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BACKGROUND Daily consumption of 400 mcg of folic acid prior to conception and throughout the first trimester of pregnancy reduces the risk of neural tube defects (NTDs) by 50%-80%. A daily multivitamin with folic acid can ensure that females receive the recommended amount of folic acid during childbearing years. OBJECTIVE The purpose of this study was to determine if vitamin consumption is influenced by providing a free bottle of multivitamins to non-pregnant women of childbearing age during a face-to-face interaction with a health care provider in health departments. METHODS An eight-question survey was given to a sample of women who had received a free bottle of multivitamins. Vitamin consumption behavior prior to the intervention was compared to current usage at the time of the survey. RESULTS Twenty-five percent of all survey respondents reported taking a daily multivitamin or folic acid tablet before the intervention. Fifty-three percent reported taking a daily multivitamin 8-10 months later, a greater than two-fold increase (PR=2.1). Latino women reported the greatest increase in daily multivitamin intake, from 21% to 70% (PR=3.3). LIMITATIONS The results may be difficult to extrapolate to the general population as the survey population differs from the general population. Prior vitamin use was determined by patient recall. The intervention occurred simultaneously with a multifaceted, public folic acid campaign. CONCLUSIONS Eight to ten months after receiving a free three-month supply of multivitamins during a face-to-face interaction with a health care provider, the number of participants reporting daily use increased significantly.

In 1916, there were 774 pregnancy-related deaths per 100,000live births in North Carolina; by 1999 this ratio had declinedto 12.3 deaths/100,000 live births (See Figure 1). Over thesame time span, the annual number of pregnancy-relateddeaths decreased from 593 to 14. The decline in pregnancy-related deaths (based on death certificate records) is attrib-uted to improved obstetrical care and particularly the use ofeffective antibiotics, which dramatically reduced deaths dueto infection.

Neural tube defects (NTDs) are severe, often lethal, congenital malformations of the spine and central nervous system, the most common of which are spina bifida, anencephaly, and encephalocele. NTDs are among the most common and preventable birth defects in the United States. Still, every year in North Carolina, about 1 in every 500-700 pregnancies is affected by an NTD. 1 For reasons we don’t yet understand, the rate of NTDs is higher in the Southeastern states, including North Carolina, than in the rest of the country. Some specific causes (single gene or chromosomal disorders, maternal diabetes, valproic acid use, and hyperthermia) have been identified, but in most cases no specific etiology is identifiable. 2 It is well documented that women who take a daily dose of the B-vitamin folic acid before conceiving can reduce the risk of NTDs by up to 70%. 3-6 Because the neural tube closes by the fourth week after conception, it is important that folic