Race and Ethnicity and Preconception Folic Acid Supplement Use in Georgia: Pregnancy Risk Assessment Monitoring Survey (PRAMS),2009-2011. Open Access

Abstract

BACKGROUND: The 1992 U.S. Public Health Service recommends that all women capable of becoming pregnant consume 400 mcg of folic acid daily to prevent neural tube defects in the offspring; however, compliance of supplement use is low. The current mandatory folic acid fortification policy in the U.S. does not enrich corn masa, a staple of Hispanic populations who have a high prevalence of neural tube defects. The purpose of this study was estimate the prevalence of preconception folic acid use, and its association with maternal race/ethnicity among women of reproductive age in Georgia.

METHODS: Using data from the 2009-2011 Georgia-Pregnancy Risk Assessment Monitoring Survey (GA-PRAMS), we examined the prevalence of preconception folic acid use, and its association with race and ethnicity among women aged 18-45 years (N=3277). We estimated adjusted odds ratios (aORs) and 95% confidence intervals using multivariable logistic regression, and accounting for the complex survey design.

RESULTS: Overall, only about 30% of all participants reported adequate supplemental folic acid intake (4-7 pills per week) before pregnancy. Specifically, 38.7% non-Hispanic whites, 21% non-Hispanic blacks, and 23.5% Hispanics reported taking folic acid prior to conception. Race-ethnicity was significantly associated with preconception folic acid intake. The odds of not taking folic acid before pregnancy were highest for Hispanics (aOR=2.15; 95% CI, 1.35-3.40) and African Americans (aOR=1.66; 95% CI, 1.18-2.32) compared to non-Hispanic whites, after controlling for maternal age, pregnancy intention, knowledge that folic acid prevents birth defects, preconception smoking and exercise, and parity.

CONCLUSIONS: Our analyses show that preconception educational programs that promote supplemental folic acid intake are failing in Georgia. Most Hispanic women are not taking recommended folic acid prior to conception and are at a disproportionately high risk for neural tube defects compared to their counterparts whose staple wheat-based diets are mandatorily enriched with folic acid. Our data support educational programs to promote intake of voluntarily fortified corn masa flour, and a push to implement mandatory fortification of the same.

Table of Contents

CHAPTER 1: INTRODUCTION....1

Background of Problem.............1

Goal of Study...........................4

Research Questions..................5

Importance of Study.................5

CHAPTER 2: LITERATURE REVIEW... 6

Introduction...........................6

Prevalence of neural tube defects... 6

Folic acid and neural tube defects... 8

Women Knowledge, attitude and pre-conception folic acid intake... 8

Determinants of pre-conception folic acid intake... 10

Racial and ethnic disparity in pre-conception folic acid intake... 13

Conclusion............................6

CHAPTER 3: METHODS.........17

Data source..........................17

Study population..................18

Dependent variable...............18

Independent variable............19

Co-variables.........................19

Statistical analysis................20

CHAPTER 4: RESULTS...........22

CHAPTER 5: DISCUSSION.....25

Public health implications.....27

Conclusion...........................28

REFERENCES.......................30

TABLE 1...............................41

TABLE 2...............................43

TABLE 3...............................44

APPENDIX A........................45

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	birth defects reproductive age women folic acid Hispanics preconception neural tube defects Prevalence
Committee Chair / Thesis Advisor	Kancherla, Vijaya , Emory University
Committee Members	Kramer, Michael R, Emory University
Partnering Agencies	Georgia state or local health department CDC

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