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Effect of Maternal Folic Acid Supplementation on Neural Tube Defect Prevention among Newborns in Nigeria

Abstract

Neural tube defects (NTDs) are serious congenital abnormalities that develop during early embryonic development and remain an important public health concern because they can result in lifelong disability, substantial healthcare needs, and infant mortality. Adequate maternal folate status before conception and during early pregnancy plays an important role in reducing the risk of NTDs, while inadequate folic acid intake may increase the risk of conditions such as spina bifida and anencephaly. Maternal folic acid supplementation provides an important opportunity for preventing these birth defects, particularly when supplementation begins before conception and continues during the early stages of pregnancy. In Nigeria, however, inadequate awareness of preconception folic acid use, late initiation of antenatal care, inconsistent supplement availability, poor adherence, limited preconception healthcare utilization, and socioeconomic barriers may reduce the effectiveness of folic acid supplementation programmes. Against this background, this study investigates the effect of maternal folic acid supplementation on neural tube defect prevention among newborns in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and Health Systems Framework. The Health Belief Model explains how women's perceptions of susceptibility to birth defects, perceived severity, perceived benefits of folic acid supplementation, perceived barriers, and cues to action may influence supplement use before conception and during pregnancy. The Social Ecological Model emphasizes the influence of individual, family, community, healthcare, socioeconomic, and policy factors on maternal nutrition and pregnancy outcomes. The Health Systems Framework emphasizes antenatal and preconception service delivery, health workforce, availability of supplements, health information, financing, governance, and accessibility as essential components of effective maternal nutrition and birth-defect prevention programmes. Collectively, these theoretical perspectives provide a suitable framework for explaining how maternal folic acid supplementation may influence neural tube defect prevention among newborns in Nigeria. The study will adopt a quantitative analytical cohort or case-control research design. The study population will comprise pregnant women or mothers and their newborns in selected healthcare facilities across Nigeria. A multistage sampling technique will be used to select states, local government areas, healthcare facilities, maternity units, pregnant women or mothers, and eligible newborns. Maternal folic acid supplementation will be assessed using indicators such as use of folic acid before conception, timing of supplementation initiation, dosage, duration of supplementation, adherence to prescribed supplementation, access to folic acid supplements, preconception healthcare utilization, antenatal care attendance, and documentation of supplementation. Neural tube defect prevention will be assessed using indicators such as occurrence of NTDs among newborns, documented diagnosis of spina bifida, anencephaly, encephalocele, other neural tube abnormalities where applicable, prenatal detection where available, and newborn clinical assessment. Data will be collected using structured questionnaires, antenatal care records, maternal health records, supplement distribution or prescription records, delivery registers, newborn medical records, congenital anomaly registers, and relevant hospital or surveillance records. Descriptive statistics will be used to summarize maternal and newborn characteristics, supplementation patterns, adherence, and NTD outcomes. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of maternal folic acid supplementation on neural tube defect prevention. Where a case-control design is adopted, maternal folic acid supplementation histories among mothers of newborns with NTDs may be compared with those among mothers of newborns without NTDs, with relevant maternal, nutritional, socioeconomic, and pregnancy-related factors appropriately controlled. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that adequate maternal folic acid supplementation has a significant protective effect on neural tube defect prevention among newborns in Nigeria. Newborns whose mothers used folic acid appropriately before conception and during early pregnancy are expected to have a lower likelihood of neural tube defects compared with newborns whose mothers had inadequate or no supplementation. Early initiation of supplementation is expected to be particularly important because neural tube closure occurs very early in embryonic development, often before pregnancy is recognized. However, late commencement of supplementation, poor adherence, inadequate dosage, limited access to supplements, unplanned pregnancies, poor preconception care, and inadequate maternal nutrition may reduce the preventive benefits of folic acid supplementation. The study therefore expects improved preconception counselling, increased availability and accessibility of folic acid supplements, early initiation of supplementation, and stronger maternal nutrition services to contribute significantly to reducing neural tube defects among newborns in Nigeria. The study is expected to contribute to the literature on maternal folic acid supplementation, neural tube defect prevention, maternal nutrition, congenital abnormalities, preconception care, antenatal care, newborn health, birth-defect prevention, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, healthcare facilities, maternal and child health programmes, obstetricians, midwives, nutritionists, community health workers, development partners, and policymakers regarding strategies for strengthening folic acid supplementation. The study will also provide evidence-based recommendations for promoting preconception folic acid use, improving maternal nutrition education, ensuring consistent availability of folic acid supplements, strengthening preconception and antenatal counselling, improving adherence to supplementation, increasing awareness of neural tube defects, and integrating birth-defect prevention into broader maternal, newborn, and child health programmes across Nigeria.

Keywords: Maternal folic acid supplementation, neural tube defects, NTD prevention, maternal nutrition, folate, preconception care, antenatal care, congenital abnormalities, newborn health, Nigeria, public health.