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

Abstract

Objective: To provide a basis for making recommendations on the potential to improve use of folic acid supplements in the UK, particularly among low-income and young women. Design: Systematic reviews of relevant research from 1989 to May 2006 in Europe, the USA, Canada, Australia and New Zealand. Results: Twenty-six systematic reviews and/or meta-analyses were identified from the wider public health literature, and eighteen studies on the effectiveness of preconception interventions were included. Ninety studies were identified which were directly relevant to folic acid supplement intake. There were factors that are particularly associated with lower rates of use of folic acid supplements. One of the most important of these is the link with unintended pregnancy, followed by age, socio-economic and ethnic group. Integrated campaigns can increase the use of folic acid supplements to some extent. Research trials indicated that: (i) printed resources and the mass media used in isolation are not effective in the longer term; and (ii) health-care-based initiatives can be effective and are more likely to be successful if they include making supplements easily available. Conclusions: Campaigns and interventions have the potential to exacerbate socioeconomic inequalities in folic acid use. One way of addressing this is to include elements that specifically target vulnerable women. To achieve and maintain an effect, they need to be based on good health promotion practice and to be sustained over a long period. However, even high-quality campaigns that increase use result in under half of women in the target group taking supplements. Keywords Folate Folic acid Supplements Neural tube defects Public health policies/interventionsThe overall aim of the work described in the present paper was to use a systematic approach to carry out literature reviews of research that has been done on influencing low-income groups, particularly girls/young women, to change their behaviour in relation to health. The intention was to provide a basis for making evidencebased recommendations on the potential to improve use of folic acid supplements in the UK.This was achieved by carrying out three complementary reviews. The first two of these provided a basis for the main (third) review. They were intended to assess whether there are findings from the wider public health literature (rather than work focusing specifically on folic acid) that might inform the development of effective interventions to increase use of folic acid supplements. Review 1 identified published systematic reviews or meta-analyses of initiatives that required 'positive precautionary action' by women. Review 2 identified research relevant to the effectiveness of different approaches to preconception interventions on behaviour. Review 3 formed the main part of the work, and focused specifically on quantitative or qualitative research aimed at encouraging women, particularly girls/young women and those from low-income groups, to take folic acid in the periconceptional p...

Factors associated with not using folic acid supplements preconceptionally

“…However, a systematic review showed that study quality was often poor. Most studies were small and were conducted late in pregnancy or even after delivery, which led to a high risk of recall bias, and most studies only used univariable analyses (18) . The most recent data on folic acid use in the Netherlands derive from studies in 2003-2004 and 1995-2005.…”

Prevention of NTDs - Proposal of a New Concept

“…Failure of contraceptive methods is one reason for an unplanned pregnancy. Secondly, unplanned pregnancy is one predictor of low compliance to the FA recommendation as reviewed by Ray et al (2004) and Stockley & Lund (2008). Combining OC with folate would result in a protective maternal folate status for OC users being advantageous to those conceiving under OC therapy.…”

“…Less than recommended or no FA supplementation was associated with unplanned pregnancy (McGuire et al, 2010). As indicated in the systematic reviews of Ray et al (2004) and Stockley & Lund (2008), unintended pregnancy is the most important factor for lack of compliance with the recommendations. …”

Folic acid supplementation for the prevention of neural tube defects: promotion and use

“…44 Nevertheless, the increased rate of FA consumption did not parallel the efforts spent to implement and establish such programs. Stockley and Lund 45 conducted a comprehensive review of published literature from 1989 to 2006 on the effectiveness of various interventions to improve the periconceptional use of FA. They concluded that even highquality campaigns that result in an increase in the use of FA would have a limited impact, as more than half of the women are poorly compliant, and programs often will not reach unplanned pregnancies.…”

“…Similar results were obtained from a systematic review by Chivu et al 46 where the average usage of FA was less than 25% following diverse interventions used to increase FA intake. 45,46 Furthermore, Botto et al 47 in a retrospective cohort study that included 8,636 cases of anencephaly or spina bifida reported by birth registries in 13 areas in Europe and Israel, identified that recommendations and broadcasting information alone did not have a measurable effect on the prevalence of NTD. 45,47 National integrated health promotion programs embracing information on patterns and predictors of FA consumption and incorporating public and health professional's education to implement environmental, behavioral, and social policy changes could be an effective way to develop a successful program.…”