Awareness and Intake of Folic Acid for the Prevention of Neural Tube Defects Among Lebanese Women of Childbearing Age

Abstract

Since the early 1990s, international recommendations have promoted folic acid supplementation during the periconception period as an effective way of preventing neural tube defects (NTDs). However, the adoption of this recommendation remains insufficient. To assess the awareness and actual intake of folic acid among married Lebanese women aged 18-45 years, a cross-sectional study was conducted among 600 women selected from all five administrative districts in Lebanon, using a multistage cluster sampling procedure. An anonymous questionnaire was completed which covered measures of knowledge and use of folate supplements, as well as demographic, socioeconomic and obstetrical factors. Sixty percent of surveyed women (60%; n = 360) had heard about folic acid. Doctors were the most frequent source of information (61.1%) but only 24.7% of women have been told of the correct period during which folic acid supplementation was useful. Overall, only 6.2% had taken folic acid tablets during the adequate period. Younger age, higher education level and stability/sufficiency of income appeared to be significant predictors of awareness among Lebanese women. Actual folic acid intake was significantly associated with younger age, higher number of pregnancies, planning the last pregnancy and having had that last one after 1990. In Lebanon, the level of folic acid awareness and adequate intake remain relatively low. Several approaches should be used to promote folic acid intake including awareness campaigns, and routine counseling by primary health care physicians on folic acid during preconception visits.

Dietary Folate Intake and Folic Acid Supplements among Pregnant Women from Southern Italy: Evidence from the “Mamma & Bambino” Cohort

“…Beyond folate intake, supplementation of folic acid during the periconceptional period represents one of the best strategies to tackle pregnancy adverse outcomes, as suggested by the WHO in 2006 [17]. However, the prevalence of folic acid supplementation remains often inadequate in several countries [20,68]. Although we showed that only~3% of pregnant women did not take folic acid supplements,~75% of them did not take supplements as recommended (i.e., 4 weeks before conception until 8 weeks after).…”

“…Several studies aimed to identify the main determinants of inadequate supplement use during pregnancy. Among social factors, for instance, it has been demonstrated that younger age [20], low income [71], educational level [68], and employment status [21] might affect the use of folic acid supplements. In our opinion, social inequalities in the use of supplements could be partially explained by the reduced level of knowledge, attitude, and awareness among the more disadvantaged groups [22].…”

“…Thus, further studies should investigate social and behavioral determinants that might affect the adherence to these recommendations and increase the awareness about benefits of folic acid supplement use [19][20][21][22]. Although inadequate folate concentrations were often associated with anencephaly and spina bifida [23], its impact on other adverse pregnancy outcomes is not fully understood.…”

The Prevalence of Micronutrient Deficiencies and Inadequacies in the Middle East and Approaches to Interventions

“…Other studies in the KSA by Musaiger et al [120,121] and Afshin et al [120,121] revealed that >80% of women aged 18–45 years were unaware of the role played by periconceptional folic acid supplementation. By contrast, in ranges across surveys from the Gulf and Levant region found that 46%–62% of women are aware of the benefits of folic acid and 6%–45% of pregnant women reported taking folic acid supplementation during their first-trimester; the lowest rate of folic acid supplement use was found in Lebanon (6%–14% of women) [122,123,124,125]. In the Feeding Infants and Toddlers Study, Abdulrazzaq et al evaluated the nutrient adequacy of 1000 infants and toddlers in the UAE and found that, although protein and energy intakes approximated the recommended allowance, iron intake was inadequate (<70% of RDA) in 66.8% of infants 6–11 months old and 100% of toddlers 12–23 months old [126].…”

Improving awareness of preconception health among adolescents: experience of a school-based intervention in Lebanon

“…Evidence from Lebanon highlights a need for promoting preconception health awareness. In a national survey of married Lebanese women aged 18 to 45 years, Nasr et al found that 40% of the participants had not heard about pre-pregnancy folic acid and its prevention of neural tube defects (NTD) [ 13 ]. Tamim et al showed a low prevalence (14%) of preconception folic acid intake among 5,280 Lebanese pregnant women [ 14 ].…”