Neural Tube Defects ( <scp>NTDs</scp> ) and Modifiable Maternal Behavioral Risks in a Low‐Resource Setting: Evidence From a Multicenter, Hospital‐Based, Case–Control Study in Ethiopia

Abstract

BACKGROUND: Neural tube defects (NTDs) are among the most common and severe congenital anomalies, with an especially high prevalence in Ethiopia. This study aimed to identify potential maternal risk and protective factors associated with NTDs in a low-resource African setting. METHODS: A multicenter, hospital-based, matched case-control study was conducted in Hawassa and Addis Ababa, in which cases were mothers of live born, stillborn, or electively terminated pregnancies after 12 weeks of gestation with an established NTD in the fetus or infant. Controls were pregnant and postpartum women whose pregnancy did not involve an NTD. The data collection tool included: maternal socio-demographic factors, reproductive histories, and current pregnancy-related and behavioral characteristics. Bivariate and multivariate conditional logistic regression analysis was performed to estimate adjusted odds ratios (AOR) and 95% confidence intervals. RESULTS: Significant associations with NTDs include: khat (Catha edulis) chewing during pregnancy (AOR: 3.214; 95% CI: 1.53-6.75), maternal alcohol intake (AOR: 3.017; 95% CI: 1.57-5.79), and high coffee consumption (more than three cups per day) (AOR: 2.46; 95% CI: 1.35-4.46). Also, industry working (AOR: 10.03; 95% CI: 2.16-46.64) and nulliparity (AOR: 2.06; 95% CI: 1.14-3.72) were significantly associated with NTDs. Folic acid/multivitamin supplementation had a strong protective effect when taken a month before conception (AOR: 0.18; 95% CI: 0.04-0.81), and to a lesser extent when taken after conception (AOR: 0.51; 95% CI: 0.31-0.85). CONCLUSION: In the high-prevalence setting of Ethiopia, maternal behavioral factors such as khat chewing, alcohol intake, and excessive coffee consumption are significantly associated with increased risk of NTDs, suggesting possible teratogenic effects. Folic acid supplementation, particularly when started before conception, is a strong protective factor.