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Increasing Folic Acid Awareness Increasing Folic Acid Awareness and Knowledge of Future Health and Knowledge of Future Health
Care Providers to Reduce the Care Providers to Reduce the Incidence of Neural Tube Birth Incidence of Neural Tube Birth
DefectsDefects
Diane Zipley, State Director of Program Services,
March of Dimes Arizona Chapter August 26, 2007
Folic Acid Folic Acid AwarenessAwareness
Research now shows that adequate intake of folic acid
before conception can prevent the incidence of neural tube
birth defects by 70%1
However, less than 50% of women are being informed about
the importance of folic acid by their health care provider2
To address this knowledge gap, the March of Dimes has developed various materials to educate health care professionals about
folic acid.
March of Dimes March of Dimes “Folic Acid and the “Folic Acid and the
Prevention of Neural Tube Prevention of Neural Tube Defects” Defects” CD-ROMCD-ROM
• Created by Jordan Perlow, MD, Folic Acid Education Campaign Chairman for the Arizona Chapter of the March of Dimes and Associate Director, Maternal-
Fetal Medicine for Phoenix Perinatal Associates
• To examine the effectiveness of incorporating CD-ROM
technology in the curriculum of future health care providers, a study was conducted
It is estimated that throughout the world 500,000 infants are born every year with a neural
tube defect (NTD)3
Approximately 3,000 of these
births occur in the United States3
Differences in NTD Differences in NTD
rates based on rates based on Race/Ethnicity?? Race/Ethnicity??
Relative Risk for Spina Bifida
By Race/Ethnicity, U.S., 1983-1990
*Based on 16 state-based birth defects surveillance systemsSource: CDC, Teratology, July/August 1997
Prepared by March of Dimes Perinatal Data Center, 1999
RACE/ETHNICITY Adjusted Relative Risk (95% CI)
White 1.00
Black 0.80 (0.72-0.88)
Hispanic 1.41 (1.26-1.58)
Asian/ Pacific Islander
0.51 (0.38-0.70)
Native American 1.13 (0.74-1.74)
NTDs AmongNTDs Among Hispanic Infants Hispanic Infants
• Hispanic infants, particularly US-born Mexicans are at greatest risk
for NTDs• In an analysis of 6 selected states,
Hispanic infants had a significantly higher rate of NTDs than non-
Hispanic white infants• Not all birth defects surveillance programs collect data on
Hispanic ethnicity
Source: National Center for Health Statistics, period linked birth/infant death filePrepared by March of Dimes Perinatal Data Center, 2001
Rate per 100,000 live births
Infant Deaths due to NTDs by Race/Ethnicity, United States, 1995-1998
8.5
10.5
15.9
17.6
11
3.9
11.7
0
2
4
6
8
10
12
14
16
18
20
Black non-
Hispanic
White non-
Hispanic
Hispanic Mexican Puerto
Rican
Cuban Central/ Southern American
Rate per 100,000 live births
Participants in the study were local, full-time, first- year PA students enrolled in a Women’s Health course Total N= 73
The purpose of the course was to introduce PA students to gynecology and obstetrics with a primary care focus
Two of the course objectives were related to folic acid and birth defects: (1) assessment and management of perinatal women, and (2) identification of common fetal abnormalities
MethodologyMethodology
PROCEDUREPROCEDURE• Single-group, pretest/posttest survey design was
used to evaluate the effectiveness of using CD-ROM technology to increase knowledge of folic
acid
• Format of the Folic Acid CD-ROM: Voice-over narration of a 45-minute PowerPoint
presentation that includes graphs, photos, and text
• Content: Includes the etiology of NTDs, clinical research on folic acid, the need for preventive education, and current recommendations for
folic acid supplementation
Pre/Post Pre/Post Test InstrumentTest Instrument
18 multiple-choice questions, with each question listing 4 possible answers
Questions factually based and derived from a validated survey provided by the March of Dimes and additional information contained on the Folic Acid CD-ROM
Posttest consisted of the same 18 questions with the order changed to reduce recall from the pretest.
Posttest included 4 evaluation questions using
a 5-point Likert scale ranging from strongly agree to strongly disagree
CONCLUSIONSCONCLUSIONS
Generally, the definitive improvement in posttest over pretest scores shows the effectiveness of the Folic Acid CD-ROM for increasing knowledge and awareness among students
In Addition…In Addition…Evaluation responses from these students
strongly suggested that the Folic Acid CD-ROM:
*provided information in a clear and effective manner
*adequately covered and delivered the
information
*encouraged students to commit to recommending folic
acid to their future patients
THE FUTURETHE FUTURE
• Educating women to supplement their food intake with synthetic folic acid will
reduce the likelihood of infants with NTDs 1,2,,4
• Given the student responses in this particular study, it is likely that this group of future PAs will promote folic acid supplementation with
their female patients, thereby potentially decreasing the number of
NTD-affected pregnancies
This represents a total 22% decrease in neural tube defects for Arizona over the course of the 7 year March of Dimes
Folic Acid Education Campaign.
REFERENCESREFERENCES1. U.S. Centers for Disease Control and Prevention. Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects. MMWR Morb Mortal Wkly Rep 1992;41(no. RR-14):1–7.
2. March of Dimes. Folic Acid and the Prevention of Birth Defects: A National Survey of Pre pregnancy Awareness and Behavior Among Women of Childbearing Age. 1995–2000. Conducted by the Gallup Organization. Publication no. 31-1404–00. White Plains, NY: March of Dimes, 2000.
3. U.S. Centers for Disease Control and Prevention. Knowledge about folic acid and use of multivitamins containing folic acid among reproductive aged women—Georgia 1995. MMWR Morb Mortal Wkly Rep 1996;45:793–795.
4. U.S. Centers for Disease Control and Prevention. Knowledge and use of folic acid by women
of childbearing age—United States, 1995 and 1998. MMWR Morb Mortal Wkly Rep 1999; 48: 325–327.