 18 years of age at time of consent

3. Subject is taking =1.1 mg of folic acid daily at the time of randomization

4. Live fetus (documented positive fetal heart prior to randomization)

5. Gestational age between 8+0 and 16+6 weeks of pregnancy (Gestational age (GA) of
subjects will be calculated based on the first day of the last menstrual period (LMP)
or ultrasound performed before 12+6. If early ultrasound and LMP dates differ by = 7
days, base GA estimate on LMP date; if > 7 days, use early < 12+6 ultrasound)

6. Subject plans to give birth in a participating hospital site

7. Pregnant subjects must fulfill at least one of the following identified risk factors
for pre-eclampsia (PE):

- Pre-existing hypertension (documented evidence of diastolic blood pressure = 90
mmHg on two separate occasions or at least 4 hours apart prior to randomization,
or use of antihypertensive medication during this pregnancy specifically for the
treatment of hypertension prior to randomization)

- Pre-pregnancy diabetes (documented evidence of Type I or type II DM)

- Twin pregnancy

- Documented evidence of history of PE in a previous pregnancy

- BMI > 35 kg/m2 within 3 months prior to this pregnancy and up to randomization of
this pregnancy (documented evidence of height and weight to calculate BMI is
required)

EXCLUSION Criteria:

1. Known history or presence of any clinically significant disease or condition which
would be a contraindication to folic acid supplementation of up to 5 mg daily for the
duration of pregnancy

2. Known major fetal anomaly or fetal demise

3. History of medical complications, including: renal disease with altered renal
function, epilepsy, cancer, or use of folic acid antagonists such as valproic acid

4. Individual who is currently enrolled or has participated in another clinical trial or
who received an investigational drug within 3 months of the date of randomization
(unless approved by the Trial Coordinating Centre)

5. Known presence of: Alcohol abuse (= 2 drinks per day) or alcohol dependence, Illicit
drug/substance use and/or dependence, Known hypersensitivity to folic acid, Multiple
Pregnancy (triplets or more), Participation in this study in a previous pregnancy
Minimum age
18 Years
Maximum age
No limit
Sex
Females
Can healthy volunteers participate?
Yes
Key exclusion criteria

Study design
Purpose
Duration
Cross-sectional
Selection
Timing
Statistical methods / analysis

Recruitment
Recruitment status
Completed
Data analysis
Reason for early stopping/withdrawal
Other reasons
Date of first participant enrolment
Anticipated
Actual
19/12/2011
Date of last participant enrolment
Anticipated
Actual
Date of last data collection
Anticipated
Actual
1/09/2016
Sample size
Target
Accrual to date
Final
51
Recruitment in Australia
Recruitment state(s)
Recruitment outside Australia
Country [1] 0 0
Canada
State/province [1] 0 0
New Brunswick
Country [2] 0 0
Canada
State/province [2] 0 0
Ontario

Funding & Sponsors
Primary sponsor type
Other
Name
Ottawa Hospital Research Institute
Address
Country

