{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T02:07:56Z","timestamp":1772935676572,"version":"3.50.1"},"reference-count":45,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,2,13]],"date-time":"2020-02-13T00:00:00Z","timestamp":1581552000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth Defects Research"],"published-print":{"date-parts":[[2020,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Maternal folate status and obesity are known risk factors for neural tube defects (NTD) in the offspring. We examined the association between body mass index (BMI) categories and blood folate concentrations, specifically, red blood cell (RBC) folate concentrations indicative of NTD risk among nonpregnant women of child\u2010bearing age (20\u201344\u2009years) in the United States.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used data from 2007 to 2010 US National Health and Nutrition Examination Survey (NHANES). Overweight, obesity, and strata within obesity were examined. Serum and RBC folate concentrations were examined as continuous and categorical variables. RBC folate concentrations were grouped indicating high (\u2264585\u2009nmol\/L) and elevated risk (586\u2013747\u2009nmol\/L) for NTDs. Unadjusted and adjusted prevalence odds ratios (aPOR) and their 95% confidence intervals (CI) were estimated using logistic regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 30,878 participants, 25.6% were overweight, 32.7% obese, and 32.3% had RBC folate concentration indicating NTD risk (&lt;748\u2009nmol\/L). Overweight was not associated with RBC folate level for NTD risk; however, a marginally significant negative association was noted for overall obesity and RBC folate concentrations indicative of elevated NTD risk (aPOR = 0.76; 95% CI = 0.45, 1.00). A significant protective association was noted between Class 3 obesity (BMI \u226540\u2009kg\/m<jats:sup>2<\/jats:sup>) and folate concentration indicative of high NTD risk (\u2264585\u2009nmol\/L; aPOR = 0.46; 95% CI = 0.24, 0.89).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The prevalence of RBC folate concentrations indicating elevated or high NTD risk varied by level of obesity among nonpregnant women of child\u2010bearing age. Further studies are needed to understand the folate pathway in overweight and obese women and subsequent NTD risk in their offspring.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bdr2.1658","type":"journal-article","created":{"date-parts":[[2020,2,13]],"date-time":"2020-02-13T12:51:10Z","timestamp":1581598270000},"page":"490-502","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Association between body mass index and folate insufficiency indicative of neural tube defects risk among nonpregnant women of childbearing age in the United States, NHANES, 2007\u20132010"],"prefix":"10.1002","volume":"112","author":[{"given":"Meryna","family":"Manandhar","sequence":"first","affiliation":[{"name":"Department of Epidemiology Rollins School of Public Health of Emory University  Atlanta Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hind","family":"Beydoun","sequence":"additional","affiliation":[{"name":"Department of Research Programs Fort Belvoir Community Hospital  Fort Belvoir Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2803-8030","authenticated-orcid":false,"given":"Vijaya","family":"Kancherla","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Rollins School of Public Health of Emory University  Atlanta Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,2,13]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/nutrit\/nuz094"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002960"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.85.1.1"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.3945\/jn.114.199117"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdra.20679"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/nqz027"},{"key":"e_1_2_8_8_1","first-page":"145","volume-title":"Folate in health and disease","author":"Christensen K.","year":"2013"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2008.06.028"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g4554"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/nqy065"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199212243272602"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/ijo.2013.41"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1995.03530210052030"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm665152a3"},{"issue":"44","key":"e_1_2_8_16_1","first-page":"8781","article-title":"Food standards: Amendment of standards of identity for enriched grain products to require addition of folic acid","volume":"61","author":"Food and Drug Administration","year":"1996","journal-title":"Federal Register"},{"issue":"2","key":"e_1_2_8_17_1","first-page":"52","article-title":"Folic acid supplementation and pregnancy: More than just neural tube defect prevention","volume":"4","author":"Greenberg J. A.","year":"2011","journal-title":"Reviews in Obstetrics and Gynecology"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.orcp.2016.04.005"},{"issue":"161","key":"e_1_2_8_19_1","first-page":"1","article-title":"National health and nutrition examination survey: Analytic guidelines, 1999\u20102010","volume":"2","author":"Johnson C. L.","year":"2013","journal-title":"Vital and Health Statistics"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1024\/0300-9831\/a000602"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kws190"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0954422417000142"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdra.23113"},{"issue":"159","key":"e_1_2_8_24_1","first-page":"1","article-title":"National Health and nutrition examination survey: Estimation procedures, 2007\u20132010. National Center for Health Statistics","volume":"2","author":"Mirel L. B.","year":"2013","journal-title":"Vital Health Statistics"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-004-2253-z"},{"key":"e_1_2_8_26_1","unstructured":"National Center for Health Statistics. (2018). Centers for Disease Control National Center for Health Statistics National Health and Nutrition Examination Survey. Retrieved fromhttps:\/\/www.cdc.gov\/nchs\/nhanes\/index.htm."},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.3945\/jn.111.156919"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.116.138529"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/nqz184"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.3945\/jn.111.141515"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1753-4887.1996.tb03917.x"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2008.04.021"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1996.03530380035028"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.113"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcp.10324"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdra.23378"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(91)90133-A"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.19193"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(94)70224-1"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpedi.161.8.745"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.111.S1.1152"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.1097\/00001648-199609000-00010"},{"key":"e_1_2_8_43_1","first-page":"2015","volume-title":"Guideline: Optimal serum and red blood cell folate concentrations in women of reproductive age for prevention of neural tube defects","author":"WHO","year":"2015"},{"issue":"1","key":"e_1_2_8_44_1","first-page":"1","article-title":"Updated estimates of neural tube defects prevented by mandatory folic acid fortification \u2010 United States, 1995\u20102011","volume":"64","author":"Williams J.","year":"2015","journal-title":"MMWR. Morbidity and Mortality Weekly Report"},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.111.013011"},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.4239\/wjd.v6.i10.1158"}],"container-title":["Birth Defects Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fbdr2.1658","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/bdr2.1658","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/bdr2.1658","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/bdr2.1658","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,6]],"date-time":"2023-09-06T16:58:33Z","timestamp":1694019513000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/bdr2.1658"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,13]]},"references-count":45,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2020,4]]}},"alternative-id":["10.1002\/bdr2.1658"],"URL":"https:\/\/doi.org\/10.1002\/bdr2.1658","archive":["Portico"],"relation":{},"ISSN":["2472-1727","2472-1727"],"issn-type":[{"value":"2472-1727","type":"print"},{"value":"2472-1727","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2,13]]},"assertion":[{"value":"2019-12-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-01-31","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-02-13","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}