1
|
Tang HY, Elhindi J, Blumenthal C, Pasupathy D, Melov SJ. Are migrants during the periconception period less likely to be supplementing with folic acid: An Australian cohort study. Midwifery 2024; 132:103984. [PMID: 38554606 DOI: 10.1016/j.midw.2024.103984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 03/15/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Folic acid (FA) supplementation before and in early pregnancy is known to improve outcomes such as reducing neural tube defects; however, little is known about groups in Australia at risk of low FA use. AIM To determine whether differences exist in FA supplementation rates between Australian-born women and migrant women, with a secondary aim of examining the sociodemographic characteristics of women who are not supplementing with FA in early pregnancy. METHODS A retrospective cohort study from January 2018-July 2022 in a high-migrant population in Western Sydney, Australia. Multivariate logistic regression analysis was conducted adjusting for confounders including place of birth, age, ethnicity, parity, history of diabetes, and type of conception. FINDINGS There were 48,045 women who met inclusion criteria; 65% of whom were migrants. We identified that 39.4% of the study population did not report FA supplementation by early pregnancy. Women who were migrants were more likely to report FA usage than those born in Australia (aOR 1.24; 95%CI 1.17-1.31). Women least likely to report use of FA were women < 20 years of age (aOR 0.54; 95%CI 0.44-0.67) and multiparous women (aOR 0.84; 95%CI 0.82-0.86). Women with type 1 or type 2 diabetes were more likely to report FA use (aOR 1.66; 95%CI 1.11-2.48, aOR 1.30; 95%CI 1.05-1.61). CONCLUSION A significant proportion of the population did not report FA supplementation before or during early pregnancy. To increase uptake of FA supplementation, clinicians and public health messaging should target at-risk groups.
Collapse
Affiliation(s)
- Hei Yee Tang
- Women's and Newborn Health, Westmead Hospital, New South Wales, Australia
| | - James Elhindi
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia; Westmead Institute for Maternal and Fetal Medicine, Women's and Newborn Health, Westmead Hospital, New South Wales, Australia
| | - Caron Blumenthal
- Women's and Newborn Health, Westmead Hospital, New South Wales, Australia
| | - Dharmintra Pasupathy
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia; Westmead Institute for Maternal and Fetal Medicine, Women's and Newborn Health, Westmead Hospital, New South Wales, Australia
| | - Sarah J Melov
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia; Westmead Institute for Maternal and Fetal Medicine, Women's and Newborn Health, Westmead Hospital, New South Wales, Australia.
| |
Collapse
|
2
|
Abdi Aw-Nuur H, Abdullahi Diriye N, Aasheim V, Engen T, Mehrara L, Skirnisdottir Vik E. Somali immigrant women's knowledge of and experiences with folic acid supplement use before and during pregnancy: A qualitative study from Norway. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 39:100946. [PMID: 38211483 DOI: 10.1016/j.srhc.2024.100946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 12/21/2023] [Accepted: 01/03/2024] [Indexed: 01/13/2024]
Abstract
INTRODUCTION Health authorities in many countries recommend that women should take folic acid supplements before and during pregnancy to prevent having babies with neural tube defects. Somali immigrant women in Norway use less folic acid supplements than the recommended amount and subsequently, less than Norwegian-born women. OBJECTIVES To explore Somali immigrant women's knowledge of and experiences with using folic acid supplements before and during pregnancy. METHODS Data were collected through semi-structured individual interviews with ten Somali immigrant women in Norway. The participants were recruited and interviewed between September and November 2019. Graneheim and Lundmańs qualitative content analysis was used for data analysis. RESULTS Two main themes were developed through the process of analysing the data: 1) Attitudes to life and pregnancy affect how health care advice is met; 2) Understanding the benefits of folic acid is crucial. CONCLUSIONS The women in this study had varied knowledge about, and experiences with the use of folic acid supplements before and during pregnancy. The findings suggest that the healthcare system needs to adapt the information it provides on folic acid supplementation to target the needs of Somali immigrant women. In line with suggestions from the study participants, information needs to be given in a timely manner, by someone they trust, in their first language, include visual aids, and be offered to all women of childbearing age before their first pregnancy.
