Background:
Regular (³4 times/week) consumption of multivitamins containing folic acid during the periconception period has been shown to reduce the occurrence of neural tube defects (NTD's). Studies have shown that women of childbearing age, nation wide and in Missouri, do not get the recommended daily dose (400 mg) of periconceptional folic acid. Identification of the risk factors associated with intermittent (£4 times/week) periconceptional multivitamin use will contribute to the design of public health interventions aimed at increasing multivitamin intake during early pregnancy.

Objectives:
What are the risk factors associated with intermittent periconceptional multivitamin use among Missouri women?


Methods:
The Missouri Pregnancy Related Assessment and Monitoring System (MoPRA) was a pilot project modeled after the Centers for Disease Control and Prevention's Pregnancy Risk Assessment and Monitoring System (PRAMS). The data were weighted for the distributions of birth weight, place of residence, and other sociodemographic variables, and non-response. Multivariable analysis was performed on factors associated with lack of regular periconceptional multivitamin consumption.

Results:
Of the 2995 women surveyed during 2005-2006, 1789 completed the survey (weighted response rate: 61%). Overall, 65% of women in the study reported not taking a multivitamin regularly during the month before they got pregnant. In the multivariate analysis, women with an unintended pregnancy (aOR = 0.46, 95% CI: 0.32-0.64, vs. those with an intended pregnancy), £ 20 years of age (aOR = 0.39, 95% CI: 0.20-0.76, vs. ³20 years of age), family income £ $35,000 per year (aOR= 0.54, 95% CI: 0.38-0.73, vs. family income ³35,000 per year) and who smoked during the three months before pregnancy (aOR = 0.49, 95% CI: 0.33-0.70, vs. women who did not smoke during the three months before pregnancy) were significantly less likely to consume multivitamins regularly during the periconceptional period.

Conclusion and implications for practice:
Adolescent age, low socioeconomic status, unintended pregnancy, and smoking were associated with lack of regular intake of multivitamins during the periconceptional period. Public health strategies to promote pre / peri-conceptional multivitamin intake among Missouri women of childbearing age should focus on certain subgroups of the population that are less likely to get the recommended daily dose of folic acid.