Lack of folic acid supplementation for nonpregnant women means missed opportunities to prevent neural tube defects in children

Research Activities, February 2012, No. 378

Less than a tenth of preventive visits for women of childbearing age, who are not pregnant, result in the clinician ordering folic acid (FA) or folic acid-containing multivitamins (FA/MVI) for the patient. Intake of 400g of FA in either form during the time surrounding conception has been shown to reduce the risk of neural tube defects in the developing embryo such as spina bifida (failure of the fetal spinal column to close properly) or anencephaly (the failure of key brain structures to form, resulting in stillbirth or neonatal death). Because 20-50 percent of pregnancies are unplanned, professional and governmental health care organizations recommend that all women of childbearing age should take FA or MVI daily. The researchers used recent data from two cross-sectional surveys to determine that, among 32.1 million preventive visits nationally for nonpregnant women of childbearing age, 7.2 percent resulted in providers ordering FA/MVI.

In comparison, providers ordered FA/MVI in 42.8 percent of preventive visits for pregnant women. Nonpregnant women ages 30-34 were most likely to have FA/MVI ordered during a preventive visit (12.5 percent), while those 15-19 and 40-44 years old were least likely (3.1 percent and 3.3 percent, respectively). Women seen by an obstetrician-gynecologist were more likely to have FA/MVI ordered than those seen by all other providers combined (9.8 vs. 3.9 percent). After adjusting for other factors, women insured through Medicaid were more than twice as likely to have FA/MVI ordered as those with private insurance. Based on their findings, the researchers suggest that, despite existing guidelines, there may be more than 29 million missed opportunities each year to formally order FA in some form for women of childbearing age.

Their findings were based on data from two annual surveys conducted by the Centers for Disease Control and Prevention of outpatient and emergency department visits in the United States, the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS), for both 2005 and 2006. The study was funded in part by the Agency for Healthcare Research and Quality (T32 HS00063).

More details are in "U.S. provider reported folic acid or multivitamin ordering for non-pregnant women of childbearing age: NAMCS and NHAMCS, 2005-2006," by Healther H. Burris, M.D., M.P.H., and Martha M. Werler, Sc.D., in the Maternal and Child Health Journal 15(3); pp. 352-359, 2011.

Current as of February 2012
Internet Citation: Lack of folic acid supplementation for nonpregnant women means missed opportunities to prevent neural tube defects in children: Research Activities, February 2012, No. 378. February 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/newsletters/research-activities/feb12/0212RA21.html