Folate promotion in Western Australia and the prevention of neural tube defects

Bower, Carol; Miller, Margaret; Payne, Jan; Serna, Peta; Klerk, Nicholas De; Stanley, Fiona

doi:10.1111/j.1467-842x.2004.tb00945.x

Cited by 19 publications

(40 citation statements)

References 25 publications

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“…27 Less than half of women surveyed in each State took periconceptional folate supplements. This finding is consistent with published studies based on Australian and overseas hospitalor service-based samples, 9,10,15,18,[28][29][30][31][32][33] and with US populationbased data. 11,12 Factors associated with not taking PFS, as in other populationbased studies, 11,12 are: being less than 25 years of age, having less education, being unmarried, having low family income, being born in non-English speaking countries, and unplanned pregnancy.…”

Section: Discussionsupporting

confidence: 92%

“…The current habitual dietary intake of folate for most Australian women is well below that recommended for risk reduction of NTDs. 8,9 Primary prevention strategies to reduce the risk of NTDs include: periconceptional intake of folic acid supplements, increased consumption of foods naturally high in folate, and fortification of staple foods.A recent systematic review of periconceptional folic acid use based on studies conducted between 1992 and 2001 found periconceptional supplement use of between 0.5% and 52%. 10 Three studies drew on population-based samples (two using data from the United States Pregnancy Risk Assessment Monitoring System (PRAMS) 11,12 ) and the other, a South Australian study, also reported hospitalbased data.…”

mentioning

confidence: 99%

“…7 The current habitual dietary intake of folate for most Australian women is well below that recommended for risk reduction of NTDs. 8,9 Primary prevention strategies to reduce the risk of NTDs include: periconceptional intake of folic acid supplements, increased consumption of foods naturally high in folate, and fortification of staple foods.…”

mentioning

confidence: 99%

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Use of periconceptional folic acid supplements in Victoria and New South Wales, Australia

Watson

Brown

Davey

2006

Australian and New Zealand Journal of Public Health

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In both surveys younger women, women with less education, less income, of nonEnglish speaking background and women who were not married were less likely to take folate supplements in the recommended period. In Victoria, multiparous women were significantly less likely to take supplements. In NSW, women with an unplanned pregnancy and those living in rural areas were significantly less likely to take periconceptional folate supplements. Fifty-three per cent of women cited a general practitioner or obstetrician as a source of folate information and 45% cited family or friends; both of these sources were significantly associated with periconceptional folate supplementation. Conclusions: Less than 50% of women took periconceptional folate supplements.Among socially disadvantaged groups, the proportion was significantly lower. Implications: Since women are unlikely to achieve adequate folate intake periconceptionally without deliberate action, there remains the need for a multifaceted approach to providing women with information about folate. Future surveys are needed to monitor usage and knowledge. (Aust N Z J Public Health 2006; 30: 42-9) N eural tube defects (NTDs) are a group of serious congenital structural abnormalities of the brain, skull, and spinal cord that are able to be detected antenatally by the use of ultrasound and maternal serum screening in the second trimester. 1 Since the routine introduction of these tests in Victoria, the birth prevalence of NTDs has reduced because pregnancies found to be affected are usually terminated. 2,3 There are also indications that since 1997, when folate awareness programs were introduced and after voluntary fortification of folate to staple foods was recommended, 4 the incidence of NTDs including pregnancies terminated after prenatal diagnosis has decreased in Victoria. 2 These data are not available for New South Wales (NSW).There is strong evidence that an adequate intake of folate periconceptionally reduces the risk of NTDs by about two-thirds, 5 and that folate (or folic acid) is only effective in reducing the risk of NTDs when recommended maternal folate levels are achieved before the critical time that neural tube closure occurs, around week four after conception. The National Health and Medical Research Council 6 has recommended that "women planning a pregnancy or likely to become pregnant should be encouraged to increase their dietary intake of folate-rich foods, particularly in the month before and in the first three months of the pregnancy. Low risk women . . . should be offered periconceptional folic acid supplementation (0.5 mg daily)." NHMRC draft documentation has this amount as 400 µg/ day, in line with overseas recommendations. The current habitual dietary intake of folate for most Australian women is well below that recommended for risk reduction of NTDs. 8,9 Primary prevention strategies to reduce the risk of NTDs include: periconceptional intake of folic acid supplements, increased consumption of foods naturally high in folate, and fortification ...