Collapse
Affiliation(s)
- Hana Abdi Aw-Nuur
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, PO.box 7030, N-5020 Bergen, Norway
| | - Nasra Abdullahi Diriye
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, PO.box 7030, N-5020 Bergen, Norway
| | - Vigdis Aasheim
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, PO.box 7030, N-5020 Bergen, Norway
| | - Tone Engen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, PO.box 7030, N-5020 Bergen, Norway
| | - Lydia Mehrara
- Faculty of Education, Arts, and Sports, Western Norway University of Applied Sciences, PO.box 6856 Sogndal, Norway
| | - Eline Skirnisdottir Vik
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, PO.box 7030, N-5020 Bergen, Norway.
| |
Collapse
|
3
|
Mao Y, Hu H, Chen D, Fang Y, Liu J, Li M, Zhou W. Investigating continuation of folic acid supplementation during peri-conceptional period: a community-based cross-sectional study. Reprod Health 2023; 20:34. [PMID: 36803517 PMCID: PMC9942345 DOI: 10.1186/s12978-023-01564-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 01/05/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Maternal folate may not reach an optimal level to prevent neural tube defects if supplementation commenced post-conception or took place pre-conception only. Our study aimed to investigate the continuation of folic acid (FA) supplementation from pre-conception to post-conception during peri-conceptional period and to examine its differences in FA supplementation between the subgroups taking the initiation timing into consideration. METHODS This study was conducted in two community health service centers in Jing-an District of Shanghai. Women accompanying their children to pediatric health clinics of the centers were recruited and asked to recall information concerning their socioeconomic and previous obstetric characteristics, utilization of healthcare and FA supplementation before and/or during pregnancy. The continuation of FA supplementation during peri-conceptional period were categorized into three subgroups: Supplementing with FA pre- and post-conception; supplementing with FA preconception only or post-conception only; no FA supplements pre-conception and post-conception. The relationship between FA continuation and couples' characteristics were examined as setting the first subgroup as the base reference. RESULTS Three hundred and ninety-six women were recruited. Over 40% of the women started FA supplementation after conception and 30.3% of them supplemented with FA from pre-conception to the first trimester of their pregnancy. Compared to this one-third of participants, women who didn't supplemented with any FA during peri-conceptional period were more likely to have no utilization of pre-conception healthcare ([Formula: see text]= 2.47, 95% [Formula: see text]: 1.33-4.61) or antenatal care ([Formula: see text]= 4.05, 95% [Formula: see text]: 1.76-9.34), or who had a lower family socioeconomic status ([Formula: see text]= 4.36, 95% [Formula: see text]: 1.79-10.64). Women who supplemented with FA pre-conception only or post-conception only were more likely to have no utilization of pre-conception healthcare ([Formula: see text]= 2.94, 95% [Formula: see text]: 1.79-4.82), or to have no previous pregnancy complication ([Formula: see text]=1.80, 95% [Formula: see text]: 0.99-3.28). CONCLUSION Over two-fifth of the women started FA supplementation and only one-third of them had an optimal supplementation from pre-conception to the first trimester. Maternal utilization of healthcare before or during pregnancy together with maternal and paternal socioeconomic status may play a role in the continuation to FA supplementation pre- and post-conception.
Collapse
Affiliation(s)
- Yanyan Mao
- NHC Key Laboratory of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai, 200237 China
| | - Hong Hu
- Community Health Service Center of Jing-An-Si, Jing-an District, Shanghai, 200040 China
| | - Dongyan Chen
- Community Health Service Center of Pengpu Estate, Jing-an District, Shanghai, 200435 China
| | - Yuhang Fang
- NHC Key Laboratory of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai, 200237 China
| | - Jun Liu
- grid.488200.6NHC Key Laboratory of Birth Defects and Reproductive Health (Chongqing Population and Family Planning Science and Technology Research Institute), Chongqing, 400020 China
| | - Min Li
- NHC Key Laboratory of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai, 200237 China
| | - Weijin Zhou
- NHC Key Laboratory of Birth Defects and Reproductive Health (Chongqing Population and Family Planning Science and Technology Research Institute), Chongqing, 400020, China.
