Prevention of Birth Defects Periconceptional Multivitamins with

							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: 800Fg 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”