Computer-Assisted Counseling Might Help Prevent Major Birth Defects

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Neural tube birth defects — a group of major birth defects including spina bifida — can be avoided in most cases by women taking folic acid supplementation before becoming pregnant. Yet, many women do not know about this simple preventive measure.

Computer-assisted counseling might help more women learn how to reduce those risks during future pregnancies, a new study finds.

The study, published online and in the December issue of the American Journal of Preventive Medicine, recruited 446 women, ages18 to 45, from two urgent care clinics, and had them view a 15-minute counseling session via computer.

Sessions covered such details as how much folic acid, or folate, women should take, how often they should take it, where they can get it and how much it costs. Each woman also received 200 folate tablets.

During follow-up phone interviews, the women in the intervention group were much more likely to know that folic acid prevents birth defects (46 percent vs. 27 percent), more than twice as likely to know that the most important time to take folic acid is in early pregnancy (36 percent vs. 17 percent) and were significantly more likely to have taken folic acid in the last few months (32 percent vs. 21 percent).

For lead study author Eleanor Bimla Schwarz, M.D., of the University of Pittsburgh’s Center for Research on Health Care, on-screen sessions offer many advantages over handing out pamphlets and other printed material.

“Pamphlets are a problem for women who don’t read well,” Schwarz said. “This module allowed people to listen with headphones and watch a series of images.”

“Ideally, physicians should provide individualized counseling and be available to respond to specific questions,” said Diane Ashton, M.D., deputy medical director of the March of Dimes. However, doctors in many settings are often too busy to provide sufficient information, so the study explored the benefits of using counseling as an educational tool.

Interactivity might be a positive attribute of computerized counseling, Ashton said. “It may engage the attention of the patient more and improve retention of the information better than a brochure alone.”

Schwarz said that just handing out supplements would not have made enough of a difference. “Prior studies have shown that just giving out free folate is not enough to get women to actually take it. Even free folate with a brochure was not as successful, which is why we think this new way of providing information has great potential.”

Women of childbearing age should take folic acid every day even if they are not planning to become pregnant.

“Because approximately 50 percent of pregnancies are unplanned it is recommended that all women of reproductive age take a multivitamin with at least 400 micrograms of folic acid every day,” Ashton said.

According to a 2005 Morbidity and Mortality Weekly report from the Centers for Disease Control and Prevention, 3,000 U.S. pregnancies involve neural tube defects each year.

American Journal of Preventive Medicine: Contact the editorial office at (858) 457-7292 or .

Schwarz EB, et al. Computerized counseling for folate knowledge and use. Am J Prev Med 35(6), 2008.

Source: Health Behavior News Service

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