Preconceptional folic acid-containing supplement use in the National Birth Defects Prevention Study.
BACKGROUND
Despite public health campaigns encouraging women to take a daily folic acid supplement, the proportion of reproductive age women, in the United States, who comply with this recommendation is less than optimal. The objective of this analysis was to identify predictors of preconceptional folic acid-containing supplement use to define subgroups of women who may benefit from targeted folic acid campaigns.


METHODS
This study included 6570 mothers of live born infants from the control population of National Birth Defects Prevention Study (1997-2005). Logistic regression analyses were used to identify predictors of preconceptional folic acid supplementation. A classification and regression tree (CART) analysis was used to define subgroups of women with different patterns of preconceptional folic acid supplementation.


RESULTS
Race/ethnicity, education, age at delivery, nativity, employment, income, number of dependents, smoking, and birth control use were significantly associated with preconceptional folic acid-containing supplement use. Based on a CART analysis, education, race/ethnicity, and age were the most distinguishing factors between women with different preconceptional supplementation patterns. Non-white women with <4 years of a college education were the least likely to use folic acid-containing supplements (11%). However, even in the most compliant subgroup (women with ≥4 years of college), only 60% of women supplemented with folic acid.


CONCLUSIONS
These results demonstrate the need for continued efforts to increase folic acid supplementation among all reproductive aged women. However, the success of such efforts may be improved if maternal characteristics such as education, race/ethnicity, and age, are considered in the development of future interventions.
Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Houston, Texas.
Zeina G
ZG
Khodr
Philip J
PJ
Lupo
A J
AJ
Agopian
Mark A
MA
Canfield
Amy P
AP
Case
Suzan L
SL
Carmichael
Laura E
LE
Mitchell
D000328:Adult; D000367:Age Factors; D044383:Black People; D019587:Dietary Supplements; D004522:Educational Status; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage*; D006293:Health Promotion; D006801:Humans; D007182:Income; D016015:Logistic Models; D017058:Mexican Americans; D009436:Neural Tube Defects / Q000453:epidemiology / Q000208:ethnology / Q000473:pathology / Q000517:prevention & control*; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D016742:Preconception Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D044465:White People; D001741:Black or African American
D005492:Folic Acid
birth defects; folic acid; neural tube defects; preconception; pregnancy; reproductive age women