title: A Mixed-Method Study to Determine the Benefits of Periconceptional Folic Acid Supplementation and Effects of Folic Acid Deficiency in Mothers on Birth Outcomes.
abstract: BACKGROUND
  Evidence from high income countries shows mothers who are supplemented with folic acid in their periconceptional period and early pregnancy have significantly reduced adverse outcomes like birth defects. However, in India there is a paucity of data on association of birth defects and folic acid supplementation. We identified a few important questions to be answered using separate scientific methods and then planned to triangulate the information.
  
  
  OBJECTIVE
  In this paper, we describe the protocol of our study that aims to determine the association of folic acid and pregnancy outcomes like neural tube defects (NTDs) and orofacial clefts (OFCs). We decided to fill the gaps in knowledge from India to determine public health consequences of folic acid deficiency and factors influencing dietary and periconceptional consumption of folic acid.
  
  
  METHODS
  The proposed study will be carried out in five stages and will examine the questions related to folic acid deficiency across selected locations in South and North India. The study will be carried out over a period of 4 years through the hierarchical evidence-based approach. At first a systematic review was conducted to pool the current birth prevalence of NTDs and orofacial clefts OFCs in India. To investigate the population prevalence, we plan to use the key informant method to determine prevalence of NTDs and OFCs. To determine the normal serum estimates of folic acid, iron, and vitamin B12 among Indian women (15-35 years), we will conduct a population-based, cross-sectional study. We will further strengthen the evidence of association between OFCs and folic acid by conducting a hospital-based, case-control study across three locations of India. Lastly, using qualitative methods we will understand community and health workers perspective on factors that decide the intake of folic acid supplements.
  
  
  RESULTS
  This study will provide evidence on the community prevalence of birth defects and prevalence folic acid and vitamin B12 deficiency in the community. The case-control study will help understand the association of folic acid deficiency with OFCs.
  
  
  CONCLUSIONS
  The results from this study are intended to strengthen the evidence base in childhood disability for planning and policy initiatives.
authors.affiliation: Indian Institute of Public Health, Hyderabad, India.
authors.forename: Gudlavalleti Venkata S
authors.initials: GV
authors.lastname: Murthy
authors.forename: Sunanda Reddy
authors.initials: SR
authors.lastname: Kolli
authors.forename: Sutapa B
authors.initials: SB
authors.lastname: Neogi
authors.forename: Samiksha
authors.initials: S
authors.lastname: Singh
authors.forename: Komal Preet
authors.initials: KP
authors.lastname: Allagh
authors.forename: Neena
authors.initials: N
authors.lastname: John
authors.forename: Srinivas
authors.initials: S
authors.lastname: N
authors.forename: Sudha
authors.initials: S
authors.lastname: Ramani
authors.forename: B R
authors.initials: BR
authors.lastname: Shamanna
authors.forename: Pat
authors.initials: P
authors.lastname: Doyle
authors.forename: Sanjay
authors.initials: S
authors.lastname: Kinra
authors.forename: Andy
authors.initials: A
authors.lastname: Ness
authors.forename: Dinesh Raj
authors.identifier: http://orcid.org/0000-0001-9118-1780
authors.initials: DR
authors.lastname: Pallepogula
authors.forename: Hira B
authors.initials: HB
authors.lastname: Pant
authors.forename: Smiksha
authors.initials: S
authors.lastname: Babbar
authors.forename: Raghunath
authors.initials: R
authors.lastname: Reddy
authors.forename: Rachna
authors.initials: R
authors.lastname: Singh
keywords: folic acid; key informant method; neural tube defects; orofacial clefts; periconceptional folic supplement