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Oregon PRAMS Presentation
Oregon PRAMS: Presentations

Prevention of Birth Defects: Periconceptional Multivitamins
with Folic Acid (MVF)


Introduction | Background | Methods | Results | Discussion 1 | Discussion 2 | Discussion 3


Introduction:


Prevention of Birth Defects: Periconceptional
Multivitamins with Folic Acid (MVF)


Jill Moore (1)
Ken Rosenberg, MD, MPH (1,2)
Al Sandoval, MS, MBA (2)
(1) Oregon Health & Science University, Portland, Oregon
(2) Department of Human Services, Office of Family Health, Portland, Oregon
Seventh Annual MCH Epidemiology Conference
December 12, 2001
Clearwater Beach, Florida


Background:

  • 4000 NTD-affected pregnancies per year in United States
  • Folic Acid: prevents at least 50% of NTDs
  • All fertile women: 400Fg (0.4 mg) of folic acid/day supplement
  • Food folate is insufficient
  • Fortification of grains provides an average of 100Fg of folic acid/day


Methods:

  • Oregon PRAMS, 1998-99
  • Question: "Were you taking the vitamin folic acid most days
    in the month before you became pregnant?"
  • n = 1867/2855 women
  • Response Rate = 65.4%


Results:


 • Took periconceptional folic acid: 29.7%
 • Knew that folic acid use can prevent birth defects: 77.1%

 • Multivariate Risk Factors (for taking FA) Odds Ratio (95% CI)
 • Knowing that folic acid use can prevent birth defects ¶ 8.30 (3.45, 20.0)
 • Intended pregnancy * 3.70 (2.33, 5.88)
 • Having medical insurance † 2.13 (1.19, 3.70)
 • Family Income >= $30,000/yr § 1.85 (1.11, 3.13)
 • Not enrolled in WIC during pregnancy ± 1.67 (1.00, 2.78)
  • ¶ compared to not knowing that folic acid use can prevent birth defects
  • * compared to unintended pregnancy
  • † any health insurance compared to no insurance prior to pregnancy.
  • § annual family income before pregnancy, comparing to <$30,000/yr
  • ± compared to enrolled in WIC during pregnancy


Discussion 1:

  • Folic Acid prevents many Birth Defects, not just NTDs.


Discussion 2:

 • Czeizel, American Journal of Medical Genetics 1996;62:179-183
 • Intervention: 800mg Folic Acid + Multivitamins
 • Control: placebo ("trace elements")
 • n= 4862

  Intervention       Controls
 • Neural Tube Defects 0       6
 • After exclusion of these 6 NTDs:          
      •  Major Birth Defects (MBD) 20.6       40.6
          per 1000 pregnancies          

 • Relative Risk of MBD for intervention group
                (compared to controls):
         •    RR= 0.54 (95% CI 0.39, 0.76)
                p= 0.0003


Discussion 3:

  • Women should be advised to take "Multivitamins with Folic Acid" rather than "Folic Acid"


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