Low compliance with recommendations on folic acid use in relation to pregnancy: is there a need for fortification?

Abstract

Objective: As a means to prevent neural tube defects (NTDs), women planning pregnancy in Denmark are recommended to take a dietary supplement of 400 mg folic acid daily during the periconceptional period. We examined compliance with this recommendation in a national survey. Design: Cohort study on pregnant women in Denmark. Setting: The Danish National Birth Cohort (DNBC). Subjects: From November 2000 to February 2002, 22 000 pregnant women were recruited for DNBC. Use of dietary supplements was recorded at enrolment. Compliance with the recommendation was related to an information campaign that took place during the second half of 2001, and to lifestyle factors provided in a telephone interview by the end of the first trimester of pregnancy. Results: An increase was seen in the proportion of women complying with the recommendation in the study period and this coincided with the information campaign events. However, even at the end of the period, only 22.3% of the women who had planned their pregnancy fully complied with the recommendation. No increase at all was seen in periconceptional folic acid use among women with unplanned pregnancies. Young age, low education and smoking were identified as factors that determined non-compliance. Conclusions: Alternative and more effective strategies are needed if the Danish population is to benefit fully from the knowledge that folic acid prevents NTDs. Future strategies should not only target vulnerable groups, such as the less educated and the young, but also women who get pregnant without planning this. The only possible way to reach the last group may be through fortification of foods with folic acid.

Research Letter: Folic acid supplementation and intake of folate in pregnancy in relation to offspring risk of autism spectrum disorder

“…In contrast to the later Norwegian MoBa cohort, recruitment to the DNBC was ongoing when recommendations of folic acid supplementation for women who planned to become pregnant was first introduced and data from the DNBC has indicated that compliance with the recommendations was strongly associated with sociodemographic and lifestyle factors (Knudsen et al 2004;Olsen & Knudsen, 2008). Since the folic acid awareness initiatives preceded the recruitment for the Norwegian MoBa Cohort, the covariate structure may have been even stronger in those analyses, compared with the analyses in the DNBC.…”

Determinants of folate status in pregnant women: results from a national cross-sectional survey in Belgium

“…22 Also other studies found that women who did not follow the supplementation recommendations were often under 25 or under 19 years of age, of low socio-economic status or born in another country. [23][24][25][26] However, it is important to note that in countries such as the US and the UK fewer than 50% of the pregnancies are planned, 27,28 which contrasts with countries such as Norway where 80% of the pregnancies are planned. 20 In those countries, information can have a bigger impact.…”

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

“…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)…”