Paediatric and Perinatat Epidemiology 1989, 3, 216 Study in progress Case control study of neural tube defects and periconceptional vitamin use Allen Mitchell Slone Epidemiological Unit, Boston, Massachusetts, USA Neural tube defects (NTDs) are among the most common birth defects, affecting approximately 1.5 per 1000 births in the US. Results of some preliminary studies have suggested that dietary supplementation with multivitamins immediately prior to conception reduces the risk of NTDs by at least 50%. Although most of these studies have focused on the protective effects among women who have previously had an NTD-affected pregnancy, the far larger issue concerns women who have not; these women are responsible for the large majority of NTD births, and yet there is very little information available on the protective effects, if any, of multivitamins in the general population. From a health policy perspective, the beneficial effects of supplementation would argue for advocacy of routine supplementation with multivitamin products of all women of childbearing potential; since so many pregnancies are unplanned, these supplements would have to be consumed routinely throughout the childbearing years. Under a grant from the Bureau of Maternal and Child Health and Resources Development, Health Resources and Services Administration of the USDHHS, the Slone Epidemiology Unit (SEU) of Boston University School of Public Health is conducting a case control study to test the hypothesis that vitamin supplementation reduces the risk of occurrent NTDs. Subjects are being enrolled as part of the SEU case control Birth Defects Study. Case and control subjects are recruited through an active survefilance network of hospitals and clinics in the metropolitan areas of Boston, Philadelphia and Toronto. For the primary hypothesis, cases include 450 liveborn/stillborn/therapeutic abortions with NTDs, and controls include 1800 infants with other malformations. Mothers of study subjects are interviewed in their homes within 6 months of the delivery/abortion; the questionnaire includes a detailed history of vitamin/mineral use, nutrition, known risk factors for NTDs, and information on health behaviours. Data collection commenced in June 1988, and will take place for 3 years. Detailed data analysis will take place in the fourth year, and will include consideration of confounding and effect modification. 21 6

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Page 1: Case control study of neural tube defects and periconceptional vitamin use

Paediatric and Perinatat Epidemiology 1989, 3, 216

Study in progress

Case control study of neural tube defects and periconceptional vitamin use

Allen Mitchell Slone Epidemiological Unit, Boston, Massachusetts, USA

Neural tube defects (NTDs) are among the most common birth defects, affecting approximately 1.5 per 1000 births in the US. Results of some preliminary studies have suggested that dietary supplementation with multivitamins immediately prior to conception reduces the risk of NTDs by at least 50%. Although most of these studies have focused on the protective effects among women who have previously had an NTD-affected pregnancy, the far larger issue concerns women who have not; these women are responsible for the large majority of NTD births, and yet there is very little information available on the protective effects, if any, of multivitamins in the general population. From a health policy perspective, the beneficial effects of supplementation would argue for advocacy of routine supplementation with multivitamin products of all women of childbearing potential; since so many pregnancies are unplanned, these supplements would have to be consumed routinely throughout the childbearing years.

Under a grant from the Bureau of Maternal and Child Health and Resources Development, Health Resources and Services Administration of the USDHHS, the Slone Epidemiology Unit (SEU) of Boston University School of Public Health is conducting a case control study to test the hypothesis that vitamin supplementation reduces the risk of occurrent NTDs. Subjects are being enrolled as part of the SEU case control Birth Defects Study. Case and control subjects are recruited through an active survefilance network of hospitals and clinics in the metropolitan areas of Boston, Philadelphia and Toronto. For the primary hypothesis, cases include 450 liveborn/stillborn/therapeutic abortions with NTDs, and controls include 1800 infants with other malformations. Mothers of study subjects are interviewed in their homes within 6 months of the delivery/abortion; the questionnaire includes a detailed history of vitamin/mineral use, nutrition, known risk factors for NTDs, and information on health behaviours. Data collection commenced in June 1988, and will take place for 3 years. Detailed data analysis will take place in the fourth year, and will include consideration of confounding and effect modification.

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