Health Professionals:

Delivering the Message

Pregnancy Risk Assessment Monitoring System

The Pregnancy Risk Assessment Monitoring System (PRAMS), based on a cooperative agreement between the Centers for Disease Control and Prevention (CDC) and the Florida Department of Health (DOH), establishes and maintains state-specific, population-based surveillance of selected maternal behaviors that occur during pregnancy and early infancy.

Since 2000, new mothers have been surveyed concerning their use of multivitamins before pregnancy. The following table compares multivitamin use over time (FDOH PRAMS, 2017 ).

















Note: percentages reflect those who indicated "at least 1-3 times per week” or “at least once per week.”

PRAMS surveillance data have been fairly consistent over a 10-year period and have reported that about 40% to 45% of new mothers took a multivitamin prior to pregnancy.

Behavioral Risk Factor Surveillance System

The Behavioral Risk Factor Surveillance System (BRFSS) is a state-based telephone surveillance system designed to collect data on individual risk behaviors and preventive health practices related to the leading causes of morbidity and mortality in the U.S. The following table compares the most recently available data (FDOH, 2005; FDOH, 2010).

Currently take a multivitamin
2000 2001 2002 2003 2007
49% 50% 46% 47% 56%

Note: data are for women age 18-44 years.

The most recent data indicate that over half of women surveyed (age 18-44 years) take a multivitamin. Healthcare providers need to continue to promote folic acid to their female patients of childbearing age.

Folic Acid Knowledge and At Risk Groups

According to national survey data ( March of Dimes, 2008) and published research studies (de Jong-van den Berg et al., 2005; Cleves et al. 2004; Rosenberg et al., 2003; Bixenstine et al., 2015, Khodr et al., 2014), certain women may be less likely to take folic acid every day, including:

  • Younger (25 years of age or less)
  • Non-Hispanic or  non-white  (other races)
  • Not married
  • Lower education level
  • Lower household income
  • From the southern U.S.
  • Having a previous live birth/more children
  • Having an unintended pregnancy
  • Women participating in the Women, Infants, and Children (WIC) program
  • Suffering stressful events pre-pregnancy
  • Smoking during pregnancy

Practitioners who work with women who have one or more of these characteristics should especially encourage folic acid intake for their patients.

Hispanic Women

Data in Florida and other states indicate that some Hispanic women may be at increased risk for having a baby with a neural tube defect. In Florida, data from the Florida Birth Defects Registry for 1998-2007 indicate that infants of mothers of Puerto Rican ethnicity experienced the highest rates of anencephaly and spina bifida among Hispanic subgroups (5.40 per 10,000 live births) followed by those of Mexican ethnicity (4.65 per 10,000 live births). Prevalence rates for spina bifida and anencephaly among infants born to women of Puerto Rican ethnicity were significantly higher than for non-Hispanic whites and non-Hispanic blacks, while infants born to women of Cuban ethnicity experienced lower prevalence rates than non-Hispanic whites (FDOH, 2017 ).  

Practitioners should be aware of risk differences among Hispanic subgroups and that these women may need special counseling concerning the importance of folic acid intake or other factors that might decrease their risk for having a baby with an NTD.

Health professional

Did you know? Eighty nine percent of women who do not take vitamins indicated that if their health provider counseled them about the benefits they would probably take it.

Although advances in fetal surgery for spina bifida are encouraging and provide hope for affected babies and their families, primary prevention should be underscored and can help many such families avoid the heartache of experiencing an NTD.

Health professionals