Periconceptional folic acid supplementation in Southern Brazil: Why are not we doing it right?

Abstract

Several countries, as Brazil, have public policies for periconceptional folic acid supplementation (FAS) in order to prevent unfavorable outcomes. Our aim was to evaluate the FAS situation in a public reference hospital from Southern Brazil. This study included all mothers who had children born at the Hospital Materno Infantil Presidente Vargas, RS, Brazil, in a 1-year period. Data collection was conducted through interviews with application of a clinical protocol and analysis of the patients' records. FAS was defined as the use of folic acid in any period of the periconceptional period, irrespective of the duration and amount. We also classified those mothers who correctly followed the national recommendation proposed by the Health Ministry of Brazil. The sample consisted of 765 mothers evaluated soon after childbirth. Their ages ranged from 12 to 45 years (mean 25.2 years). The overall level of FAS was 51.5%, and the use according to the national recommendation occurred in only 1.6%. Factors associated with non-FAS consisted of lower maternal age (p = .009) and maternal schooling (p = .023), higher number of pregnancies (p = .003), fewer prenatal visits (p = .050) and later prenatal care onset (p = .037). Periconceptional FAS in our midst seems to be very far from the ideal goal. Susceptible groups appeared to be mothers who were younger, less educated, multiparous, and had inadequate prenatal care. We believe that efforts of education and awareness should be especially targeted for these groups. These recommendations should also be strengthened among those who prescribe the FAS. K E Y W O R D Slow maternal schooling, multiparous, Periconceptional folic acid supplementation, pregnancy, prenatal care, prevention, younger mother

Periconceptional Folic Acid Supplementation and the Risk of Spontaneous Abortion among Women Who Prepared to Conceive: Impact of Supplementation Initiation Timing

“…Our findings might not be completely attributed to the effects of FA supplementation because the supplementation has been associated with an array of maternal and paternal factors and may be a proxy for all these factors. Other determinants of SA such as maternal and paternal age, educational level, fertility treatment, experiencing a complicated pregnancy, unplanned pregnancy, alcohol consumption, and smoking have also well predicted the use of FA supplementation in periconceptional period [29][30][31][32]. Maternal smoking and BMI may also modify the association between FA supplementation and SA [3].…”

Investigating continuation of folic acid supplementation during peri-conceptional period: a community-based cross-sectional study

“…[ 9 – 16 ]. Timely utilization of healthcare for pregnancy is likely to predict earlier and/or higher FA supplementation [ 12 , 14 – 16 ]. Maternal peri-conceptional supplementation with FA has also been related to the spouse’s characteristics [ 9 , 17 ].…”