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Oregon PRAMS: Presentations
Birth Defect Prevention: Risk Factors Associated with Periconceptional Use of Folic Acid
Jill Moore, Kenneth D. Rosenberg, MD, MPH, Alfredo P. Sandoval, MS, MBA
Oregon Health Division, Portland, Oregon
Background. Daily periconceptional use of multivitamins with folic acid (MVF) can prevent many birth defects, including at least 50% of neural tube defects (NTDs). This study was conducted to determine the predictors of women taking periconceptional folic acid.
Methods. Oregon PRAMS surveys a stratified random sample of women after a live birth. In 1998-1999, 1867 women were interviewed (65.4% response rate). Women were asked whether they took folic acid most days in the month before becoming pregnant and whether they had heard or read that taking folic acid can help prevent some birth defects. Responses were analyzed using SPSS and SUDAAN; all reported data were weighted for oversampling and non-response.
Results. Although 77.1% of women said that they knew that folic acid can prevent birth defects, only 29.7% of women had taken folic acid most days in the month before becoming pregnant. Hispanic women (15.8%) and African American women (19.7%) were less likely to have taken folic acid than non-Hispanic white women (35.9%). The multivariate significant predictors of taking folic acid were: knowledge that taking folic acid can percent birth defects (ORa=9.09; 95% CI 3.70, 20.0); intended pregnancy (ORa=3.70; 95% CI 2.33, 5.88); any health insurance (ORa=2.38; 95% CI 1.35, 4.17); and family income $$30,000/year (ORa=2.27; 95% CI 1.47, 3.57).
Conclusions. Many women not taking periconceptional folic acid (Hispanic, African American, unintended pregnancy, no health insurance, low income) receive services from public health providers. The most powerful predictor of taking folic acid was knowing that folic acid can prevent birth defects.
Public Health Implications. Public health programs need to increase the proportion of fertile women taking MVF daily. This can be accomplished via media campaigns and improved individual counseling by providers. In particular, state and local health departments can encourage increased use of periconceptional MVF by family planning and postpartum WIC clients. Negative pregnancy tests may represent a valuable opportunity for education.
CDC Maternal and Child Health Epidemiology Workshop, December 12, 2001.
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