Graduation Year


Document Type




Degree Name

MS in Public Health (M.S.P.H.)

Degree Granting Department

Epidemiology and Biostatistics

Major Professor

Roneé E. Wilson, Ph.D.

Committee Member

Alfred Mbah, Ph.D.

Committee Member

Hamisu M. Salihu, MD, Ph.D.


B12, folic acid, imputation, MCMC, supplementation, logistic


Background: Preterm birth is one of the leading causes of perinatal mortality and morbidity and poses extensive economic liability. The rate of preterm births globally is approximately 11.1%, and in the US, the preterm birth rate has been estimated to be 12-13%. Folate and B12 requirements increase during pregnancy as a result of increased cell division to accommodate maternal and fetal growth; inadequate levels can result in placental abnormalities and thus present implications for preterm birth.

Objective: To investigate the association between red blood cell (RBC) folate and B12 concentrations with the risk of preterm birth.

Methods: Study participants were recruited from Tampa General Hospital between January 2011 and May 2013. Women with a singleton delivery occurring less than 37 weeks gestation were classified as cases and those with a singleton delivery occurring between 37 and 42 weeks gestation were classified as controls. The study had a final sample size of 227 women, including 36 cases and 191 controls. Maternal blood was collected in order to measure folate and B12 concentrations. The association between folate/B12 and preterm birth was assessed using logistic regression; odds ratio (OR), 95% confidence interval (CI) and p values are reported. A power analysis was also performed using the available sample as well as imputation for missing values in the B12 variable.

Results: Although not statistically significant, the mean concentration of folate and B12 levels were higher in the cases than in the controls, 894 ± 158.1 vs. 869.2 ± 169.6 and 245.2 ± 102.2 vs 238.3 ± 81.5, respectively. No significant associations were found between folate or B12 and the risk of preterm birth.

Conclusions: This study did not detect a significant association between folate or B12 and preterm birth; however, due to the small sample size this analysis was underpowered. Additional studies are needed, preferably using a randomized control study design, in order to elucidate the relationship between folate/B12 and preterm births.