Prior Pregnancies Deplete Maternal Folate Status and Increase Risks of Neural Tube Defects in Addis Ababa, Ethiopia.

Overview

1. Center for Food Science, Addis Ababa University, Addis Ababa, Ethiopia
2. Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
3. National Clinical Chemistry Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
4. Nutritional Science Department, Oklahoma State University, Stillwater, OK, United States

Abstract

Background: Folate is essential for fetal neural development, and maternal deficiency during early pregnancy increases risk of neural tube defects (NTDs). Ethiopia has among the highest NTD rates globally, yet data on folate status determinants among pregnant women are scarce.

Objectives: This study aimed to identify the role of dietary and demographic factors in determining maternal folate status and to interpret these findings in the context of NTD prevention.

Methods: We conducted a cross-sectional study among pregnant women (n = 404) attending their first antenatal care visit at 3 public health centers in Addis Ababa, Ethiopia. Serum folate was measured using electrochemiluminescence immunoassay. Increased risk of NTD was defined by serum folate <24.3 nmol/L. Sociodemographic, dietary, and clinical data were collected by questionnaire. We examined factors associated with serum folate concentrations using linear regression models.

Results: A total of 61% of women had concentrations below levels estimated to be protective against NTDs. Supplement use was rare (<3%). After adjustment for wealth, residency, dietary intake, body mass index, inflammation and trimester, serum folate was lower among women with 2 (β = –2.2 nmol/L; P = 0.04), 3 (β = –6.2 nmol/L; P < 0.001), 4 (β = –11.2 nmol/L; P < 0.001), and 5 (β = –13.7 nmol/L; P < 0.001) prior pregnancies compared with primigravidae. Serum folate was higher in the second than the first trimester (β = 3.90 nmol/L; P = 0.003).

Conclusions: Higher gravidity is strongly associated with lower folate status, consistent with maternal depletion. Multiparous women may be at increased risk of NTD-affected pregnancies. Interventions to improve folate status before conception, including supplementation, food fortification, and strategies to lengthen interpregnancy intervals, should be prioritized in Ethiopia.

Reproduced under the paper's license (CC BY), from the paper cited above.

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Data availability

The data generated and analyzed during this study are not publicly available. Neither participant consent nor the approved ethics protocol included data sharing beyond the project, reflecting confidentiality concerns. Reasonable requests for access will be considered on a case-by-case basis, subject to a data-transfer agreement and approval by the ethics committee. Only de-identified data may be shared. Enquiries can be directed to the first author.

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Version 1, 27 September 2026: the first record

Recorded: type, language, journal, volume, issue, pages, dates, 7 authors, 7 keywords, 15 MeSH terms, 1 funder, 28 references.

Cite

This paper

Molla, H. T., Joy, E. J., Gashu, D., Bikila, D., Garomsa, T. L., Stoecker, B., & Sandalinas, F. (2026). Prior Pregnancies Deplete Maternal Folate Status and Increase Risks of Neural Tube Defects in Addis Ababa, Ethiopia. The Journal of nutrition, 156(8), 101666. https://doi.org/10.1016/j.tjnut.2026.101666

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