Background:
Neural tube defects (NTDs) occur in approximately 1 per 1000 births in the general population. However, once a woman has had a pregnancy with an NTD, her risk for recurrence is 30-50 times higher. Studies have shown that daily preconception consumption of 4.0 mg of folic acid can reduce recurrence risk by 70%.
A Texas study found only 33% of women with a previous NTD-affected pregnancy reported regular folic acid supplementation. Use of folic acid was significantly higher for women who recalled receiving advice to use folic acid versus those who did not. Clearly, receiving information about the use of folic acid can improve the likelihood of supplementation.

Objectives:
Previous efforts to prevent recurrent NTDs in Texas were limited to areas with relatively high rates of NTDs. While these efforts proved effective, they were expensive and did not include the at-risk population in other parts of Texas. We will describe a newly developed initiative that provides targeted and timely information for women at risk for NTD recurrence living throughout Texas.

Methods:
Focus groups of parents of children with spina bifida will inform the development of a brochure on reducing NTD recurrence. Feedback will guide the content, language, and visual appeal of the brochure. Once the material has been developed, lists of cases of neural tube defects, including mother's most recent mailing address, will be generated from completed cases in the Texas Birth Defects Registry every month. Mailing labels will be created and the brochures will be sent.
Finally, trained telephone support will be provided to women who receive the brochure and phone for more information.

Results:
We will present 1) Background, design and rationale of this intervention and 2) Findings from the focus groups. Specific aspects of focus group feedback will be described, such as perceived threat, sensitivity, comprehension, appearance, perceived confidentiality, and message tailoring.

Conclusion and implications for practice:
This project will demonstrate that a statewide active birth defects surveillance system can employ evidence-based health promotion practices to identify, contact and educate this high-risk population about the need for folic acid supplementation before their next pregnancy.