(850) Direct dispensation of folic acid supplements is associated with significant reduction in neural tube defects

To evaluate the impact of a public health effort to directly dispense prenatal vitamins 

 to patients in a medically underserved community on the incidence of pregnancies complicated by neural tube defects (NTD) among those who established care in the first trimester. 


Study Design:
Beginning in 9/2019, a prenatal supplement containing 1000 µg of folic acid was provided to patients during routine prenatal appointments. This retrospective cohort study examined singleton pregnancies with established prenatal care in the first trimester before (1/2016-8/2019) and after (9/2019-12/2023) program implementation. Patients with an isolated NTD on ultrasound were identified from the electronic medical record, pregnancies complicated by genetic syndromes were excluded. Data regarding demographics, pregnancy outcomes, and NTD characteristics were examined. Analysis was performed using student t-test, chi square and Fisher’s Exact Test. Adjustment for demographic factors was conducted using logistic regression.  

Results:
Before direct dispensation, 36 out of 25,591 patients were diagnosed with NTD (1.4/1000) compared to 13 out of 26,336 patients post-dispensation (0.5/1000) (Figure). Anencephaly and spinal myelomeningocele were the most common NTD, rates 0.09% and 0.04% pre-dispensation and 0.02% and 0.03% post-dispensation respectively. Rate of NTD after direct dispensation was significantly lower (0.14% vs 0.05%, p value < .001) with an adjusted odds ratio of 0.35 (95%CI 0.17-0.66) indicating a 65% reduction in likelihood of NTD.  

Conclusion:
Direct dispensation of folate containing prenatal supplements in the first trimester was associated with reduction in the incidence of NTDs among patients delivering at a single safety net hospital. Direct dispensation of prenatal vitamins is a low-cost intervention that was associated with reduced incidence of NTD in this population, prompting further investigation of direct dispensation of folic acid as a method of reducing NTD.