Race and ethnicity and preconception folic acid supplement use among pregnant women in Georgia, PRAMS 2009 to 2011

Birth Defects Res. 2017 Jan 20;109(1):38-48. doi: 10.1002/bdra.23597.


Background: The United States Public Health Service recommends that all women of reproductive age consume 400 μg of folic acid daily to prevent major neural tube defects. Hispanics have the highest prevalence of neural tube defects compared with other race/ethnic groups. We studied prevalence of preconception folic acid supplement use, and its association with race/ethnicity among pregnant women in Georgia.

Methods: Using state-wide population-based data from 2009 to 2011 Georgia Pregnancy Risk Assessment Monitoring System, we examined the prevalence of preconception folic acid supplement use among pregnant women aged 18 to 45 years. We conducted multivariable logistic regression and estimated adjusted odds ratios and 95% confidence intervals to examine the association between race/ethnicity and supplemental folic acid use among study participants.

Results: Overall, 25% of all participants reported taking folic acid supplements daily before conception. Only 21% of Hispanic women reported preconception folic acid supplement use. Hispanic women were twice as likely to not take folic acid supplements (adjusted odds ratio = 2.15; 95% confidence interval, 1.35-3.40) compared with non-Hispanic whites, after controlling for maternal age, parity, pregnancy intention, knowledge that folic acid prevents birth defects, and preconception smoking and exercise.

Conclusion: Hispanics are a growing population in the United States with an expected 14 million women of child-bearing age by 2020, and the prevalence of preconception folic acid supplement use is low in this group with a high risk of neural tube defects. Promotion of voluntarily fortified corn masa flour can lower neural tube defects in Hispanics. Mandatory corn masa fortification will be a more effective public health policy.Birth Defects Research 109:38-48, 2017. © 2016 Wiley Periodicals, Inc.

Keywords: Georgia; Hispanic; anencephaly; dietary supplementation; ethnicity; folic acid; neural tube defects; spina bifida.

MeSH terms

  • Adolescent
  • Adult
  • Anencephaly / diet therapy
  • Anencephaly / epidemiology
  • Anencephaly / prevention & control
  • Dietary Supplements / statistics & numerical data
  • Ethnicity / genetics
  • Female
  • Folic Acid / metabolism*
  • Folic Acid / therapeutic use*
  • Food, Fortified
  • Georgia / epidemiology
  • Hispanic or Latino
  • Humans
  • Middle Aged
  • Neural Tube Defects / diet therapy*
  • Neural Tube Defects / epidemiology
  • Neural Tube Defects / prevention & control
  • Nutritional Requirements
  • Preconception Care / methods
  • Pregnancy
  • Prevalence
  • Racial Groups / genetics
  • United States
  • Zea mays


  • Folic Acid