Correlates of intake of folic acid–containing supplements among pregnant women

Abstract

Objective-This study describes the timing and correlates of folic acid supplement intake among pregnant women.Study design-Data from 2518 women with estimated delivery dates from 1997 to 2000, collected for the National Birth Defects Prevention Study, a population-based case-control study, were analyzed. Multinomial logistic regression was used to identify correlates of supplement intake.Results-Fifty-three percent of women began taking folic acid supplement during the periconceptional period, 35% during early pregnancy, and 8% during late pregnancy (ie, 3 months before through 1 month after conception, 2-3 months after conception, or more than 3 months after conception, respectively). Women who did not take folic acid supplement periconccptionally tended to be nonwhite, speak Spanish, have low education, be younger than 25 years old. be nulliparous, smoke, have no previous miscarriage and no fertility treatments, begin prenatal care and become aware of their pregnancy after the first trimester, have nonplanned pregnancies, and eat less breakfast cereal.Conclusion-This study identifies correlates of folic acid supplement intake, which may contribute to the design of interventions to improve intake during early pregnancy. Keywords Folic acid; Supplements; PregnancyThe Public Health Service and the Institute of Medicine recommend that women of childbearing age consume at least 400 μg/day of synthetic folic acid (FA), 1,2 an amount that is present in most multivitamin/ mineral supplements. The recommendation was originally intended to prevent neural tube defects. FA also may prevent other birth defects, 3-7 other adverse reproductive outcomes, 8 and chronic diseases. 8 Taking FA-containing supplements remains the most likely route of meeting the recommended intake level, even after considering folate intake from fortified foods. 9,10 By the end of pregnancy, most women are taking FA NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript supplements, 11 but in the first few weeks, before pregnancy is clinically evident, closer to one third of women take supplements daily. 4,11-14 Intake during early pregnancy is critical because most birth defects occur during the first few weeks of pregnancy. For example, neural tube closure is completed by day 28 after conception, or 6 weeks after the last menstrual period.Information on patterns of FA supplement intake during pregnancy and correlates of this behavior is critical to the design of effective interventions to improve intake. Few studies have examined correlates of supplement intake during pregnancy in relatively large and diverse study populations and included multivariable analysis. 11,15,16 We are aware of only 1 study that examined whether predictors of supplement intake varied as pregnancy progressed, and its data are from births that occurred in 1988, before the issuance of major public health recommendations regarding FA. 11 This study describes the pattern of intake of FA supplements among pregnant women and examines correlates of F...

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

“…21 In the national birth defects prevention study in the US women who did not take periconceptional folic acid supplements tended to be non-white, have lower education levels, be younger than 25 years old, be nulliparous, smoke, have no previous miscarriage and no fertility treatments, begin prenatal care and become aware of their pregnancy after the first trimester, have non-planned pregnancies, and eat less breakfast cereals. 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.…”

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)…”

Primary Prevention of Neural Tube Defects

“…The impact of this factor increases with the proximity of the planned conception, with women who indicate their desire to become pregnant at some time in the future but with no specific plan, being no more likely to take a daily folic acid supplement than women never wanting to become pregnant (Cleves et al, 2004). The number of pregnancies was also found as a determinant of folic acid intake with women having had anterior pregnancies more likely to take folic acid supplements than women with their first pregnancy (Carmichael et al, 2006;Nasr Hage et al, 2011;Nilsen et al, 2006). Only one study conducted in Australia by Forster and his colleagues showed that having had other pregnancies is correlated with lower levels of folic acid intake (Forster et al, 2009).…”

“…Studies in the USA showed that African-American and Hispanic women were less likely to use folic acid supplements than Caucasian women (Ahluwalia et al, 2007;Carmichael et al, 2006;Cleves et al, 2004). Half of Hispanic women, and one third of African-American women aged 18-24 years, as compared to Caucasian women were taking folic acid supplements.…”

“…Daily folic acid intake is shown to be related to race/ethnicity, income, marital status, a positive attitude toward taking a physician's advice, knowledge about the relationship between folic acid and birth defects, planning for the pregnancy, earlier pregnancies and earlier discussion between the women and her physician about vitamins (Ahluwalia et al, 2007;Carmichael et al, 2006;Cleves et al, 2004;French et al, 2003;Rosenberg et al, 2003). Studies also found that younger age is related to a lower intake of folic acid supplements (Morin et al, 2002;CDC, 2008;Timmermans et al, 2008).…”