Folic acid audit
Use and recording of folic acid to prevent neural tube defects in pregnancy: South West Region, 2003-2004. Julie Mytton, October 2006.
To improve the accuracy of the data held by SWCAR we have recently undertaken an audit of folic acid use in cases of neural tube defects.
An evaluation of the recording of folic acid use in the South West
Congenital Anomaly Register
J Mytton, V Harrison, A McLoughlin, R Thompson and T Overton
Prenatal Diagnosis 2008; 28: 722-726
1. To establish the completeness of the recording of folic acid use prepregnancy and during early pregnancy in recently registered cases of neural tube defect in the South West Region.
2. To validate the accuracy of recording of folic acid use in cases of NTD on the SWCAR database with information on folic acid consumption recorded in antenatal records.
3. To enable SWCAR to enhance its ability to collect useful information on risk factors for NTD.
The audit team proposes the following recommendations:
1) Given the current concerns regarding failure to reduce the incidence of NTD, ongoing debate regarding food fortification with folic acid, and concern regarding uptake of folic acid pre-pregnancy and during early pregnancy, it would be appropriate to encourage enhanced recording of folic acid use within the South West Region.
2) The most appropriate time to collect information on folic acid use is at the booking antenatal visit. The ongoing development of a regional computer system by the NHS Southern Cluster Connecting for Health will enable the opportunity for consistency in the recording of risk factors for anomalies such as folic acid at the booking visit, across the South West Region.
3) It is recommended that information on folic acid use should be collected in a consistent manner, specifically:
1. Taken at any time this pregnancy? Yes / No
2. Taken pre-conceptually? Yes / No
If not, number of weeks pregnant when folic acid was started ___ wks
3. Once started did you take folic acid every day? Yes / No
4) Such information entered onto the new regional computerised maternity recording system, would enable it to be accessible by SWCAR in the event of an anomaly subsequently being identified in that pregnancy.
5) SWCAR should review the current coding of folic acid use in cases referred to the Register. Coding categories should reflect variable folic acid use, and categories should not be unique. A single category to identify when information is ‘not known’ is required.
6) SWCAR should review the default setting for parity of the mother of a case notified to the Register, such that it no longer defaults to G1P0.
7) This audit should be repeated to assess changes in the light of these recommendations. The timing should be such that at least 12 months worth of notifications can be audited following the commencement of the new regional computerised recording system for antenatal care.
8) The suspected incompleteness and inaccuracy of folic acid recording identified by this audit should preclude the interpretation of this data field until such time as the completeness and accuracy of the information can be demonstrated to be improved.
9) The continued collection of other risk factor information by SWCAR, such as smoking, alcohol and drug consumption etc, should be supported. Such data can inform the surveillance of anomalies for which preventative strategies exist, and this information is not reported nationally at this time. However, the findings of this audit highlight the importance of assessing the accuracy and completeness of data on such risk factors.