High dose folic acid during pregnancy and the risk of autism; The birth order bias: A nested case-control study.

OBJECTIVE: To examine whether there is an association between the cumulative dose of folic acid (FA) purchased by mothers, and risk of autistic spectrum disorders (ASD) in their progeny. METHODS: We identified 2009 singletons who received an ASD diagnosis from a cohort of 480,526 children born in a large health organization in Israel from 2000 through 2013. ASD patients were individually matched to ASD-free children (n = 19,886). Median cumulative daily doses of supplemented FA during the 12-month period prior to the end of pregnancy (from dispensing records) were compared using conditional logistic regression models. RESULTS: Children with ASD were more likely to be first-born, and birth-order was significantly associated with FA use. In multivariable analysis, there were no statistically significant differences in the cumulative dose of FA between the groups. CONCLUSION: Birth order effects need to be accounted for in analyses aiming to decipher the associations between gestational FA use and developmental outcomes.

Parity and the use of folic acid supplementation during pregnancy.

OBJECTIVE: Folic acid (FA) supplementation has long been recommended before and during pregnancy to reduce the risk of neural tube defects. Factors influencing adherence to FA supplementation have been extensively evaluated, but little is known on the effect of parity. This study comes to examine the association between parity and maternal use of FA prior to and during pregnancy. METHODS: In this retrospective population-based study, we identified mothers (N=228 555) of all children (N=578 204) born between the years 2000 and 2016 among members of a large health provider in Israel. Data on FA supplementation purchases were obtained from centralised medical databases. RESULTS: The median (IQR) total dose of FA purchased 12 months prior to child birth among previously nulliparous women (120 mg, 48-240) was significantly (p<0.001) higher than the dose purchased by women with one (90 mg (39-202)) and two prior births (84 mg (36-182)). The dose was even lower in women for three or more prior births (75 mg (36-165)). Despite the overall increasing secular trend in FA purchases during the study period, the negative relationship with parity remained. CONCLUSIONS: Adherence to FA supplementation is negatively associated with parity. Women with increasing parity may be at higher risk for pregnancy complications associated with low FA levels. The results of this study may inform the design of interventions to specifically increase adherence to FA supplementations among multiparous women.

Prevalence and characteristics of malnutrition among community-dwelling older adults in Israel.

BACKGROUND & AIMS: Limited data are available on the characteristics of older adults (age ≥ 65) diagnosed with malnutrition in the community in Israel. This retrospective cohort study describes the prevalence and characteristics of malnutrition among a representative cohort of Israeli community-dwelling older adults. To better understand the characteristics of oral nutritional supplement (ONS) users with malnutrition, we also compared this group to non-ONS users with malnutrition. METHODS: Older adults enrolled in a large not-for-profit healthcare organization in Israel were defined as malnourished according to a diagnosis of malnutrition and/or body mass index (BMI) ≤ 20 kg/m2. Index date was defined by the earliest indication of malnutrition. ONS purchases in the year following index date were used to classify patients into ONS and non-ONS users. RESULTS: The malnutrition prevalence rate was 3.4%. ONS users comprised 19.9% (1881/9445) of the malnourished patients. The mean age of ONS users was higher than that of non-ONS users (80.5 vs. 75.4 years, P ≤ 0.001), and women were predominant in both groups (59.2% ONS users vs. 61.8% non-ONS users, P = 0.04). ONS users (vs. non-ONS users) were significantly (P < 0.05) more likely to have co-morbidities such as cardiovascular disease (49.5% vs. 35.1%), diabetes mellitus (26.5% vs. 20.9%), hypertension (72.2% vs. 57.4%), cancer (32.0% vs. 20.7%), and dementia (24.8% vs. 9.8%). Mean baseline BMI (up to a year before index date) was similar in ONS users (20.74 kg/m2) and non-ONS users (20.26 kg/m2). ONS users had higher health services utilization, including visits to primary care physicians and dietitians, and hospitalizations (P-values < 0.05). CONCLUSIONS: Malnutrition is prevalent among 3.4% of community-dwelling older Israeli adults. However, older adults are not screened and treated for malnutrition systematically. Improved guidance from healthcare professionals, including earlier nutrition screening and assessment, may lead to improved health outcomes and reduced healthcare services utilization.