Folic acid use


 

Pre-pregnancy folic acid use in MN mothers

 
Source: PRAMS 2012*-2015
*2012 contains eight months of data due to CDC software change.
 
Source: PRAMS 2012*-2015
*Eight months of data

Folic acid supplementation during the month before pregnancy was defined as taking a multivitamin, prenatal vitamin, or folic acid vitamin every day of the month before pregnancy ("During the Month before you got pregnant with your new baby, how many times a week did you take a multivitamin, a prenatal vitamin or a folic acid vitamin?").

In Minnesota, 38% of PRAMS respondents took folic acid daily. Nationally, daily folic acid use during the month before pregnancy was reported by 30% of women in 29 states (Source).

 


 

Daily folic acid use

 
Source: PRAMS 2012*-2015  **Black:  Only US Born African Americans
*2012 contains eight months of data due to CDC software change.
 
Source: PRAMS 2012*-2015
*2012 contains eight months of data due to CDC software change.
 
Source: PRAMS 2012*-2015
*2012 contains eight months of data due to CDC software change.
 
Source: PRAMS 2012*-2015
*2012 contains eight months of data due to CDC software change.
 
 
 
 
Source: PRAMS 2012*-2015
*2012 contains eight months of data due to CDC software change.

Hispanic, American Indian & Black women less likely to take folic acid

In Minnesota, Hispanic women report lower consumption of folic acid (22%) compared to non-Hispanic white women (43%). To target Hispanic women who have inadequate folate intake, one strategy in the U.S. is to fortify corn masa flour with folic acid, as is done with other cereal grains.

Nationally, the reduction in NTDs has been observed for all race/ethnic groups. However, NTDs still occur at higher rates for Hispanic women. Possible reasons for this could include lower folic acid use and genetic factors that prevent the body breaking down and using folic acid, according to this CDC MMWR.

Hispanic, American Indian and Black mothers report lower daily folic acid intake the month before pregnancy than non-Hispanic white women. However, less than half of all Minnesota mothers take folic acid daily and could benefit from further education and awareness about the importance of folic acid. 

WIC participants have low folic acid use

The Women Infant and Children (WIC) Supplemental Nutrition Program serves lower-income pregnant, breastfeeding, and postpartum women and children under age five. While 37% of MN PRAMS respondents reported participating in WIC during their pregnancy, only 22% took folic acid supplements daily in the month before they became pregnant.

This does not reflect WIC program services since WIC enrollment occurs after the pre-conception period. 

Folic acid use is related to education and poverty

The percent of mothers that take folic acid daily during the month before pregnancy incrementally increases with education level beginning with high school education. Only 22% of mothers with less than a high school education reported daily folic acid use one month prior to pregnancy as compared to 53% of mothers with a college education. 

Women living in poverty were less likely to take folic acid prior to pregnancy. Mothers who were in the "poor" category (within 0-100% Federal Poverty Levels) had the lowest percentage (19%) who took folic acid daily during the month before pregnancy, as compared to mothers that were in the "not poor" category  (over 185% of the FPL) (50%).


MN PRAMS works to improve health of mothers and infants

The Minnesota Pregnancy Risk Assessment Monitoring System (PRAMS) was established in 2002 to reduce infant death, illness, and low birth weight in Minnesota. PRAMS is a population–based surveillance survey designed to collect information on the behaviors and experiences of mothers before, during, and after a pregnancy.

Data from 2012-2014 PRAMS surveys are combined to assess daily folic acid supplement use. The 2012 data contains only eight months of data due to CDC changing the data managing software. Each month, approximately 200 mothers are selected from the birth certificates of babies born in Minnesota during the preceding 2–4 months. Mothers complete the survey by mail or by a telephone interview. One of the PRAMS questions is about folic acid supplement use ("During the month before you got pregnant with your new baby, how many times a week did you take a multivitamin, a prenatal vitamin or a folic acid vitamin?").

Responses from Minnesota mothers can identify disparities in daily folic acid supplement use. Targeting mothers with low folic acid use through culturally sensitive, targeted education and increasing the availability of affordable, high-folate foods and folic acid supplements can reduce the risk of NTDs occurring.

 


 

Minnesota Pregnancy Risk Assessment Monitoring System (PRAMS), Minnesota Department of Health, Division of Community and Family Health, Maternal and Child Health This data was made possible by grant number IU01DP003117-01 from the Centers for Disease Control and Prevention