Continuing low uptake of periconceptional folate warrants increased food fortification

Abstract

Correspondence 4 Wexham Lodge,Objective To assess whether the Health Education Authority's recent promotion of periconceptional folic acid has been successful in increasing uptake sufficient to prevent neural tube defects.Design A retrospective questionnaire, completed by 162 patients in the early pregnancy clinic in Doncaster Royal Infirmary, an averagesized UK district general hospital. The study ran in February and March 1999.Methods and main outcome measures Data were collected on: supplementation and dietary intake of folic acid, both preconceptionally and after confirmation of pregnancy; awareness of the benefits of folic acid; source of information on folic acid; the reasons for not taking folic acid (if this was so); planned or unplanned pregnancy; previous pregnancies; previous neural tube defect in a pregnancy; smoking habit; and age.Results Eighty-one per cent of women were aware of the benefits of folic acid, but only 27% took it preconceptionally. Sixty-eight per cent took it after confirmation of pregnancy. A quarter of patients made an attempt to increase dietary folate. Unplanned pregnancy was a significant bar to uptake, with significant differences in awareness and consumption. Number of pregnancies had no effect. Older women were more likely to take postconceptional folate, but awareness and preconceptional use were the same as younger women.Conclusion Despite an extensive campaign commissioned by the Department of Health and run by the Health Education Authority, use of periconceptional folate will probably only prevent one-sixth of affected pregnancies. The adverse effects of fortification discussed in the body of this paper are small. It is now time for increased fortification of all cereal-grain products to be instituted in the UK in a similar manner to the United States.

Social and ethnic differences in folic acid use preconception and during early pregnancy in the UK: effect on maternal folate status

“…Only 16% of participants claimed to have no knowledge of folic acid. These results are analogous to a previous UK study (Sillender, 2000) where only 19% of participants had no knowledge of folic acid. It is clear that, although knowledge of the requirement for folic acid periconception is high, its use is consistently low and shows no sign of improving.…”

“…Subsequent to the introduction of the recommendations in 1992, the proportion of women using folic acid pre-pregnancy has improved from 1.8% in 1993 to 31% in 1996 (Wild et al, 1997). More recent studies have shown that preconception use of folic acid remains low (24-31%) and, although postconception use is higher (63-83%), it is thought that many women do not begin until after neural tube closure (Mathews et al, 1998;Sillender, 2000;Brooke & Doyle, 2001).…”

Use of folic acid supplements, particularly by low-income and young women: a series of systematic reviews to inform public health policy in the UK

“…Cano-Serral et al (2006) (94) ; Coll et al (2004) (95) ; Garcia (97) ; Glasgow Perinatal Effectiveness Committee (1998) (98) ; Haslam et al (2003) (99) ; Howell et al (2001) (100) ; ICM Research (2004) (101) ; Johnson (2000) (102) ; Langley-Evans & Langley-Evans (2002) (103) ; Mathews et al (1998) (104) ; Neill et al (1999) (105) ; *Relton et al (2005) (106) ; Rogers & Emmett (1998) (107) ; Sen et al (2001) (108) ; Sillender (2000) (109) ; Sillender & Pring (2000) (110) ; Wald (personal communication, 2005) USA Ahluwalia & Daniel (2001) (111) ; Alozie Arole et al (2003) (112) ; Carmichael et al (2006) (113) ; CDC (1999) (114) ; CDC (2001) (115) ; CDC (2004) (116) ; CDC (2005) (117) ; de Jong-van den Berg et al (2005) (119) ; Goldberg et al…”

“…The main comparable findings are summarised in Table 4 by country. The source papers were those listed in Table 1: Australia (71)(72)(73) ; Canada (74)(75)(76)(77)(78)(79)(80) ; Croatia (81) ; Denmark (82) ; Ireland (83)(84)(85) ; The Netherlands (67,86,87) ; New Zealand (88,89) ; Norway (90)(91)(92) ; Poland (93) ; Spain (94)(95)(96) ; the UK (NJ Wald, personal communication, 2005) (97)(98)(99)(100)(101)(102)(103)(104)(105)(106)(107)(108)(109)(110) ; and the USA (111)(112)(113)(114)(115)(116)…”

Knowledge and practices of folate and multivitamin supplementation among Jordanian pregnant women

“…This percentage is small in comparison to other studies. For example in a Canadian study, 95% of the participants reported having heard of folate (French at al., 2003) and in a UK study 81% of women were aware of the benefits of folic acid (Sillender, 2000). In a US study conducted with Hispanic women in Texas, 78% of mothers knew about folic acid (Canfield et al, 2006).…”