P0680 - High Prevalence of Neural Tube Defects in a Rural Hispanic Population: Call to Action

Background: Folic acid supplementation, typically as a prenatal vitamin in addition to a diet, has shown to prevent neural tube defects (NTDs). However, because of ethnic disparities in the United States (US), that are based on diet, biological and social factors, NTDs are more common in Hispanic populations. In this study, we reviewed our experience at a rural clinic with a substantial Hispanic population and determined the prevalence of NTDs.

Methods: Our Institution Review Board approved this study. We reviewed prenatal visits from January 2016 to December 2019 at a small, rural Wisconsin town with a substantial Hispanic population (31.2% vs. 6.5% overall in Wisconsin). Based on communications with all physicians and nurse practitioners who provide prenatal and pediatric care at this clinic, a retrospective search of the electronic health record and records obtained from the and prenatal coordinator were done. As a result, we identified prenatally diagnosed NTDs. Fisher’s exact test was used for categorical variables; a P-value ≤ 0.025 was considered statistically significant.

Results: During the study period, 329 unique patients underwent prenatal care at the clinic, of which 227 (69%) were Hispanic. NTDs were noted in 4 cases: (1) newborn survived with a lipomeningocele; (2) anencephaly observed with ultrasonography and the patient underwent medical termination of pregnancy; (3) anencephaly observed with ultrasonography and the mother delivered via Cesarean section and newborn was not viable at birth; and (4) newborn had visible anencephaly and expired a few hours after birth. Of the four cases, 3 (75%) were of Hispanic ethnicity. The prevalence of NTDs among the patients in this study was significantly higher than the expected US median of 6 per 10,000 live births (P< 0.005).

Conclusion: In this study of a clinic at which a majority of the prenatal patients were Hispanic, the prevalence of NTDs over a four year period was more than 10-fold higher than the overall US median. To help this minority population, we engaged the local medical and nursing leaders about the importance of folic acid supplementation for all women of childbearing age, undertook a local newspaper, television and internet campaign to raise public awareness. We then contacted the two largest supermarket in the area to encourage stocking of enriched foods, and began working with our state perinatal society (Wisconsin Association for Perinatal Care) which subsequently brought representatives of Medicaid and Women, Infants and Children (WIC) program to consider a government mandate for folic acid enrichment of masa and other foods that that are staples of the Hispanic diet.