Ethics approval
Ethics application status

Summary
Brief summary
The FACT Biomarker Subgroup Analysis is a pilot study of mothers who participated in the
Folic Acid Clinical Trial (FACT, NCT01355159). This subgroup analysis aims to determine the
effect of high-dose folic acid supplementation in pregnancy on maternal folate status and
subsequent impact on risk for pre-eclampsia.
Trial website
https://clinicaltrials.gov/ct2/show/NCT03981029
Trial related presentations / publications
Wen SW, White RR, Rybak N, Gaudet LM, Robson S, Hague W, Simms-Stewart D, Carroli G, Smith G, Fraser WD, Wells G, Davidge ST, Kingdom J, Coyle D, Fergusson D, Corsi DJ, Champagne J, Sabri E, Ramsay T, Mol BWJ, Oudijk MA, Walker MC; FACT Collaborating Group. Effect of high dose folic acid supplementation in pregnancy on pre-eclampsia (FACT): double blind, phase III, randomised controlled, international, multicentre trial. BMJ. 2018 Sep 12;362:k3478. doi: 10.1136/bmj.k3478.
Wen SW, Chen XK, Rodger M, White RR, Yang Q, Smith GN, Sigal RJ, Perkins SL, Walker MC. Folic acid supplementation in early second trimester and the risk of preeclampsia. Am J Obstet Gynecol. 2008 Jan;198(1):45.e1-7. doi: 10.1016/j.ajog.2007.06.067.
Shane B, Stokstad EL. Vitamin B12-folate interrelationships. Annu Rev Nutr. 1985;5:115-41. doi: 10.1146/annurev.nu.05.070185.000555.
Guven MA, Coskun A, Ertas IE, Aral M, Zencirci B, Oksuz H. Association of maternal serum CRP, IL-6, TNF-alpha, homocysteine, folic acid and vitamin B12 levels with the severity of preeclampsia and fetal birth weight. Hypertens Pregnancy. 2009 May;28(2):190-200. doi: 10.1080/10641950802601179.
Lindblad B, Zaman S, Malik A, Martin H, Ekstrom AM, Amu S, Holmgren A, Norman M. Folate, vitamin B12, and homocysteine levels in South Asian women with growth-retarded fetuses. Acta Obstet Gynecol Scand. 2005 Nov;84(11):1055-61. doi: 10.1111/j.0001-6349.2005.00876.x.
Dalery K, Lussier-Cacan S, Selhub J, Davignon J, Latour Y, Genest J Jr. Homocysteine and coronary artery disease in French Canadian subjects: relation with vitamins B12, B6, pyridoxal phosphate, and folate. Am J Cardiol. 1995 Jun 1;75(16):1107-11. doi: 10.1016/s0002-9149(99)80739-5.
Powers RW, Evans RW, Majors AK, Ojimba JI, Ness RB, Crombleholme WR, Roberts JM. Plasma homocysteine concentration is increased in preeclampsia and is associated with evidence of endothelial activation. Am J Obstet Gynecol. 1998 Dec;179(6 Pt 1):1605-11. doi: 10.1016/s0002-9378(98)70033-x.
Stover PJ. Physiology of folate and vitamin B12 in health and disease. Nutr Rev. 2004 Jun;62(6 Pt 2):S3-12; discussion S13. doi: 10.1111/j.1753-4887.2004.tb00070.x.
Hustad S, Midttun O, Schneede J, Vollset SE, Grotmol T, Ueland PM. The methylenetetrahydrofolate reductase 677C-->T polymorphism as a modulator of a B vitamin network with major effects on homocysteine metabolism. Am J Hum Genet. 2007 May;80(5):846-55. doi: 10.1086/513520. Epub 2007 Mar 13.
Parle-McDermott A, Kirke PN, Mills JL, Molloy AM, Cox C, O'Leary VB, Pangilinan F, Conley M, Cleary L, Brody LC, Scott JM. Confirmation of the R653Q polymorphism of the trifunctional C1-synthase enzyme as a maternal risk for neural tube defects in the Irish population. Eur J Hum Genet. 2006 Jun;14(6):768-72. doi: 10.1038/sj.ejhg.5201603.
Parle-McDermott A, Mills JL, Kirke PN, Cox C, Signore CC, Kirke S, Molloy AM, O'Leary VB, Pangilinan FJ, O'Herlihy C, Brody LC, Scott JM. MTHFD1 R653Q polymorphism is a maternal genetic risk factor for severe abruptio placentae. Am J Med Genet A. 2005 Feb 1;132A(4):365-8. doi: 10.1002/ajmg.a.30354.
Parle-McDermott A, Pangilinan F, Mills JL, Signore CC, Molloy AM, Cotter A, Conley M, Cox C, Kirke PN, Scott JM, Brody LC. A polymorphism in the MTHFD1 gene increases a mother's risk of having an unexplained second trimester pregnancy loss. Mol Hum Reprod. 2005 Jul;11(7):477-80. doi: 10.1093/molehr/gah204.
Furness DL, Fenech MF, Khong YT, Romero R, Dekker GA. One-carbon metabolism enzyme polymorphisms and uteroplacental insufficiency. Am J Obstet Gynecol. 2008 Sep;199(3):276.e1-8. doi: 10.1016/j.ajog.2008.06.020.
Tam LE, McDonald SD, Wen SW, Smith GN, Windrim RC, Walker MC. A survey of preconceptional folic acid use in a group of Canadian women. J Obstet Gynaecol Can. 2005 Mar;27(3):232-6. doi: 10.1016/s1701-2163(16)30515-1.
