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. 2015 Jun;103(6):517-26.
doi: 10.1002/bdra.23378. Epub 2015 Apr 17.

U.S. women of childbearing age who are at possible increased risk of a neural tube defect-affected pregnancy due to suboptimal red blood cell folate concentrations, National Health and Nutrition Examination Survey 2007 to 2012

Sarah C Tinker  1 , Heather C Hamner  2 , Yan Ping Qi  1 , Krista S Crider  1
Affiliations

U.S. women of childbearing age who are at possible increased risk of a neural tube defect-affected pregnancy due to suboptimal red blood cell folate concentrations, National Health and Nutrition Examination Survey 2007 to 2012

Sarah C Tinker et al. Birth Defects Res A Clin Mol Teratol. 2015 Jun.

Abstract

Background: Red blood cell (RBC) folate concentrations are a potential biomarker of folate-sensitive neural tube defect (NTD) risk in the population. The purpose of this analysis was to describe women in the U.S. population with RBC folate concentrations below those associated with optimal NTD prevention.

Methods: We used data from the 2007 to 2012 National Health and Nutrition Examination Survey (NHANES) to assess the RBC folate status of U.S. women of childbearing age relative to risk categories for NTD risk based on RBC folate concentrations. We defined suboptimal RBC folate concentrations as those associated with a prevalence of ≥9 NTDs per 10,000 live births.

Results: Among nonpregnant women age 12 to 49 years, 22.8% (95% Confidence Interval: 21.1, 24.6) had suboptimal RBC folate concentrations. Women had greater odds of having a suboptimal RBC folate concentration if they did not use dietary supplements containing folic acid; had mandatorily fortified enriched cereal grain products as their only source of folic acid; were non-Hispanic black or Hispanic; or were current smokers.

Conclusion: Based on RBC folate concentrations, we would predict that the majority of U.S. women of reproductive age are not at increased risk for folate sensitive NTDs in the presence of mandatory folic acid fortification. Prevention policies and programs can be aimed at population subgroups identified as having higher predicted risk for folate-sensitive NTDs based on RBC folate concentrations.

Keywords: NHANES; folic acid; fortification; neural tube defects; optimal RBC folate concentration.

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Conflict of interest statement

The authors declare no conflicts of interest. No financial disclosures were reported by the authors of this study.

Figures

Figure 1
Figure 1
Cumulative distribution of red blood cell (RBC) folate concentrations among nonpregnant women aged 12 to 49 years, by supplement use and folic acid dose, NHANES 2007 to 2012. NTDs, neural tube defects.
Figure 2
Figure 2
Cumulative distribution of red blood cell (RBC) folate concentrations among nonpregnant women aged 12 to 49 years, by folic acid source(s), NHANES 2007 to 2010. NTDs, neural tube defects; ECGP, enriched cereal grain products; RTE, ready-to-eat cereals; SUPP, dietary supplements containing folic acid.
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References

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