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Objective: The objective of the present study was to assess the prevalence and determinants of preconceptional folic acid supplement use among pregnant women in Lebanon. Design/setting/subjects: The study was a descriptive epidemiological study. Analysis was performed on 5280 deliveries admitted to twelve member hospitals of the National Collaborative Perinatal Neonatal Network during the period September 2003-January 2005. Information on folic acid intake and maternal and neonatal characteristics were obtained from obstetric charts along with direct interviews performed by trained personnel. Logistic regression was performed to determine the predictors of preconceptional folic acid use. Results: The overall use of preconceptional folic acid supplementation was 14?0 % (18?6 % in urban hospitals v. 2?7 % in rural hospitals). Higher socio-economic status, lower parity and having a history of previous spontaneous abortions were significantly associated with preconceptional folic acid use. Conclusion: Our study shows that Lebanon currently has a low rate of preconceptional folic acid supplement use. Intervention through the means of awareness campaigns needs to be implemented on a national level. Keywords Folic acid Preconception LebanonCongenital anomalies affect an estimated 3 % of newborns worldwide. In the early 1990s, it ranked tenth on the list of disability-adjusted life years lost in the Global Burden of Disease Study (1) . Nearly 50 years ago, it was found that the B-vitamin folic acid plays a role in promoting normal embryonic development (2) . It was advised as a general guideline that all females of childbearing age take a supplement of 0?4 mg folic acid to reduce the risk of congenital malformations, including neural tube defects (NTD) (3) . Periconceptional supplementation with folic acid (before conception and during the first 12 weeks of pregnancy) was found to decrease the risk of NTD by 50-70 %, while also protecting from other birth defects such as those of the heart, limbs, urinary tract, cleft lip and palate, as well as other major structural abnormalities (4,5) . The 1990s and early 2000s witnessed an increase in the worldwide use of periconceptional folic acid supplementation as many developed countries promoted awareness campaigns on the importance of folic acid. Increases in the prevalence of periconceptional folic acid use were seen: from 27 % to 48 % in the UK (6) , from 5 % to 36 % in The Netherlands (6) , from 14 % to 83 % in Ireland (7) , from 19 % to 43 % in Western Australia (8) , from 32 % to 40 % in the USA (3) and from 17 % to 28 % in Canada (9)

Providing quality maternity care within the emergency care packages for internally displaced populations in war-affected areas is somewhat challenging, although very essential. In this retrospective study, we describe the experiences and health care seeking behaviors of 1,015 pregnant and postpartum women during the 2006 war in Lebanon. Women reported interruptions in regular maternity care and experienced more complications during this period. Availability of health services and experiences of complications were the most important determinants of health care seeking behaviors. Maternal health services should be a part of any comprehensive emergency responsiveness plan, catering to women's needs in war-affected areas.

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