Objective To investigate the association between maternal periconceptional folic acid supplementation and the risk for abdominal wall defects (including gastroschisis and omphalocele), and to evaluate the preventive effect of the major public health project "folic acid supplementation to prevent neural tube defects" on congenital abdominal wall defects. Methods The study was based on data collected during 2013 and 2018 from Prenatal Health Care System and Birth Defects Surveillance System of Tongzhou District, Beijing, China. A total of 63 715 singleton birth records were included in the study. Inverse probability of weights, a method of propensity score weighting, was used to control the differences in groups with different patterns of folic acid supplementation use. Poisson loglinear model was used to estimate the effect of periconceptional folic acid supplementation on the risk for abdominal wall defects. Results The overall prevalence of gastroschisis and omphalocele was 3.5 and 2.8 per 10 000 births, respectively. Compared to fetuses whose mothers did not use folic acid supplements during periconceptional period, the overall risk for abdominal wall defects among fetuses whose mothers were folic acid supplementation users, low-frequency users or high-frequency users decreased by 82%, 88% and 74%, respectively. For overall isolated cases, fetuses whose mothers used folic acid supplements, used at a low or high frequency, the adjusted risk ratios (aRRs) were 0.15 (95% confidence interval [CI]:0.09-0.24), 0.10 (95% CI:0.04-0.20) and 0.25 (95% CI:0.14-0.41), respectively, compared to the fetuses whose mothers were nonusers. However, differences of risk for abdominal wall defects were not statistically significant between fetuses whose mothers used folic acid only (FAO) and multiple nutrients containing folic acid (MFA), either for the total abdominal wall defects (aRR=0.81, 95% CI:0.47-1.39) or isolated abdominal wall defects (aRR=0.56, 95% CI:0.28-1.08). Conclusion Maternal use of folic acid supplementation during the periconceptional period could reduce the risk for abdominal wall defects, and the effects of MFA were similar to FAO. The implementation of the major public health project "Supplementing folic acid to prevent neural tube defects" reduced the risk of congenital abdominal wall defects in China.
Key words
folic acid /
abdominal wall defects /
gastroschisis /
omphalocele /
retrospective cohort
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