Prior Pregnancies Deplete Maternal Folate Status and Increase Risks of Neural Tube Defects in Addis Ababa, Ethiopia

Area of Science:

• Obstetrics and Gynecology
• Public Health Nutrition
• Maternal-Fetal Medicine

Background:

• Folate is crucial for fetal neural development; deficiency elevates neural tube defect (NTD) risk.
• Ethiopia faces high NTD rates, with limited understanding of maternal folate status determinants.
• This study investigates factors influencing folate levels in pregnant Ethiopian women.

Purpose of the Study:

• Identify dietary and demographic factors affecting maternal folate status.
• Interpret findings for effective NTD prevention strategies in Ethiopia.
• Assess the relationship between gravidity and folate status.

Main Methods:

• Cross-sectional study of 404 pregnant women in Addis Ababa, Ethiopia.
• Serum folate measured via electrochemiluminescence immunoassay; NTD risk defined by serum folate <24.3 nmol/L.
• Linear regression models analyzed associations between sociodemographic, dietary, clinical data, and serum folate.

Main Results:

• 61% of women had folate levels below protective thresholds for NTDs.
• Supplement use was infrequent (<3%).
• Increased gravidity (2-5+ prior pregnancies) was significantly associated with lower serum folate, indicating maternal depletion. Higher folate levels observed in the second trimester compared to the first.

Conclusions:

• Higher gravidity strongly correlates with diminished folate status, suggesting maternal depletion.
• Multiparous women may face a heightened risk of NTD-affected pregnancies.
• Prioritizing interventions like preconception supplementation, food fortification, and extended interpregnancy intervals is essential in Ethiopia.