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Trial details imported from ClinicalTrials.gov

For full trial details, please see the original record at https://clinicaltrials.gov/study/NCT01355159




Registration number
NCT01355159
Ethics application status
Date submitted
11/05/2011
Date registered
17/05/2011
Date last updated
7/07/2020

Titles & IDs
Public title
High Dose Folic Acid Supplementation Throughout Pregnancy for Preeclampsia Prevention
Scientific title
Effect of Folic Acid Supplementation in Pregnancy on Preeclampsia-Folic Acid Clinical Trial (FACT)
Secondary ID [1] 0 0
ISRCTN23781770
Secondary ID [2] 0 0
2009-107
Universal Trial Number (UTN)
Trial acronym
FACT
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Pregnancy Complications 0 0
Preeclampsia 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
Interventional
Description of intervention(s) / exposure
Treatment: Drugs - Folic Acid 4 mg
Treatment: Drugs - Placebo

Experimental: Folic Acid 4 mg - 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

Placebo comparator: Placebo - Women will be randomised in a 1:1 ratio to folic acid 4.0 mg or placebo


Treatment: Drugs: Folic Acid 4 mg
Folic Acid 1.0 mg or placebo 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

Treatment: Drugs: Placebo
Placebo x 4 tablets will be taken daily by oral administration.
Intervention code [1] 0 0
Treatment: Drugs
Comparator / control treatment
Control group

Outcomes
Primary outcome [1] 0 0
Preeclampsia
Timepoint [1] 0 0
Participants will be followed from 20+0 weeks of gestational age until 42 days postpartum (after delivery)
Secondary outcome [1] 0 0
Maternal Death
Timepoint [1] 0 0
Time Frame: Participants will be followed from 20+0 weeks of gestation until 42 days postpartum (after delivery)
Secondary outcome [2] 0 0
Spontaneous Abortion
Timepoint [2] 0 0
Participants will be followed from randomization until 20+0 weeks of gestation
Secondary outcome [3] 0 0
Placenta Abruption
Timepoint [3] 0 0
Participants will be followed from 20+0 weeks of gestation until delivery
Secondary outcome [4] 0 0
Premature Rupture of Membranes
Timepoint [4] 0 0
Participants will be followed from randomization (8-16 weeks' completed gestation) until the onset of labor
Secondary outcome [5] 0 0
Preterm Birth
Timepoint [5] 0 0
Participants will be followed from 20+0 weeks to 36+6 weeks of gestation
Secondary outcome [6] 0 0
HELLP (Hemolysis, Elevated Liver Enzyme Levels & Low Platelet Count)
Timepoint [6] 0 0
Participants will be followed from 20+0 weeks of gestation until delivery
Secondary outcome [7] 0 0
Severe Preeclampsia
Timepoint [7] 0 0
Participants will be followed from 20+0 weeks of gestation until delivery.
Secondary outcome [8] 0 0
Antenatal Inpatient Length of Stay
Timepoint [8] 0 0
Participants will be followed from date of randomization (8-16 weeks' completed gestation) until admission for delivery
Secondary outcome [9] 0 0
Stillbirth
Timepoint [9] 0 0
Participants will be followed from 20+0 weeks of gestation up to delivery.
Secondary outcome [10] 0 0
Intrauterine Growth Restriction (<3rd Percentile)
Timepoint [10] 0 0
Participants will be followed from 20+0 weeks of gestation until delivery
Secondary outcome [11] 0 0
Intrauterine Growth Restriction (<10th Percentile)
Timepoint [11] 0 0
Participants will be followed from 20+0 weeks of gestation until delivery
Secondary outcome [12] 0 0
Neonatal Death
Timepoint [12] 0 0
Participants will be followed from birth until 28 days of life
Secondary outcome [13] 0 0
Perinatal Mortality
Timepoint [13] 0 0
Participants will be followed from 20+0 weeks of gestation until 28 days of life.
Secondary outcome [14] 0 0
Retinopathy of Prematurity
Timepoint [14] 0 0
Infants born to the participant will be followed for the duration of hospital stay, or up to 6 weeks
Secondary outcome [15] 0 0
Early Onset Sepsis
Timepoint [15] 0 0
Infants born to the participants will be followed first 48 hours of life.
Secondary outcome [16] 0 0
Necrotising Enterocolitis
Timepoint [16] 0 0
Infants borm to the participants will be followed for the duration of hospital stay, or up to 6 weeks.
Secondary outcome [17] 0 0
Intraventricular Hemorrhage (IVH)
Timepoint [17] 0 0
Time Frame: Infants born to the participants will be followed for the duration of hospital stay, or up to 6 weeks
Secondary outcome [18] 0 0
Ventilation
Timepoint [18] 0 0
Infants born to the participants will be followed for the duration of hospital stay, or up to 6 weeks.
Secondary outcome [19] 0 0
Need for Oxygen at 28 Days
Timepoint [19] 0 0
Infants to the participants will be followed for 28 days after birth.
Secondary outcome [20] 0 0
Composite Severe Adverse Fetal/Neonatal Outcome
Timepoint [20] 0 0
Outcomes included in the composite outcome were measured for each of their respective time frames, up to 6-weeks after birth
Secondary outcome [21] 0 0
Length of Stay in 'High Level' Neonatal Care Unit
Timepoint [21] 0 0
Infants to the participants will be followed for the duration of hospital stay, or up to 6 weeks.
Secondary outcome [22] 0 0
Neonatal Death
Timepoint [22] 0 0
Infants to the participants will be followed for 28 days after birth.
Secondary outcome [23] 0 0
Periventricular Leukomalacia
Timepoint [23] 0 0
Infants to the participants were followed for 28 days after birth.
Secondary outcome [24] 0 0
Neonatal Intensive Care Unit (NICU) Admission
Timepoint [24] 0 0
Infants to the participants will be followed for the duration of hospital stay, or up to 6 weeks.

