Maternal preconception intake of folic acid in Malta

Abstract

Background: Neural tube defects (NTDs) are serious birth defects arising from abnormalities in neural tube development during early embryogenesis. Research shows that taking folic acid (FA) prior to and throughout the first 12 weeks of pregnancy will significantly decrease the occurrence of NTDs. The prevalence of NTDs in Malta is 10.0/10,000 births, yet this rate can be brought down to 5.0-6.0/10,000 births with preconception FA. This study aims to investigate the maternal intake of preconception FA in Malta. Methods: The National Obstetric Information System (NOIS) collects detailed demographic, pregnancy, delivery and infant outcome data on all births in Malta. One of the variables recorded at the first antenatal visit is whether the mother took FA prior to pregnancy. NOIS data for 2015 was obtained, Excel and SPSS were used for analysis. Results: 4385 women delivered a baby in 2015, of these 1125 (25.7%) reported taking FA before pregnancy. Both univariate and multivariate logistic regression showed that maternal age, parity, education, nationality, locality of residence, marital status, planned pregnancy and use of artificial reproductive technology were all significantly associated with taking preconception FA (p<0.001). Conclusion: Although preconception folic acid supplementation has been advised since the early 1990s, in Malta only a quarter of mothers are taking this before pregnancy. This low compliance is also documented in other countries. Several maternal factors have been found to be associated with better intake of preconception FA. Effective methods of increasing maternal preconception intake of FA are necessary to decrease the rate of NTDs in Malta.