Risk Factors for Folic Acid-resistant Spina Bifida

The prevalence of spina bifida has decreased since folic acid fortification, but an estimated 800 cases are born each year in the US to women who ingested at least the recommended daily amount (400 ug) of folic acid. Because spina bifida is a serious condition that has substantial impacts on families and society, further strategies for prevention are warranted. Using data collected in our large US case-control study, the Pregnancy Health Interview Study (Birth Defects Study), from years 1988 to the present, preventable risk factors for folic acid-resistant spina bifida will be identified.

The PHIS is a unique resource with detailed data on mothers of spina bifida cases and controls for vitamin supplementation and dietary intakes. These data allow mothers to be classified according to sufficient or insufficient intake of folic acid during the periconceptional period. Further, detailed data are available on many other potential risk factors. The mothers of as many as 463 folic acid resistant spina bifida cases will be compared to two different control groups. One control group would comprise mothers of spina bifida offspring who ingested insufficient amounts of folic acid, and the other would comprise mothers of non-malformed offspring who ingested sufficient amounts of folic acid. Comparisons will be made for factors that have previously been suggested as risk factors for neural tube defects or spina bifida, including obesity, diabetes, upper respiratory illness, fever, heat source exposure, infertility, assisted reproductive technology, smoking, alcohol, caffeine, and medication exposures. In addition to hypothesis testing, all risk factor data, including all medications, illnesses, and nutrients, will be screened to identify new preventable risk factors.

Investigators and Study Staff

Martha M. Werler, Sc.D., Principal Investigator
Allen A. Mitchell, M.D., Co-Investigator
Mahsa Yazdy, M.P.H., Co-Investigator
Samantha Parker, Data Analyst
Corey Benedum, Data Analyst

Study Details

Source of Funding:

Centers for Disease Control and Prevention

Study Period:

2010 to 2014

Presentations

  • Werler MM, Parker SE, Yazdy MM, Mitchell AA. Epidemiologic characteristics of spina bifida cases: before and after folic acid fortification. Presented at the National Birth Defects Prevention Network Annual Meeting, Atlanta, Georgia, February 2013.
  • Parker SE, Yazdy MM, Tinker SC, Mitchell AA, Werler MM. The impact of folic acid intake on the association of diabetes and obesity with the risk of spina bifida. Presented at the annual meeting of the Society for Pediatric and Perinatal Epidemiology Research, Minneapolis, Minnesota, June 2012.
  • Yazdy MM, Tinker SC, Mitchell AA, Demmer LA, Werler MM. Maternal tea consumption during early pregnancy and the risk of spina bifida. Presented at the 7th International Conference on Neural Tube Defects, Austin, Texas, November 8, 2011.
  • Yazdy MM, Tinker SC, Mitchell AA, Werler MM. Periconceptional use of opioids and the risk of neural tube defects.  Presented at the 7th International Conference on Neural Tube Defects, Austin, Texas, November 8, 2011.
  • Yazdy MM, Tinker SC, Mitchell AA, Demmer LA, Werler MM. Maternal tea consumption during early pregnancy and the risk of spina bifida. Presented at the annual meeting of the Society for Pediatric and Perinatal Epidemiology Research, Montreal, Canada, June 2011.

Publications

  • Parker SE, Yazdy MM, Tinker SC, Mitchell AA, Werler MM. The impact of folic acid intake on the association between diabetes, obesity, and spina bifida. American Journal of Obstetrics and Gynecology (under review).
  • Yazdy MM, Tinker SC, Mitchell AA, Demmer LA, Werler MM. Maternal tea consumption during early pregnancy and the risk of spina bifida. Birth Defects Research Part A Clinical and Molecular Teratology 2012;94(10):756–61.

Contact Information

Dawn Jacobs, R.N., M.P.H., Project Coordinator
(617) 734-6006

Participant Information:

(866) 896-1097 (toll-free bilingual English/Spanish line)