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Prevention of Birth Defects: Periconceptional Multivitamins with Folic Acid (MVF)

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

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Prevention of Birth Defects: Periconceptional Multivitamins with Folic Acid (MVF)

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  1. 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

  2. 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

  3. 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%

  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

  5. Discussion-1 • Folic Acid prevents many Birth Defects, not just NTDs.

  6. 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

  7. Discussion-3 • Women should be advised to take “Multivitamins with Folic Acid” rather than “Folic Acid”

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