| |
Collapse
|
4
|
Nilsen RM, Klungsøyr K, Stigum H. Adjusting for outcome risk factors in immigrant datasets: total or direct effects? BMC Med Res Methodol 2023; 23:37. [PMID: 36765287 PMCID: PMC9912500 DOI: 10.1186/s12874-023-01861-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 02/03/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND When quantifying differences in health outcomes between immigrants and non-immigrants, it is common practice to adjust for observed differences in outcome risk factors between the groups being compared. However, as some of these outcome risk factors may act as mediators on the causal path between the exposure and outcome, adjusting for these may remove effects of factors that characterize the immigrants rather than removing a bias between immigrants and non-immigrants. METHODS This study investigates the underlying conditions for which adjusting for outcome risk factors in regression models can lead to the estimation of either total or direct effect for the difference in health outcomes between immigrants and non-immigrants. For this investigation, we use modern tools in causal inference to construct causal models that we believe are highly relevant in an immigrant dataset. In these models, the outcome risk factor is modeled either as a mediator, a selection factor, or a combined mediator/selection factor. Unlike mediators, selection factors are variables that affect the probability of being in the immigrant dataset and may contribute to a bias when comparing immigrants and non-immigrants. RESULTS When the outcome risk factor acts both as a mediator and selection factor, the adjustment for the risk factor in regression models leads to the estimation of what is known as a "controlled" direct effect. When the outcome risk factor is either a selection factor or a mediator alone, the adjustment for the risk factor in regression models leads to the estimation of a total effect or a controlled direct effect, respectively. In all regression analyses, also adjusting for various confounding paths, including mediator-outcome confounding, may be necessary to obtain valid controlled direct effects or total effects. CONCLUSIONS Depending on the causal role of the outcome risk factors in immigrant datasets, regression adjustment for these may result in the estimation of either total effects or controlled direct effects for the difference in outcomes between immigrants and non-immigrants. Because total and controlled direct effects are interpreted differently, we advise researchers to clarify to the readers which types of effects are presented when adjusting for outcome risk factors in immigrant datasets.
Collapse
Affiliation(s)
- Roy Miodini Nilsen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
| | - Kari Klungsøyr
- grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway ,grid.418193.60000 0001 1541 4204Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Hein Stigum
- grid.5510.10000 0004 1936 8921Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| |
Collapse
|
5
|
Dennis C, Prioreschi A, Birken CS, Brennenstuhl S, Brown HK, Bell RC, Marini F, Wrottesley SV. Predictors of preconception health knowledge among Canadian women: A nationwide cross‐sectional study. J Clin Nurs 2022. [DOI: 10.1111/jocn.16584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 09/13/2022] [Accepted: 10/17/2022] [Indexed: 12/04/2022]
Affiliation(s)
- Cindy‐Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing University of Toronto Toronto Ontario Canada
- Department of Psychiatry University of Toronto Toronto Ontario Canada
- Li Ka Shing Knowledge Institute St. Michael's Hospital Toronto Ontario Canada
| | - Alessandra Prioreschi
- SAMRC/Wits Developmental Pathways for Health Research Unit, School of Clinical Medicine University of the Witwatersrand Johannesburg South Africa
| | - Catherine S. Birken
- Department of Pediatrics, Faculty of Medicine University of Toronto Toronto Ontario Canada
- Hospital for Sick Children Toronto Ontario Canada
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing University of Toronto Toronto Ontario Canada
| | - Hilary K. Brown
- Dalla Lana School of Public Health University of Toronto Toronto Ontario Canada
- Department of Health & Society University of Toronto Scarborough Toronto Ontario Canada
| | - Rhonda C. Bell
- Department of Agricultural, Food and Nutritional Sciences University of Alberta Edmonton Alberta Canada
| | - Flavia Marini
- Li Ka Shing Knowledge Institute St. Michael's Hospital Toronto Ontario Canada
| | - Stephanie V. Wrottesley
- SAMRC/Wits Developmental Pathways for Health Research Unit, School of Clinical Medicine University of the Witwatersrand Johannesburg South Africa
| |
Collapse
|
6
|
Fekadu M, Ketema K, Mamo Y, Aferu T. Peri-conception folic acid supplementation knowledge and associated factors among women visiting Maternal and Child Health clinics in Addis Ababa, Ethiopia. Heliyon 2022; 8:e11114. [PMID: 36303927 PMCID: PMC9593184 DOI: 10.1016/j.heliyon.2022.e11114] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/06/2021] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