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Section: Discussionsupporting

confidence: 92%

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confidence: 99%

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Use of periconceptional folic acid supplements in Victoria and New South Wales, Australia

Watson

Brown

Davey

2006

Australian and New Zealand Journal of Public Health

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“…There was high participation in our study (79%) but non-responders were more likely to be young, unmarried, not to have private health insurance, to smoke during pregnancy, and have either had no previous births or more than two previous births 15 . With the exception of women with two or more previous births, all of these characteristics were associated with a greater risk of not knowing the correct message and not taking periconceptional folic acid supplements 20 .…”

Section: Discussionmentioning

confidence: 85%

“…Information collected from the long and short questionnaires included: awareness of the main health message about folate and spina bifida and timing of awareness of this message 15 ; and awareness of folate fortification measured as (1) awareness of folate added to foods, (2) knowledge of folate labelling of foods and (3) how often labels were read. We measured the proportion of women who noticed any labels on foods that mentioned folate, whether they were aware that folate was added to foods, how often they read the labels on foods and packaging, what foods they were aware of that had folate added to them, if they ate folate-fortified food, and if so, how much of the fortified food was eaten in the six months before their recent pregnancy.…”

Section: Data Collectionmentioning

confidence: 99%

Awareness and consumption of folate-fortified foods by women of childbearing age in Western Australia

Oddy

Miller

Payne

et al. 2007

Public Health Nutr.

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Objectives: The introduction of voluntary fortification of some foods with folic acid in Australia has been implemented since evidence of the prevention of neural tube defects with periconceptional folic acid was published. Our objectives were to determine how many women were aware of folate and when they became aware, what was the awareness of labels on foods that mentioned folate, and how much folate-fortified food women ate. Methods: To address these objectives we collected data by self-administered questionnaire from a random sample of 578 recently pregnant women in Western Australia between September 1997 and March 2000. Results: Overall, 89% of women had heard, seen or read anything about the link between folate and birth defects such as spina bifida, 62% first became aware of the folate message before their recent pregnancy and 42% of women noticed any labels on foods that mention folate before or during their recent pregnancy. Overall, 53% of women were aware of foods that have folate added to them and 33% usually or always read the labels on food packaging. The folate-fortified foods most often consumed by women were cereals (69%), breads (34%) and milk (15%). Of the women who consumed folate-fortified foods (78%), the earlier they became aware of the folate message and noticed labels on food, the more fortified foods they consumed. Conclusions: These results indicate that staple foods fortified with folate are consumed by almost 80% of women in the population. Therefore, mandatory fortification of staple foods may reach most women, providing improved opportunity for the prevention of neural tube defects in Australia.

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Trends in childhood acute lymphoblastic leukemia in Western Australia, 1960–2006

Milne

Laurvick

Klerk

et al. 2007

Intl Journal of Cancer

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Increases in the incidence of childhood acute lymphoblastic leukemia (ALL) have been reported in some countries, while other reports from similar geographical regions have indicated stable rates. The reasons for the discrepancies have been debated in the literature, with the focus on whether the observed increases are “real” or an artifact resulting from improvements in diagnosis, case ascertainment and population coverage over time. We used population‐based data from Western Australia to investigate trends in the incidence of childhood ALL between 1960 and 2006. Age‐standardized incidence rates (ASRs) and rate ratios (indicating annual percent change) were estimated using Poisson regression. Between 1960 and 2006, the ASR was 3.7 per 100,000 person‐years, with an annual percent increase of 0.40% (95% CI: −0.20, 1.00). Between 1982 and 2006, the ASR was 3.8, with an annual percent increase of 0.80% (95% CI = −0.70 to 2.30). This increased to 1.42% (95% CI: −0.30, 3.0) when a sensitivity analysis was undertaken to assess the effect of excluding the final 2 years of data. Annual increases of 3.7% (95% CI: −0.50, 8.00) among children aged 5–14 years, and of 3.10% (95% CI: 0.50, 5.70) in girls, were observed for this latter period. These results were supported by national Australian incidence data available for 1982–2003. There may have been a small increase in the incidence of ALL since 1982 among girls and older children, but an overall increase appears unlikely. No impact of folate supplementation or fortification is apparent. © 2007 Wiley‐Liss, Inc.

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Folate promotion in Western Australia and the prevention of neural tube defects

Cited by 19 publications

References 25 publications

Use of periconceptional folic acid supplements in Victoria and New South Wales, Australia

Use of periconceptional folic acid supplements in Victoria and New South Wales, Australia

Awareness and consumption of folate-fortified foods by women of childbearing age in Western Australia

Trends in childhood acute lymphoblastic leukemia in Western Australia, 1960–2006

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