Association between Pre-Pregnancy Diabetes Mellitus and Pre-Conception Folic Acid Supplement Use by Hispanic Ethnicity: Findings from Georgia, New York City and Puerto Rico PRAMS 2016-2018 Open Access
Guzman, Iridian (Spring 2021)
Published
Abstract
BACKGROUND: In the US all women of reproductive age are recommended to consume 400 mcg of folic acid daily to prevent neural tube defects (NTDs). Both Hispanic ethnicity and pre-pregnancy diabetes are associated with increased risk of NTDs. Preconception folic acid supplement use has been shown to attenuate the risk of NTDs among women with pre-pregnancy diabetes. The purpose of this study was to assess the association between pre-conception folic acid use and pre-pregnancy diabetes particularly among Hispanic women in the US.
METHODS: Using data from three-state based Pregnancy Risk Assessment Monitoring System (PRAMS) 2016-2018, we examined the association between preconception folic acid supplement use and pre-pregnancy diabetes mellitus stratified by Hispanic ethnicity. We used multivariable logistic regression to estimate the adjusted odds ratio (aORs) and 95% confidence intervals. All analyses accounted from PRAMS complex survey design.
RESULTS: Our study found that 44% of non-Hispanic women with pre-pregnancy diabetes and 29% of Hispanic women with pre-pregnancy diabetes reported recommended intake of folic acid supplements (4-7 times/week) before pregnancy. There was no significant association between pre-pregnancy diabetes and preconception folic acid supplement use overall. The prevalence odds of not taking preconception folic acid supplements were lower for women with pre-pregnancy diabetes compared to women without pre-pregnancy diabetes (aOR=0.39; 95% CI, 0.05, 3.25) among Hispanics who received preconception folic acid advice from a health provider and among those who did not receive preconception folic acid advice the odds were higher (aOR=1.50; 95% CI, 0.27, 8.52). In our site-specific analysis, we noted that Hispanic women in Puerto Rico had a higher prevalence odds of not taking preconception folic acid supplement when they had pre-pregnancy diabetes compared to when they did not (aOR=7.60; 95% CI, 1.73, 33.46).
CONCLUSIONS: Overall, there was no association between pre-pregnancy diabetes and preconception folic acid supplement use. However, some differences were noted by advice from a health provider and site. Mandatory fortification of corn masa products should be implemented. Until then, culturally tailored education on preconception folic acid supplement use from providers or community health workers needs to expand to reach Hispanic women in the US and Puerto Rico.
Table of Contents
TABLE OF CONTENTS
CHAPTER I: BACKGROUND
Neural Tube Defects
Prevalence of NTDs in the US
Risk Factors for NTDs
NTDs and Hispanic Ethnicity
NTDs and maternal pre-pregnancy diabetes
Folic acid
Folic acid use and race/ethnicity in the US
Folic acid supplement use among diabetic women of reproductive age
Promotoras de salud model to communicate folic acid message to Hispanic women
Conclusions
Study Rationale and Objectives
Research Questions
CHAPTER II: MANUSCRIPT
Introduction
Methods
Results
Discussion
FIGURE 1.
TABLE 1.
TABLE 2.
TABLE 3.
TABLE 4.
TABLE 5.
CHAPTER III: SUMMARY, PUBLIC HEALTH IMPLICATIONS, POSSIBLE FUTURE DIRECTIONS
Summary
Public Health Implications
Future Directions
REFERENCES
About this Master's Thesis
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