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PEDIATRICS Vol. 112 No. 3 September 2003, pp. 536-542

Neural Tube Defects: Knowledge and Preconceptional Prevention Practices in Minority Young Women

Mariam R. Chacko, MD^*, Roberta Anding, MS, RD/LD, CDE^*, Claudia A. Kozinetz, PhD, MPH^*, Janice L. Grover, MS, RD/LD^* and Peggy B. Smith, PhD

^* Department of Pediatrics
Obstetrics & Gynecology, Baylor College of Medicine, Houston, Texas

Objective. To assess 1) knowledge of neural tube defect (NTD) prevention by folic acid, 2) frequency of intake of multivitamins and folate- and folic acid–fortified food, and 3) factors associated with knowledge and prevention practices among sexually active minority adolescent and young adult women.

Methods. Young minority women were enrolled in a folic acid program at 3 urban Houston, Texas, reproductive health clinics and assessed for NTD knowledge and preventive practices. A 3-month supply of multivitamins was also dispensed at enrollment. A 3-month program follow-up survey of a randomly selected sample at 2 sites was conducted.

Results. Of 387 women (mean age: 18 ± 1.9 years), 72% were black and 28% were Hispanic. At enrollment, clinics were a major source of information of NTD prevention (44%); 52% had heard of folic acid, 45% had heard of NTDs, and 50% had heard of birth defects prevention by multivitamins. Significantly more Hispanic than black young women had heard of NTDs (59% vs 39%). Pregnancy history, regular birth control use, and education level for age were independently associated with knowledge. In young women with low education level for age, regular birth control use was significantly associated with knowledge. At enrollment, daily multivitamin intake was very low (9%) and folate-rich foods were consumed in inadequate amounts. Adequate folate diet was not associated with knowledge. The program follow-up survey indicated that 88% to 92% had knowledge of NTDs and folic acid, and 67% reported taking a daily multivitamin.

Conclusions. Publicly funded clinics may be the only source of information on NTD prevention for many minority young women. Preliminary evidence suggests that a promotion program improves knowledge, and dispensing of multivitamins increases multivitamin use. However, clinicians in such programs need to reinforce daily adherence to multivitamins in young women.

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Key Words: neural tube defects • spina bifida • folic acid • folate

Abbreviations: NTD, neural tube defect • SB, spina bifida • OR, odds ratio • CI, confidence interval

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Received for publication Jul 15, 2002; Accepted Dec 12, 2002.

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