Background Increased risk of neural tube defects (NTDs) has been attributed to lower levels of folate in obese women.¹The Centre for Maternal and Child Enquires (CMACE) and The Royal College of Obstetrics and Gynaecology (RCOG) guidelines advise obese women should take 5mg folate supplements daily, periconceptionally and throughout the first trimester.² NICE define obesity as a Body Mass Index (BMI) >=30 kg/m² at the first antenatal consultation.³

Aims/Objectives To assess if women with a BMI >= 30 kg/m² are being managed according to the CMACE/RCOG guidelines.

Materials/Methods A 50 day, prospective data collection of all deliveries in a tertiary referral centre. 846 charts were included, 25 could not be located. Notes were reviewed for evidence that 5mg folate was prescribed in the first trimester or taken pre-conceptionally where BMI >= 30 kg/m².

Results 821 charts were reviewed. 161 patients had a BMI >=30 kg/m². 9% (14/161) of patients received the recommended 5mg folate where indicated. 3 out of 821 fetuses were found to have spina bifida. In two of these cases, patients had a BMI >=30 kg/m² but neither had taken high dose folate pre-conceptionally or in the first trimester.

Summary/ Conclusions Patients with a BMI >=30Kg/m² are not receiving 5mg folate according to the current CMACE/RCOG guidelines. Increased awareness particularly in the primary care setting is vital so that risk of NTD’s is decreased in this population. Further education and dissemination of results to all staff is required. We plan to re-audit in 1 year.

References

1. Mojtabai R. Body mass index and serum folate in childbearing age women. Eur J Epidemiol. 2004;19(11):1029–36

2. CMACE/RCOG Joint Guideline. Management of women with obesity in Pregnancy. 2010

3. National Institute of Health and clinical excellence. Weight management before, during and after pregnancy. 2010