Back ground Peri-conception care plays an essential and vital role for the health of the mother, her child and her family. Taking folic acid orally prior to conception and during the early stages of pregnancy plays a significant role in preventing Neural Tube Defects and has been associated with preventing other folic acid sensitive congenital anomalies. There exists problem in different parts of the globe on women's understanding of the importance of folic acid making them not to take this supplement in peri-conception period. Objective This study aimed at assessing the knowledge of peri-conception folic acid supplementation among women visiting Maternal and Child Health clinics of public health facilities in Addis Ababa, Ethiopia. Methods Institution based cross-sectional study was conducted from May 15 to June 20/2020 among 226 women visiting Maternal and Child Health clinics of health centers in Addis Ababa. Consecutive sampling technique was used to select study participants. Data were collected through interviewer administered structured questionnaire and analyzed using Statistical Package for Social Sciences version 24. Tables, charts and graphs were used for data presentation. Multivariable logistic regression analysis was done to identify the independent predictors of women's knowledge of folic acid at p-value ≤ 0.05. Results More than two-third of the study participants, 156 (69.0%) had good knowledge on peri-conception folic acid supplementation and its health benefits. Participants with age 25–30 years were 2.14 times more likely to have good knowledge compared to those aged less than 25 years while women with age greater than 30 years were 5.20 times more likely to have good knowledge compared to those with age less than 25 years. Women who had attended high school were 2.93 times more likely to have good knowledge compared to those with no formal education. Likewise, women who had attended college and above were 4.18 times at odd of having good knowledge on periconception folic acid supplementation compared to those with no formal education. Women who had information on prenatal care were 1.48 times more likely to have good knowledge compared to those who never had no information. Conclusion Folic acid supplementation knowledge in more than two third of the study participants was good. Participants' age, educational status and information on prenatal care were the independent predictors of knowledge on folic acid supplementation. The Ministry of health, Addis Ababa city health bureau, the study facilities’ management as well as Non-Governmental Organizations working on health in the city should focus on means to increase knowledge of peri-conception folic acid health benefits for women with poor knowledge on the same.
Collapse
Affiliation(s)
- Mesfin Fekadu
- Department of Medicine, College of Health Sciences, Selale University, Fiche, Ethiopia,Corresponding author.
| | - Kassahun Ketema
- Department of Public Health, College of Health Sciences, Selale University, Fiche, Ethiopia
| | - Yitagesu Mamo
- School of Pharmacy, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Temesgen Aferu
- School of Pharmacy, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
| |
Collapse
|
7
|
ZAÇE DRIEDA, ORFINO ALESSIA, MARIAVITERITTI ANNA, VERSACE VALERIA, RICCIARDI WALTER, DI PIETRO MARIALUISA. A comprehensive assessment of preconception health needs and interventions regarding women of childbearing age: a systematic review. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E174-E199. [PMID: 35647378 PMCID: PMC9121675 DOI: 10.15167/2421-4248/jpmh2022.63.1.2391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 02/15/2022] [Indexed: 11/24/2022]
Abstract
Background This systematic review summarizes the preconception health needs of women in childbearing age, necessary to be addressed to have an eventual safe and healthy pregnancy. Methods Web of Science, PubMed and Scopus were searched. We excluded studies involving women with reproductive system pathologies and referring to interconceptive or pregnancy period and non-empirical or only abstract studies. Two researchers independently performed the blind screening based on titles/abstracts and full-text and the quality assessment. Results Four major domains resulted from the thematic analysis: knowledge, behaviors and attitudes, health status and access to healthcare services. The most examined topics were knowledge and awareness on preconception health, folic acid assumption, tobacco and alcohol consumption, physical activity and healthy diet. Conclusions This review could assist healthcare professionals (physicians, nurses, midwives) in guiding tailored counselling to women to provide the adequate level of preconception care and act as a reference to policymakers.
