Multivitamins, Folic Acid and Birth Defects: Knowledge, Beliefs and Behaviors of Hispanic Women in North Carolina

By deRosset, Leslie; Mullenix, Amy et al. | American Journal of Health Education, May-June 2009 | Go to article overview

Multivitamins, Folic Acid and Birth Defects: Knowledge, Beliefs and Behaviors of Hispanic Women in North Carolina


deRosset, Leslie, Mullenix, Amy, Zhang, Lei, American Journal of Health Education


ABSTRACT

Background: Consumption of folic acid prior to conception can prevent up to 70% of neural tube defect (NTD)-affected pregnancies. In 1992, the U.S. Public Health Service (USPHS) issued a recommendation that all women of childbearing age capable of becoming pregnant consume 400 [micro]g of folic acid daily to reduce their risk for a NTD- affected pregnancy. A 26% decrease in the overall NTD rate in the United States was observed between 1995 and 2000, after the fortification of cereal grain products. However, the NTD prevalence for Hispanics remains almost twice that of the general population, both nationally and in North Carolina. Purpose: To measure the baseline knowledge, beliefs and behaviors about multivitamins, folic acid and birth defects of Spanish-speaking Hispanic women ages 18-35 in North Carolina. Methods: Face-to-face oral interviews with Spanish-speaking Hispanic women were conducted by native Spanish-speaking data collectors using a culturally appropriate survey instrument in 12 North Carolina counties. Results: Thirty-three percent of the total respondents (n = 896) reported taking a daily multivitamin. Of those who reported currently planning a pregnancy or trying to become pregnant (n = 134), 22% reported taking a daily multivitamin. Knowledge was highest about birth defects (79%), followed by multivitamins (64%), and then folic acid (54%). Ninety-nine percent of respondents who did not take a daily multivitamin reported they would do so upon the recommendation of their health care provider. Discussion: Multivitamin consumption is low among this group at increased risk, and even lower among those actively attempting or contemplating pregnancy. Health care professionals play a critical role in increasing the knowledge and influencing the behaviors of this population. Translation to Health Education Practice: Folic acid education in all preconception encounters with Hispanic women is critical to address this health disparity and help prevent NTD-affected pregnancies.

BACKGROUND

Neural tube defects (NTDs) are serious birth defects of the spine (spina bifida) and brain (anencephaly) that affect approximately 3,000 pregnancies each year in the United States. (1) These defects occur early during pregnancy, often before a woman knows she is pregnant. Folic acid, a B vitamin, can prevent up to 70% of NTDs if consumed daily before conception and in the early weeks of pregnancy? For this reason, the U.S. Public Health Service (USPHS) issued a recommendation in 1992 that all women of childbearing age in the United States capable of becoming pregnant consume 400 [micro]g of folic acid daily to reduce their risk for a NTD-affected pregnancy. (1-3) In 1998, the U.S. Food and Drug Administration mandated that folk acid be added to cereal grain products. A 26% decrease in the NTD rate was observed from the period prior to fortification (1995-1996) to the period following fortification (1999-2000). (1) However, despite this overall national decline, racial/ethnic disparities in NTD rates still exist, with Hispanic women having higher NTD prevalence than other racial/ethnic groups. (2, 4)

[FIGURE 1 OMITTED]

Disparities in NTD prevalence also exist in North Carolina. Although the overall NTD prevalence in the state declined following fortification and educational efforts, rates are highest among Hispanic women. In North Carolina, the overall NTD prevalence decreased nearly 40% from 9.95/10,000 live births in 1995/1996 to 6.05/10,000 live births in 2004/2005. (5) The prevalence among Hispanics declined 43% during the same time period, from 19.94/10,000 to 11.54/10,000, but remained almost double that of the overall prevalence (Figure 1). (5) North Carolina's NTD trends parallel NTD prevalence declines and racial/ethnic disparities observed in other states with large Hispanic populations. (5-9)

Folic Acid Consumption and Knowledge

The Healthy People 2010 objective regarding folic acid consumption aims to increase the percentage of all women of childbearing age who consume 400 [micro]g of folic acid daily to 80%. …

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