An exceptionally low percentage of Thai expectant mothers and medical personnel with folic acid knowledge and peri-conceptional consumption urges an urgent education program and/or food fortification

Abstract

It has been widely accepted that peri-conceptional consumption of folic acid (FA) can prevent many congenital anomalies, including more than one-half of all neural tube defects. In several developed countries, educational campaigns and/or food fortification with FA have been launched, resulting in lower incidences of some anomalies. In Thailand, congenital anomalies preventable by FA are still an important public health problem. However, there have been no recommendations on the use of FA supplementations from the health authorities. In order to achieve a goal of reducing the diseases' incidences, our initial effort is to assess knowledge and use of peri-conceptional FA. We conducted a questionnaire survey of 500 pregnant women and 500 child-bearing-age female medical personnel in the King Chulalongkorn Memorial Hospital from June 2003 through December 2003. Of the 383 pregnant women who completed the survey, 23.5% (90/383) knew that FA helped to prevent birth defects, 3.4% (13/383) knew that FA should be taken before pregnancy, and only 0.3% (1/383) reported taking FA before pregnancy. Among the 422 female medical personnel who completed the survey, 84.4% (356/422) knew that FA could prevent birth defects, whereas 40.0% (169/422) knew that FA should be taken prior to pregnancy. This study provided strong evidence that educational campaigns and/or food fortification are urgently needed.

Birth prevalence of selected external structural birth defects at four hospitals in Dar es Salaam, Tanzania, 2011–2012

“…In developed countries, folic acid supplementation policy faces significant challenges from unplanned pregnancies, lack of easy access to a functioning health system and effective local social marketing interventions [ 29 – 31 ]. In developing countries like Tanzania, folic acid supplementation policy will be difficult to implement given that these countries have high levels of poverty, poor health care infrastructure, and high rates of unplanned pregnancies compared to their counterparts [ 32 – 34 ]. Mandatory folic acid fortification policy is an option for developing countries to consider, which overcomes some of the challenges of supplementation.…”

The effect of folic acid, protein energy and multiple micronutrient supplements in pregnancy on stillbirths

“…The main contributing factors to this could be a relatively high proportion of unplanned pregnancies [82] and lack of easy access to a functioning health system and effective local social marketing interventions [23]. A policy of folic acid supplementation would be even more difficult to implement in low-income countries with high levels of poverty, poor health-care infrastructure and more number of unplanned pregnancies compared to developed countries [23,81,83,84]. Folic acid fortification seems a more suitable option for developing countries but it requires careful considerations including level of folic acid fortification and selection of suitable food vehicle.…”

Genetics and genomics in Thailand: challenges and opportunities

“…It has been widely accepted that periconceptional consumption of folic acid (FA) can prevent many congenital anomalies. In 2003, a survey of 383 pregnant Thai women showed 23% knew that FA helped to prevent birth defects, 3% knew that FA should be taken before pregnancy, and only 0.3% reported taking FA before pregnancy (Vilaiphan et al 2007). The Thai Government Pharmaceutical Organization has produced Triferdine (ferrous fumarate 185 mg + iodine 0.15 mg + folic acid 0.4 mg) for pregnant women; however, FA has not been produced for women of reproductive age and there have been no government policies for educational campaigns or food fortification with FA.…”