American Journal of Epidemiology Advance Access originally published online on October 25, 2008
American Journal of Epidemiology 2009 169(1):9-17; doi:10.1093/aje/kwn331
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Neural Tube Defects and Maternal Folate Intake Among Pregnancies Conceived After Folic Acid Fortification in the United States
Correspondence to Dr. Charlotte A. Hobbs, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital Research Institute, 1120 Marshall Street, Slot 512-40, Little Rock, AR 72202 (e-mail: hobbscharlotte{at}uams.edu).
Received for publication March 1, 2008. Accepted for publication June 11, 2008.
Rates of neural tube defects have decreased since folic acid fortification of the food supply in the United States. The authors’ objective was to evaluate the associations between neural tube defects and maternal folic acid intake among pregnancies conceived after fortification. This is a multicenter, case-control study that uses data from the National Birth Defects Prevention Study, 1998–2003. Logistic regression was used to compute crude and adjusted odds ratios between cases and controls assessing maternal periconceptional use of folic acid and intake of dietary folic acid. Among 180 anencephalic cases, 385 spina bifida cases, and 3, 963 controls, 21.1%, 25.2%, and 26.1%, respectively, reported periconceptional use of folic acid supplements. Periconceptional supplement use did not reduce the risk of having a pregnancy affected by a neural tube defect. Maternal intake of dietary folate was not significantly associated with neural tube defects. In this study conducted among pregnancies conceived after mandatory folic acid fortification, the authors found little evidence of an association between neural tube defects and maternal folic acid intake. A possible explanation is that folic acid fortification reduced the occurrence of folic acid-sensitive neural tube defects. Further investigation is warranted to possibly identify women who remain at increased risk of preventable neural tube defects.
folic acid; neural tube defects
Abbreviations: B3, 3 months before pregnancy; CI, confidence interval; DFE, dietary folate equivalent; OR, odds ratio; P1, first month of pregnancy
Editor's note: An invited commentary on this article appears on page 18, and the authors' response is published on page 22.
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Am. J. Epidemiol. 2009 169: 22-23.[Extract] [FREE Full Text]
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