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Abstract

Background: Neural tube defects (NTDs) are among the most common and severe congenital anomalies, with spina bifida and anencephaly being the most prevalent. Despite global advancements in prevention through periconceptional folic acid supplementation, NTDs continue to occur, particularly in low-resource settings. In developing countries, limited health education, suboptimal prenatal care, and overlooked maternal comorbidities may contribute to the continued burden of NTDs, even among supplement users.
Objective: To determine the frequency of neural tube defects and associated anomalies in women who reported periconceptional folic acid supplementation and to assess the association of NTDs with maternal and demographic variables.
Methods: A cross-sectional study was conducted at the Department of Obstetrics and Gynecology, Hayatabad Medical Complex, Peshawar, over six months. A total of 385 women aged 15–49 years who reported using folic acid at least one month before conception through two months after were enrolled using non-probability consecutive sampling. Data on demographics, health status, and ultrasound-confirmed NTDs were collected and analyzed using SPSS version 22. Mean and standard deviation were calculated for continuous variables, while frequencies and percentages were reported for categorical variables. Associations were tested using Chi-square and Fisher’s Exact tests with a significance level set at p < 0.05.
Results: The frequency of NTDs was 2.3% (9 out of 385). No statistically significant association was observed between NTDs and maternal age (p=0.081), BMI (p=0.302), gravidity (p=0.350), parity, education level (p=1.000), socioeconomic status (p=0.282), dietary pattern (p=1.000), or cousin marriage (p=1.000). A statistically significant association was found between maternal comorbidities—such as anemia, hypertension, and diabetes—and NTDs (p=0.031).
Conclusion: Folic acid supplementation remains essential in reducing the incidence of NTDs; however, it is not universally protective. Maternal comorbid conditions may significantly increase the risk of NTDs. Preventive efforts must include comprehensive maternal health screening and management, alongside continued promotion of folic acid use.