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: 400 F g (0.4 mg) of folic acid/day supplement Food folate is insufficient Fortification of grains provides an average of 100 F g 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: 800 F g 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”