Eligibility
Key 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)
Minimum age
18 Years
Maximum age
No limit
Sex
Females
Can healthy volunteers participate?
No
Key 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
6. Known hypersensitivity to folic acid
7. Multiple Pregnancy (triplets or more)
8. Participation in this study in a previous pregnancy

Study design
Purpose of the study
Prevention
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Masking / blinding
Blinded (masking used)
Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
The people analysing the results/data
Intervention assignment
Parallel
Other design features
Phase
Phase 3
Type of endpoint/s
Statistical methods / analysis

Recruitment
Recruitment status
Completed
Data analysis
Reason for early stopping/withdrawal
Other reasons
Date of first participant enrolment
Anticipated
Actual
1/04/2011
Date of last participant enrolment
Anticipated
Actual
Date of last data collection
Anticipated
Actual
1/09/2016
Sample size
Target
Accrual to date
Final
2464
Recruitment in Australia
Recruitment state(s)
NSW,QLD,SA,VIC
Recruitment hospital [1] 0 0
Nepean - Penrith
Recruitment hospital [2] 0 0
Townsville - Douglas
Recruitment hospital [3] 0 0
Ipswich - Ipswich
Recruitment hospital [4] 0 0
Adelaide - North Adelaide
Recruitment hospital [5] 0 0
Royal Women's Hospital - Parkville
Recruitment hospital [6] 0 0
Sunshine - St Albans
Recruitment postcode(s) [1] 0 0
2750 - Penrith
Recruitment postcode(s) [2] 0 0
4814 - Douglas
Recruitment postcode(s) [3] 0 0
4305 - Ipswich
Recruitment postcode(s) [4] 0 0
5006 - North Adelaide
Recruitment postcode(s) [5] 0 0
3052 - Parkville
Recruitment postcode(s) [6] 0 0
3021 - St Albans
Recruitment outside Australia
Country [1] 0 0
Argentina
State/province [1] 0 0
Santa Fe
Country [2] 0 0
Argentina
State/province [2] 0 0
Buenos Aires
Country [3] 0 0
Canada
State/province [3] 0 0
Alberta
Country [4] 0 0
Canada
State/province [4] 0 0
British Columbia
Country [5] 0 0
Canada
State/province [5] 0 0
New Brunswick
Country [6] 0 0
Canada
State/province [6] 0 0
Newfoundland and Labrador
Country [7] 0 0
Canada
State/province [7] 0 0
Ontario
Country [8] 0 0
Canada
State/province [8] 0 0
Quebec
Country [9] 0 0
Canada
State/province [9] 0 0
Saskatchewan
Country [10] 0 0
Jamaica
State/province [10] 0 0
Kingston 7
Country [11] 0 0
Jamaica
State/province [11] 0 0
Kingston
Country [12] 0 0
United Kingdom
State/province [12] 0 0
Cambridgeshire
Country [13] 0 0
United Kingdom
State/province [13] 0 0
Cheshire
Country [14] 0 0
United Kingdom
State/province [14] 0 0
County Durham
Country [15] 0 0
United Kingdom
State/province [15] 0 0
Cumbria
Country [16] 0 0
United Kingdom
State/province [16] 0 0
Lancashire
Country [17] 0 0
United Kingdom
State/province [17] 0 0
Lincolnshire
Country [18] 0 0
United Kingdom
State/province [18] 0 0
Merseyside
Country [19] 0 0
United Kingdom
State/province [19] 0 0
Middlesex
Country [20] 0 0
United Kingdom
State/province [20] 0 0
Newcastle Upon Tyne
Country [21] 0 0
United Kingdom
State/province [21] 0 0
Northumberland
Country [22] 0 0
United Kingdom
State/province [22] 0 0
Tooting
Country [23] 0 0
United Kingdom
State/province [23] 0 0
Tyne And Wear
Country [24] 0 0
United Kingdom
State/province [24] 0 0
West Midlands
Country [25] 0 0
United Kingdom
State/province [25] 0 0
Blackburn
Country [26] 0 0
United Kingdom
State/province [26] 0 0
Burnley
Country [27] 0 0
United Kingdom
State/province [27] 0 0
Crumpsall
Country [28] 0 0
United Kingdom
State/province [28] 0 0
London
Country [29] 0 0
United Kingdom
State/province [29] 0 0
Middlesbrough
Country [30] 0 0
United Kingdom
State/province [30] 0 0
Newcastle upon Tyne
Country [31] 0 0
United Kingdom
State/province [31] 0 0
North Shields
Country [32] 0 0
United Kingdom
State/province [32] 0 0
Norwich
Country [33] 0 0
United Kingdom
State/province [33] 0 0
Nottingham
Country [34] 0 0
United Kingdom
State/province [34] 0 0
Oldham
Country [35] 0 0
United Kingdom
State/province [35] 0 0
Stockton
Country [36] 0 0
United Kingdom
State/province [36] 0 0
Sunderland
Country [37] 0 0
United Kingdom
State/province [37] 0 0
Uxbridge

