Abstract 741 Health Services Research: Organization & Policy Platform, Monday, 5/3

Between 1995 and 1998 the British Department of Health conducted a national campaign to increase the folate intake of women of childbearing age. We examined the effectiveness of the campaign locally. A regional congenital malformation register was used to collect data relating to all neural tube defects (NTDs) reported in 1996 from 47 500 births plus terminations. Red cell folate was estimated in successive blood samples collected from 192 healthy women of child-bearing age (16-50 years) in 1996 (immunoassay, Abbott IMX, normal range 150-645 ng/ml) in the local hospital. An anonymous survey was carried out in the central antenatal clinic of successive mothers to determine whether they had used folic acid supplements in the first trimester (200 mothers questioned in 1996 and 1357 in 1998). 52 NTDs were reported in 1996, 38 to mothers of Indian/Pakistani ethnicity (only one consanginous couple). Indian/Pakistani women had significantly lower levels of red cell folate than other women (mean levels and range of 246±87 vs 286±160 ng/ml, p<0.02 using an independent samples t test). 32.5% of women surveyed had not taken any folic acid supplements in the first trimester in 1996, 28% in 1998. Neural tube defects were more frequent in the Indian/Pakistani group in West London, in whose women red cell folate levels were significantly lower. Initial work suggests that this deficiency is dietary rather than genetic in origin. Further, a significant proportion of women in this geographical region do not take folic acid supplements as recommended, despite the national campaign. Given that a range of congenital malformations other than NTDs may be reduced by using folic acid supplements, and that adult heart disease is also linked to folate intake, there is a clear role for paediatricians to monitor and contribute to this important public health problem.