A multivitamin supplementation and education intervention as an effective means of increasing multivitamin use among postpartum women of Mexican origin.

Postpartum Hispanic women in the USA are at elevated risk for neural tube defects in subsequent pregnancies from the combined effects of ethnicity, folate depletion from the prior pregnancy and lactation, and high parity rates with short inter-birth intervals. This study evaluated an education programme and distribution of a 3-month starter package of multivitamins among Hispanic women attending nutrition clinics for low-income women in El Paso, Texas. At 1-6 weeks postpartum, 329 subjects were selected to receive education only, multivitamins only, education and multivitamins, or no intervention. Multivariable regression obtained odds ratios (OR) and 95% confidence intervals [CI] to measure the association between intervention status and self-reported multivitamin use at least four times per week at 6 and 12 months postpartum, while controlling for potential confounding variables. Multivitamin distribution was related to consumption at both 6 months (OR = 3.5 [95% CI 1.1, 11.2]) and 12 months (OR = 6.5 [95% CI 1.5, 28.3]). Multivitamins plus education was most effective in increasing multivitamin use at both periods: 6 months (OR = 4.0 [95% CI 1.53, 11.7]) and 12 months (OR = 6.4 [95% CI 1.7, 24.2]). At enrolment, 66% of women regularly took vitamins, and approximately 35% took them at both 6 and 12 months postpartum. The education intervention alone was not associated with multivitamin use at either 6 months (OR = 0.79 [95% CI 0.3, 2.4]) or 12 months (OR = 3.1 [95% CI 0.8, 12.1]). Multivitamin use declines precipitously during postpartum at the time Hispanic women may be susceptible to a subsequent pregnancy. This study provides evidence that multivitamin starter packs sustain multivitamin usage up to 1 year postpartum for a specific high-risk group, but the effect of educational intervention alone should be further studied.

Predictors of early postpartum vitamin use among women of Mexican origin: implications for healthcare provider recommendations.

OBJECTIVE: High parity and short birth intervals among Hispanic women may deplete their folic-acid levels and place them at risk for neural tube defects (NTDs). The purposes of this study were to evaluate factors associated with multivitamin supplementation rates during the early (one to six weeks) postpartum period among Mexican-origin women and present their implications in preventing NTDs in subsequent pregnancies. DESIGN: A cross-sectional study was conducted among Hispanic mothers attending women, infant, and children (WIC) clinics in El Paso, Texas. Information was ascertained via interview on regular multivitamin use, and independent variables including sociodemographic characteristics, multivitamin knowledge, obstetric and health history, and birth control and infant feeding methods. RESULTS: Only 66% of 329 mothers took postpartum multivitamins. Multivitamin consumption declined by 29% for each postpartum week (P=.0003). Adjusted odds ratios indicated positive associations between multivitamin supplementation and prenatal care exclusively in the United States (P=.007), breastfeeding (P=.071), preconceptional (P=.005) and prenatal multivitamin use (P=.0002), and multivitamin recommendation from a healthcare provider (P < or = .0001). The majority of 247 women with multivitamin counsel (59%) were told to finish prenatal vitamins or to continue use while breastfeeding. Smokers were less likely to take multivitamins than nonsmokers (P=.007). CONCLUSIONS: A provider recommendation highly motivates early postpartum women to consume multivitamins. Since most women have more than one child, this period likely represents an interpregnancy interval and is an opportune time to educate and encourage women to take multivitamins. This simple and inexpensive measure could prevent birth defects in future pregnancies.