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Public Health


Diana Naser


Periconceptional folate level deficiencies are associated with birth defects of the brain and spinal cord, posing a significant public health problem. In 2009, Black and Hispanic women exhibited lower periconceptual folate levels and higher rates of folate-related birth defects compared with non-Hispanic White women, prior to enactment of the Affordable Care Act (ACA) of 2010. It is not known if improved access to prenatal care under the ACA narrowed the gap in mean periconceptual folate levels between non-Hispanic White, Black, and Hispanic women between 2009 and 2017. The purpose of this causal-comparative cross-sectional quantitative study was to determine whether there was a significant difference in folic acid concentration between periconceptual Black and Hispanic women and non-Hispanic White women for 2009-2017 pre- and post-ACA, after controlling for age, education, marital status, and income. Data from periconceptual women who participated in the blood draw portion of the National Health and Nutrition Examination Survey between 2009 and 2017 were analyzed using binary logistic regression. Hispanic White women were 6.317 times more likely than Black and Hispanic women to have higher folate levels, albeit not significant (p = .335); mean post-ACA folate levels were significantly different than pre-ACA (p < .001). Potential positive social change from this study includes policymakers examining the need for additional interventions to improve folic acid intake for underserved periconceptual women.

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