Collapse
Affiliation(s)
- DRIEDA ZAÇE
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - ALESSIA ORFINO
- ASL Roma 2, Rome, Italy
- Correspondence: Alessia Orfino, ASL Roma 2, Rome, Italy - E-mail:
| | | | - VALERIA VERSACE
- Dipartimento di Salute della Donna e del Bambino e Sanità Pubblica - Area Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - WALTER RICCIARDI
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Salute della Donna e del Bambino e Sanità Pubblica - Area Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - MARIA LUISA DI PIETRO
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
8
|
Maeland KS, Morken NH, Schytt E, Aasheim V, Nilsen RM. Placental abruption in immigrant women in Norway: A population-based study. Acta Obstet Gynecol Scand 2021; 100:658-665. [PMID: 33341933 DOI: 10.1111/aogs.14067] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Placental abruption is a serious complication in pregnancy. Its incidence varies across countries, but the information of how placental abruption varies in immigrant populations is limited. The aims of this study were to estimate the incidence of placental abruption in immigrant women compared with non-immigrants by maternal country and region of birth, reason for immigration, and length of residence. MATERIAL AND METHODS We conducted a nationwide population-based study using data from the Medical Birth Registry of Norway and Statistics Norway (1990-2016). The study sample included 1 558 174 pregnancies, in which immigrant women accounted for 245 887 pregnancies and 1 312 287 pregnancies were to non-immigrants. Crude and adjusted odds ratios with 95% CI for placental abruption in immigrant women compared with non-immigrants were estimated by logistic regression with robust standard error estimations (accounting for within-mother clustering). Adjustment variables included year of birth, maternal age, parity, multiple pregnancies, chronic hypertension, and level of education. RESULTS The incidence of placental abruption decreased during the study period for both immigrants (from 0.68% to 0.44%) and non-immigrants (from 0.80% to 0.34%). Immigrant women from sub-Saharan Africa had an adjusted odds ratio of 1.35 (95% CI 1.15-1.58) compared with non-immigrants for placental abruption, whereas immigrant women from Ethiopia had an adjusted odds ratio of 2.39 (95% CI 1.67-3.41). We found a small variation in placental abruption incidence by other countries or regions of birth, length of residence, and reason for immigration. CONCLUSIONS Immigrant women from sub-Saharan Africa, especially Ethiopia, have increased odds for placental abruption when giving birth in Norway. Reason for immigration and length of residence had little impact on the incidence of placental abruption.
Collapse
Affiliation(s)
- Karolina S Maeland
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Nils-Halvdan Morken
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Center for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Erica Schytt
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Center for Clinical Research Dalarna, Uppsala University, Uppsala, Sweden.,Department of Women's and Children's Health, Karolinska Institute, Solna, Sweden
| | - Vigdis Aasheim
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Roy M Nilsen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| |
Collapse
|
9
|
Maternal use of folic acid and multivitamin supplements and infant risk of birth defects in Norway, 1999-2013. Br J Nutr 2020; 124:316-329. [PMID: 32238218 DOI: 10.1017/s0007114520001178] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The association between folic acid supplementation and birth defects other than neural tube defects (NTD) remains unclear. We used a log-binomial regression model to investigate if periconceptional folic acid and/or multivitamin use was associated with birth defects in Norway with prospectively collected data from the Medical Birth Registry of Norway (MBRN) during 1999-2013. We used the European Surveillance of Congenital Anomalies (EUROCAT) classification system to define eleven organ-specific major birth defect groups (nervous system, eye, ear-face-neck, cardiovascular system, respiratory system, oral clefts, digestive system, abdominal wall, urinary system, genital organs and limb), with additional subgroups. Fetuses or infants whose mothers used folic acid and/or multivitamin supplements before and during pregnancy were classified as exposed. During the years 1999-2013, 888 294 (99·0 %) live-born infants, 6633 (0·7 %) stillborn infants and 2135 (0·2 %) fetuses from terminated pregnancies due to fetal anomalies were registered in the MBRN. Among the live- and stillborn infants of women who used vitamin supplements compared with infants of non-users, the adjusted relative risk (aRR) was 0·94 (95 % CI 0·91, 0·98) for total birth defects (n 18 382). Supplement use was associated with reduced risk of abdominal wall defects (aRR 0·58; 95 % CI 0·42, 0·80, n 377), genital organ defects (aRR 0·81; 95 % CI 0·72, 0·91, n 2299) and limb defects (aRR 0·81; 95 % CI 0·74, 0·90, n 3409). Protective associations were also suggested for NTD, respiratory system defects and digestive system defects although CI included the null value of 1. During the full study period, statistically significant associations between supplement use and defects in the eye, ear-face-neck, heart or oral clefts were not observed.
Collapse
|