Shakur YA, Garriguet D, Corey P, O'Connor DL. Folic acid fortification above mandated levels results in a low prevalence of folate inadequacy among Canadians. Am J Clin Nutr. 2010 Oct;92(4):818-25. doi: 10.3945/ajcn.2010.29696. Epub 2010 Aug 25.
Czeizel AE, Tomcsik M. Acute toxicity of folic acid in pregnant women. Teratology. 1999 Jul;60(1):3-4. doi: 10.1002/(SICI)1096-9926(199907)60:13.0.CO;2-4. No abstract available.
Czeizel AE, Dudas I, Metneki J. Pregnancy outcomes in a randomised controlled trial of periconceptional multivitamin supplementation. Final report. Arch Gynecol Obstet. 1994;255(3):131-9. doi: 10.1007/BF02390940.
Czeizel AE, Susanszky E. Diet intake and vitamin supplement use of Hungarian women during the preconceptional period. Int J Vitam Nutr Res. 1994;64(4):300-5.
Ericson A, Kallen B, Aberg A. Use of multivitamins and folic acid in early pregnancy and multiple births in Sweden. Twin Res. 2001 Apr;4(2):63-6. doi: 10.1375/1369052012155.
Kirke PN, Daly LE, Elwood JH. A randomised trial of low dose folic acid to prevent neural tube defects. The Irish Vitamin Study Group. Arch Dis Child. 1992 Dec;67(12):1442-6. doi: 10.1136/adc.67.12.1442.
Stevens VL, McCullough ML, Sun J, Gapstur SM. Folate and other one-carbon metabolism-related nutrients and risk of postmenopausal breast cancer in the Cancer Prevention Study II Nutrition Cohort. Am J Clin Nutr. 2010 Jun;91(6):1708-15. doi: 10.3945/ajcn.2009.28553. Epub 2010 Apr 21.
Wu K, Helzlsouer KJ, Comstock GW, Hoffman SC, Nadeau MR, Selhub J. A prospective study on folate, B12, and pyridoxal 5'-phosphate (B6) and breast cancer. Cancer Epidemiol Biomarkers Prev. 1999 Mar;8(3):209-17.
Zhang SM, Cook NR, Albert CM, Gaziano JM, Buring JE, Manson JE. Effect of combined folic acid, vitamin B6, and vitamin B12 on cancer risk in women: a randomized trial. JAMA. 2008 Nov 5;300(17):2012-21. doi: 10.1001/jama.2008.555.
Zhang SM, Willett WC, Selhub J, Hunter DJ, Giovannucci EL, Holmes MD, Colditz GA, Hankinson SE. Plasma folate, vitamin B6, vitamin B12, homocysteine, and risk of breast cancer. J Natl Cancer Inst. 2003 Mar 5;95(5):373-80. doi: 10.1093/jnci/95.5.373.
Larsson SC, Giovannucci E, Wolk A. Folate and risk of breast cancer: a meta-analysis. J Natl Cancer Inst. 2007 Jan 3;99(1):64-76. doi: 10.1093/jnci/djk006.
Figueiredo JC, Mott LA, Giovannucci E, Wu K, Cole B, Grainge MJ, Logan RF, Baron JA. Folic acid and prevention of colorectal adenomas: a combined analysis of randomized clinical trials. Int J Cancer. 2011 Jul 1;129(1):192-203. doi: 10.1002/ijc.25872. Epub 2011 Apr 1.
Kim DH, Smith-Warner SA, Spiegelman D, Yaun SS, Colditz GA, Freudenheim JL, Giovannucci E, Goldbohm RA, Graham S, Harnack L, Jacobs EJ, Leitzmann M, Mannisto S, Miller AB, Potter JD, Rohan TE, Schatzkin A, Speizer FE, Stevens VL, Stolzenberg-Solomon R, Terry P, Toniolo P, Weijenberg MP, Willett WC, Wolk A, Zeleniuch-Jacquotte A, Hunter DJ. Pooled analyses of 13 prospective cohort studies on folate intake and colon cancer. Cancer Causes Control. 2010 Nov;21(11):1919-30. doi: 10.1007/s10552-010-9620-8. Epub 2010 Sep 5.
Mills JL, Von Kohorn I, Conley MR, Zeller JA, Cox C, Williamson RE, Dufour DR. Low vitamin B-12 concentrations in patients without anemia: the effect of folic acid fortification of grain. Am J Clin Nutr. 2003 Jun;77(6):1474-7. doi: 10.1093/ajcn/77.6.1474.
Wilson RD; GENETICS COMMITTEE; MOTHERISK. RETIRED: Pre-conceptional vitamin/folic acid supplementation 2007: the use of folic acid in combination with a multivitamin supplement for the prevention of neural tube defects and other congenital anomalies. J Obstet Gynaecol Can. 2007 Dec;29(12):1003-1013. doi: 10.1016/S1701-2163(16)32685-8. Erratum In: J Obstet Gynaecol Can. 2008 Mar;30(3):193. Goh, Ingrid [corrected to Goh, Y Ingrid]. English, French.
Public notes
This record is viewable in the ANZCTR as it had previously listed Australia and/or New Zealand as a recruitment site, however these sites have since been removed

Contacts
Principal investigator
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Email 0 0
Contact person for public queries
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Contact person for scientific queries