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Periconceptional use of multivitamins and the occurrence of neural tube defects
J Mulinare1, J F Cordero, J D Erickson
1Birth Defects and Genetic Diseases Branch, Centers for Disease Control, Atlanta, Georgia 30333.
Insights
Periconceptional multivitamin use may reduce the risk of neural tube defects in infants. Further research is needed to confirm if this protective effect is directly from multivitamins or other maternal factors.
Area of Science:
- Obstetrics and Gynecology
- Pediatric Neurology
- Nutritional Epidemiology
Background:
- Neural tube defects (NTDs) are serious congenital anomalies.
- Periconceptional nutritional status is critical for early embryonic development.
- Previous studies suggest a link between folic acid and NTD prevention.
Purpose of the Study:
- To investigate the association between periconceptional multivitamin use and NTD occurrence.
- To evaluate the potential protective effect of multivitamins during the critical periconceptional period.
- To analyze data from a large case-control study on birth defects.
Main Methods:
- Case-control study design utilizing data from the Atlanta Birth Defects Case-Control Study (1968-1980).
- Inclusion of 347 infants with NTDs and 2829 control infants without birth defects.
- Definition of periconceptional multivitamin use as use during the three months before conception through the first three months of pregnancy.
Main Results:
- An apparent protective effect of periconceptional multivitamin use on NTDs was observed.
- The crude estimated relative risk for NTDs among multivitamin users was 0.40 (95% CI, 0.25-0.63).
- Multivitamin users differed demographically and in lifestyle characteristics from nonusers.
Conclusions:
- Periconceptional multivitamin use shows an apparent association with a reduced risk of neural tube defects.
- The observed protective effect may be attributable to multivitamin use or confounding factors.
- Further investigation is warranted to elucidate the direct impact of periconceptional multivitamins on NTD prevention.
Abstract:
We studied the association between multivitamin use during the periconceptional period and the occurrence of neural tube defects using data from the Atlanta Birth Defects Case-Control Study. There were 347 babies with neural tube defects who were live born or stillborn to residents of metropolitan Atlanta from 1968 through 1980. The 2829 control-babies born without birth defects were randomly selected through birth certificates. Periconceptional multivitamin use was defined as reported use for each of the three months before conception through the first three months of pregnancy. Mothers who reported not using multivitamins any time during the six-month period were defined as nonusers. Fourteen percent of mothers reported periconceptional multivitamin use and 40% reported nonuse. Multivitamin users were different from nonusers in a number of demographic, health-related, and life-style characteristics. We found an overall apparent protective effect of periconceptional multivitamin use on the occurrence of neural tube defects, with a crude estimated relative risk of 0.40 (95% confidence interval, 0.25 to 0.63). At this time, it is not possible to determine whether this apparently lower risk is the direct result of multivitamin use or the result of other characteristics of women who use multivitamins.