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Journal of Peking University (Health Sciences) ›› 2020, Vol. 52 ›› Issue (4): 719-725. doi: 10.19723/j.issn.1671-167X.2020.04.024

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Maternal periconceptional folic acid supplementation and its effects on the prevalence of fetal neural tube defects

Lei JIN1,Cheng WANG2,Jie ZHANG2,Wen-ying MENG3,Jia-yu ZHANG1,Jin-hui YU2,Gui-yin LIN1,Ming-kun TONG2,Lei JIN2,△()   

  1. 1. Department of Maternal Health Care, Tongzhou Maternal and Child Health Hospital of Beijing, Beijing 101100, China
    2. Institute of Reproductive and Child Health, Peking University; Key Laboratory of Reproductive Health, the National Health Commission of the People’s Republic of China; Department of Epidemiology and Biostatistics, Peking University School of Public Health; Beijing 100191, China
    3. Department of Obstetrics, Tongzhou Maternal and Child Health Hospital of Beijing, Beijing 101100, China
  • Received:2019-01-07 Online:2020-08-18 Published:2020-08-06
  • Contact: Lei JIN E-mail:jinlei@bjmu.edu.cn
  • Supported by:
    National Key R&D Program of China(2018YFC1004300);National Key R&D Program of China(2018YFC1004301)

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Abstract:

Objective: To find out the status of folic acid supplementation among women, to evaluate the prevention effects on neural tube defects (NTDs), and to explore the factors impact on folic acid supplementation compliance. Methods: Based on the routine data of 92 121 women in prenatal health care and birth defect surveillance system in Tongzhou District of Beijing from 2013 to 2018, we described the prevalence of periconceptional folic acid supplementation, pre-pregnancy folic acid supplementation and regularly folic acid supplementation (compliance supplementation). Trend χ 2 tests were used to evaluate the change of folic acid supplementation prevalence. The prevalence difference among the women with folic acid supplementation and without supplementation were tested with Fisher’s exact test. Factors asso-ciated with folic acid supplementation compliance rate were analyzed with univariate and multivariate Logistic regression model. Results: The prevalence of periconceptional folic acid supplementation during the six years was 90.08% and it was increased from 2013 to 2018, but the rate of pre-pregnancy and regular supplementation was only 41.5% and declined from 2013 to 2018, especially 2013 to 2015. The prevalence of NTDs among the fetuses whose mothers took folic acid during periconceptional period was 5.5/10 000, while the prevalence for the fetuses whose mothers did not take folic acid was 19.7/10 000 (P<0.001), the rates ratio was 27.9% (χ2=23.74, P<0.001). The difference between the prevalence of NTDs among the fetuses whose mothers took folic acid only and multiple micronutrients was not statistically significant. After controlling the confounding factors, it was found that the compliant folic acid supplementation rates in women, whose household registrations were outside Beijing and whose education levels were junior high school or below, and who were younger than 25 years old, and who were multiparas and who were pre-pregnancy underweight or obese, were lower than those of the corresponding control groups (P<0.05). Conclusion: The rate of folic acid supplementation among women in Tongzhou District of Beijing was relatively high, but their compliance was poor. Women who did not take folic acid during periconception seriously affected the prevention effect of NTDs. We should focus on women who are younger than 25 years old, lower educated, pre-pregnancy underweight or obese, multiparas and nonlocal household registers, in order to improve the periconceptional folic acid supplementation compliance and improve the effects of NTDs prevention.

Key words: Periconception, Folic acid, Compliance, Neural tube defects

CLC Number: 

  • R714.7

Table 1

General characteristics of pregnant women in Tongzhou District of Beijing from 2013 to 2018a"

