(P37-36-26) Prior Pregnancies Deplete Maternal Folate Status and Increase Risks of Neural Tube Defects in Addis Ababa, Ethiopia

Objectives: The aim of this study was to identify the role of dietary and demographic factors in determining maternal folate status and to interpret these findings in the context of NTD prevention, to inform effective and equitable interventions. The specific hypothesis was to test whether gravidity/ parity and gestational age affect maternal folate status.

Methods: We conducted a cross-sectional study among pregnant women (n = 404) attending their first antenatal care visit at three public health centers in Addis Ababa, Ethiopia. Serum folate was measured using electrochemiluminescence immunoassay, with deficiency defined as < 10 nmol/L. Sociodemographic, dietary, and clinical data were collected by questionnaire. We examined factors associated with serum folate concentrations using linear regression models.

Results: Mean serum folate was 10·0 nmol/L (SD 4·0), with 54% prevalence of deficiency. Supplement use was rare ( < 3%). After adjustment for wealth, residency, dietary intake, BMI, inflammation and trimester, serum folate was lower among women with two (β = −1·0 nmol/L; p = 0·04), three (β = −2·7 nmol/L; p < 0·001), four (β = −4·9 nmol/L; p < 0·001), and five (β = −6·0 nmol/L; p < 0·001) prior pregnancies compared with primigravidae. Serum folate was higher in the second than first trimester (β = 1·70 nmol/L; p = 0·003).

Conclusions: Higher gravidity is strongly associated with lower folate status, consistent with maternal depletion. Multiparous women may be at increased risk of NTD-affected pregnancies. Interventions to improve folate status before conception, including supplementation, food fortification, and strategies to lengthen interpregnancy intervals, should be prioritized in Ethiopia.

Funding Sources: Gates Foundation ‘GeoNutrition’ [INV-009129]