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: 400g (0.4 mg) of folic

acid/day supplement• Food folate is insufficient• Fortification of grains provides an average

of 100g 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 š$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: 800g 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”