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