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Immigrant women may be at higher risk of having a baby with a birth defect

April 17, 2009

Immigrant women are less likely to use folic acid supplements before pregnancy to prevent spina bifida, particularly those who recently immigrated to the country, according to a new study led by a St. Michael's Hospital physician in collaboration with Statistics Canada, Health Canada and the University of Toronto. The study is the first to provide national estimates of pre-pregnancy folic acid use in Canada.

"Our study's findings report that while about six in 10 Canadian-born mothers take folic-acid supplements in the three-month period before conception, mothers from non-western countries -- China, Northern African, Middle Eastern, Caribbean, Latin American or South Pacific countries -- are less likely to use the supplements," St. Michael's Hospital's Dr. Joel Ray said. "This information is important for policy makers and health practitioners as we aim to better educate new mothers and prevent neural tube defects in their babies."

Neural tube defects are birth defects of the spinal cord and brain, otherwise known as spina bifida and anencephaly. Research has shown the risk of neural tube defects can be reduced by nearly 50 per cent with folic acid supplements taken just before and soon after conception, or through consumption of food fortified with folic acid. However, an estimated six to 12 in every 10,000 fetuses in Canada still develop neural tube defects.

The study, an analysis of 6,349 new mothers aged 18 to 45 years, examined the relationship between folic acid supplement use in the three months before conception and the mother's maternal country of birth and years of residence in Canada.

Sixty one per cent of Canadian-born women in the study reported using folic acid supplements in the three month period before conception. However, these rates were much lower among women born in the Caribbean or Latin America (41%), Sub-Sahara Africa (44%), Northern Africa or the Middle East (31%), or South Asia (46%). What's more, only 39% of foreign-born women living in Canada less than four years reported using supplements compared to 64% of foreign-born women living in Canada at least 17 years.

"The disparity in pre-conceptual folic acid supplement use may be due to unplanned/unintended pregnancies or lack of awareness of the benefits of folic acid supplements," Ray said. "Immigrant women, especially those from non-Western countries, are least likely to have this information, which can otherwise be easily provided to these women through various communication mediums."

The study's authors suggest immigrant women be provided with a language-specific pamphlet on the benefits of folic acid, or even with free supplements.

St. Michael's Hospital