Characteristics n (%)
Ethnicity
Han 80 954 (94.6)
Other 4 589 (5.4)
Age/years
14- 18 326 (19.9)
25- 42 002 (45.6)
30- 24 819 (26.9)
35-56 6 974 (7.6)
Education
Junior high school and below 10 241 (11.5)
High school or equivalent 17 441 (19.5)
College school 26 111 (29.3)
Bachelor degree or above 35 459 (39.7)
Occupation
Manager of a unit 9 782 (11.3)
Professional 16 641 (19.2)
Clerical personnel 13 216 (15.3)
Commercial or service personnel 15 091 (17.4)
Unemployment 15 318 (17.7)
Other occupations 16 468 (19.0)
Household registration
Couples both with non-local household registration 36 298 (39.8)
Couples both with local household registration 40 283 (44.2)
Couples only the husband had local household
registration		 14 574 (16.0)
Pre-pregnancy BMI/(kg/m2)
10- 7 766 (11.3)
18.5- 42 865 (62.6)
24.0- 13 292 (19.4)
28.0-45 4 542 (6.6)
Gestational week age/weeks
<37 4 387 (4.8)
≥37 86 233 (95.2)
Parity
Primiparity 55 840 (62.5)
Multiparity 33 553 (37.5)
Get pregnancy with assisted reproductive technology
Yes 1 362 (1.5)
No 90 759 (98.5)
Delivery year
2013 7 586 (8.2)
2014 12 033 (13.1)
2015 14 334 (15.6)
2016 17 548 (19.1)
2017 21 076 (22.9)
2018 19 544 (21.2)

Figure 1

Maternal periconceptional folic acid supplement rates and compliance supplementation rates in Tongzhou District of Beijing from 2013 to 2018 a, χ trend 2 =33.1, P<0.001; b, χ trend 2 =745.5, P<0.001. "

Figure 2

The prevalence of neural tube defects and the subtypes among the fetus whose mother with or without periconceptional folic acid supplements The P values were estimated with Fisher’s exact test."

Figure 3

The effects of maternal periconceptional folic acid supplementation on the prevalence of fetal neural tube defects or the subtypes"

Table 2

Factors associated with the prevalence of folic acid compliance supplementation among pregnant women in Tongzhou District of Beijing from 2015 to 2018a"

Characteristics Compliant supplementation Univariate analysis Multivariate analysis
n Rate/% OR (95%CI) P OR (95%CI) P
Ethnicity
Han 26 059 43.0 0.95 (0.89-1.02) 0.147 0.99 (0.92-1.07) 0.838
Others 1 558 43.2 1.00 1.00
Age/years
14- 3 716 35.0 1.00 1.00
25- 13 534 45.4 1.64 (1.57-1.72) <0.001 1.59 (1.59-1.76) <0.001
30- 8 315 44.0 1.56 (1.49-1.64) <0.001 2.00 (1.88-2.11) <0.001
35-56 2 249 41.4 1.35 (1.27-1.44) <0.001 2.02 (1.87-2.17) <0.001
Education
Junior high school and below 2 142 33.4 1.00 1.00
High school or equivalent 4 386 38.3 1.40 (1.32-1.49) <0.001 1.14 (1.06-1.22) <0.001
College school 8 036 42.6 1.80 (1.70-1.90) <0.001 1.29 (1.21-1.37) <0.001
Bachelor degree or above 12 950 47.4 2.27 (2.15-2.40) <0.001 1.43 (1.34-1.53) <0.001
Occupation
Manager of a unit 2 931 44.3 1.00 1.00
Professional 6 322 47.4 1.13 (1.07-1.20) <0.001 1.32 (1.23-1.40) <0.001
Clerical personnel 4 150 41.1 0.88 (0.82-0.93) <0.001 1.03 (0.96-1.09) 0.973
Commercial or service personnel 4 816 42.9 0.94 (0.89-1.00) 0.061 1.21 (1.13-1.29) <0.001
Unemployment 3 755 37.1 0.74 (0.70-0.79) <0.001 1.08 (1.01-1.16) 0.100
Other occupations 5 066 43.5 0.97 (0.91-1.03) 0.282 1.18 (1.11-1.26) <0.001
Household registration
Couples both with non-local household registration 10 703 37.7 0.65 (0.63-0.67) <0.001 0.62 (0.60-0.65) <0.001
Couples both with local household registration 12 868 48.1 1.00 1.00
Couples only the husband had local household
registration		 4 243 44.2 0.86 (0.82-0.90) <0.001 0.84 (0.80-0.88) <0.001
Pre-pregnancy BMI/(kg/m2)
10- 2 721 38.8 0.85 (0.81-0.89) <0.001 0.84 (0.79-0.88) <0.001
18.5- 16 675 43.0 1.00 1.00
24.0- 5 245 44.0 1.02 (0.98-1.07) 0.245 1.05 (1.01-1.10) 0.017
28.0-45.0 1 655 41.5 0.90 (0.85-0.96) 0.001 0.92 (0.86-0.99) 0.022
Parity
Primiparity 17 681 48.2 1.00 1.00
Multiparity 9 179 34.9 0.54 (0.52-0.56) <0.001 0.48 (0.46-0.49) <0.001
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