Abstract
BackgroundAlthough adequate folic acid or multivitamins can prevent up to 70 % of neural tube defects, the majority of U.S. non-pregnant women of childbearing age do not use multivitamins every day. Factors influencing consistent multivitamin use are not fully explored. This study aims to investigate the association between pre-pregnancy body mass index (BMI) and multivitamin use before pregnancy using a large, nationally representative sample of women with recent live births.MethodsThe national 2009–2011 Pregnancy Risk Assessment Monitoring System data were analyzed. The sample included women with recent singleton live births (N = 104,211). The outcome of interest was multivitamin use which was categorized as no multivitamin use, 1–3 times/week, 4–6 times/week, and daily use. Maternal BMI was examined as underweight (<18.50 kg/m2), normal weight (18.50–24.99 kg/m2), overweight (25.00–29.99 kg/m2), and obese (≥30.00 kg/m2). Multinomial logistic regression was conducted, and adjusted odds ratios and 95 % confidence intervals were calculated.ResultsCompared to women with normal weight, overweight and obese women had significantly increased odds of not taking multivitamins after adjusting for confounding factors. Further, the lack of multivitamin use increased in magnitude with the level of BMI (ORoverweight = 1.2, 95 % CI = 1.1–1.3; ORobese = 1.4, 95 % CI = 1.2–1.5).ConclusionsObese and overweight women were less likely to follow the recommendation for preconception multivitamin use compared to normal weight women. All health care professionals must enhance preconception care with particular attention to overweight and obese women. Preconception counseling may be an opportunity to discuss healthy eating and benefits of daily multivitamin intake before pregnancy.
Highlights
Adequate folic acid or multivitamins can prevent up to 70 % of neural tube defects, the majority of U.S non-pregnant women of childbearing age do not use multivitamins every day
Underweight and obese women were 1.6 times as likely to report no multivitamin use compared to women of normal weight (COR = 1.6, 95 % confidence intervals (CI) = 1.4–1.8; crude odds ratio (COR) = 1.6, 95 % CI = 1.5–1.7, respectively)
Overweight women had 1.3 times the odds of reporting no intake compared to women with normal body mass index (BMI) (COR = 1.3, 95 % CI = 1.2–1.4)
Summary
Adequate folic acid or multivitamins can prevent up to 70 % of neural tube defects, the majority of U.S non-pregnant women of childbearing age do not use multivitamins every day. One hospital-based case–control study reported the use of folic acid (0.4 mg daily for three months before and after conception, and continuing for at least one month) was associated with decreased neural tube defects (OR = 0.32, 95 % CI = 0.17–0.58), but the protective effects of folic acid supplementation was attenuated for overweight or obese women [8]. A cohort study that followed women during the last trimester to 24 months after delivery reported a lower mental development index among children exposed to prenatal iron deficiency anemia at 12, 18, and 24 months of age; supplementation with sufficient iron was found to be protective [10]. Prenatal vitamin intake during pregnancy has been shown to significantly reduce the risk of birth defects, low birth weight, small for gestational age, and spontaneous preterm birth [11,12,13,14]
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