An investigation of the variation of level of lesion of spinabifida in all births in the presence and absence of maternal folicacid supplementation in China, 1993-1996 Open Access

Patimeteeporn, Calvin (2015)

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Introduction: Folic acid (FA) supplementation has been conclusively shown to prevent neural tube defects (NTDs), including spina bifida. However, the potential impact of FA supplementation on the severity of the spina bifida, as estimated by highest level of the lesion, requires more research.

Methods: Birth outcomes of a cohort of Chinese women who were enrolled into a perinatal health care system between 1993 and 1996 in two regions in China, were evaluated to assess the relation between the location of the spina bifida lesion and the any use of FA supplement prior to the end of the woman's first trimester.

Results: 540,000 women were included in the final analysis and of those women, 242 women had a spina bifida affected pregnancy with level of lesion information available. There was an overall decrease in prevalence of spina bifida in the study population by FA supplement exposure, though the effect appeared to vary by region. Spina bifida cases residing in the southern region were twice as likely to have high level of lesion, as were spina bifida cases in the northern region. Using polytomous logistic regression models stratified by child's sex and region and adjusted for maternal age, a statistically significant difference in prevalence of high level of lesion spina bifida was observed in the northern but not in the southern region.

Conclusions: The impact of FA supplementation on the change in prevalence of high level of lesion spina bifida appears to vary by region, possibly dependent on the baseline prevalence of NTDs existing in the population prior to the introduction of FA. This observation may be explained by genetic or environmental factors or a combination of both. More research is needed to clarify the roles FA and other factors in spina bifida presentation.

Table of Contents

Chapter I: Background/Literature Review 1

Chapter II: Manuscript 8

Introduction 8

Methods 10

Results 12

Discussion 13

Tables 21

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