Funding & Sponsors
Primary sponsor type
Other
Name
Ottawa Hospital Research Institute
Address
Country
Other collaborator category [1] 0 0
Government body
Name [1] 0 0
Canadian Institutes of Health Research (CIHR)
Address [1] 0 0
Country [1] 0 0

Ethics approval
Ethics application status

Summary
Brief summary
To determine the efficacy of high dose folic acid supplementation for prevention of preeclampsia in women with at least one risk factor: pre-existing hypertension, pre-pregnancy diabetes (type 1 or 2), twin pregnancy, preeclampsia in a previous pregnancy, or body mass index =35. It was hypothesized that high dose (4.0 mg per day) supplementation starting in early pregnancy and continued throughout the entire pregnancy will lower the incidence of preeclampsia in pregnant women at high risk of developing preeclampsia.
Trial website
https://clinicaltrials.gov/study/NCT01355159
Trial related presentations / publications
Rose EG, Murphy MSQ, Erwin E, Muldoon KA, Harvey ALJ, Rennicks White R, MacFarlane AJ, Wen SW, Walker MC. Gestational Folate and Folic Acid Intake among Women in Canada at Higher Risk of Pre-Eclampsia. J Nutr. 2021 Jul 1;151(7):1976-1982. doi: 10.1093/jn/nxab063.
Corsi DJ, Gaudet LM, El-Chaar D, White RR, Rybak N, Harvey A, Muldoon K, Wen SW, Walker M. Effect of high-dose folic acid supplementation on the prevention of preeclampsia in twin pregnancy. J Matern Fetal Neonatal Med. 2022 Feb;35(3):503-508. doi: 10.1080/14767058.2020.1725882. Epub 2020 Feb 18.
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, Champagne J, Rennicks White R, Coyle D, Fraser W, Smith G, Fergusson D, Walker MC. Effect of folic acid supplementation in pregnancy on preeclampsia: the folic acid clinical trial study. J Pregnancy. 2013;2013:294312. doi: 10.1155/2013/294312. Epub 2013 Nov 18.
Public notes

Contacts
Principal investigator
Name 0 0
Shi Wu Wen, PhD
Address 0 0
Ottawa Hospital Research Institute
Country 0 0
Phone 0 0
Fax 0 0
Email 0 0
Contact person for public queries
Name 0 0
Address 0 0
Country 0 0
Phone 0 0
Fax 0 0
Email 0 0
Contact person for scientific queries



Summary Results

For IPD and results data, please see https://clinicaltrials.gov/study/NCT01355159