Periconceptional folic acid use: Still room to improve

Woude, Priscilla A. Zetstra-van der; Walle, de Hermien; Berg, de Lolkje Jong-van den

doi:10.1002/bdra.22882

Cited by 17 publications

(15 citation statements)

References 78 publications

(66 reference statements)

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“…The lack of change in attitude could be caused either by the intervention not being effective or by a ceiling effect (a score of 4·5 on scale of 6 may leave little room for improvement). The latter explanation and the contribution of increased knowledge match findings in other studies: that hardly any objections against use of FA supplements are found, but also that, although many women know something about FA supplements, especially knowledge on when to start taking FA supplements is relatively low (2) . In the present study we did not test at the individual level for association between theoretical determinants of behaviour (knowledge, attitude) and intention or use of FA.…”

Section: Discussionsupporting

confidence: 83%

Effects of a simple educational intervention in well-baby clinics on women’s knowledge about and intake of folic acid supplements in the periconceptional period: a controlled trial

Smit¹,

Weinreich

Cornel

2014

Public Health Nutr.

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Objective: To test the hypothesis that a concise intervention to promote the preconception use of folic acid (FA) supplements among mothers who visit a wellbaby clinic (WBC) for the 6-month check-up of their youngest child is effective. Effectiveness was measured as intention to use or actual use of FA supplements before a next pregnancy among women who expected to be pregnant within 0-12 months. Design: Controlled intervention study with independent samples of intervention and control mothers. The intervention took place at the 6-month visit. A postintervention measurement was done in the intervention group and a comparable measurement in the control group at the 11-month check-up visit. Setting: The intervention, verbal and in writing, was implemented in four Dutch WBC and given by the WBC physician to the mothers who visited the WBC. Subjects: All mothers visiting the WBC were eligible for inclusion, unless they were unable to complete a questionnaire. The intervention group consisted of 198 (68 %) mothers recruited from 291 6-month intervention visits and the control group of 215 (84 %) mothers recruited from 255 11-month normal visits. Results: In mothers who expected to be pregnant within 0-12 months, the proportion using or intending to use FA was 65 % in the intervention group (n 49) v. 42 % in the control group (n 43; difference 23 %, 95 % CI 4, 43 %, P < 0·05). Conclusions: Health education intervention at the 6-month WBC visit is an effective means to promote the use of FA supplements or the intention to do so. Keywords Health promotion Folic acid supplements Preconception careMore than 20 years ago it was proved that the intake of folic acid (FA) in the periconceptional period protects against neural tube defects (NTD). In many countries policy was developed to increase FA intake, including the advice to use FA supplements before conception, and to fortify staple foods. Nine years after the first one-off mass media campaign in the Netherlands in 1994, which was followed by a number of smaller initiatives mainly directed to supposed intermediaries like general practitioners, midwives and obstetricians/gynaecologists (1) , the percentage of women using FA in the periconceptional period had increased to approximately 43 % in 2003 (2) . The Dutch Ministry of Health decided in 2004 to allocate funds for the development and implementation of additional strategies to achieve a 70 % adequate FA intake by 2010. The focus was on the development and implementation of interventions and channels through which the target group of women who would become pregnant could be educated effectively and in time. Two channels were identified as specifically appropriate: community pharmacies and wellbaby clinics (WBC). Through these channels it would be possible to deliver information and advice by so-called 'important others', in this case highly appreciated medical professionals, who are part of the social influence, one of the determinants of behavioural intentions in the ASE model (3) . Community pharmacies had s...

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Section: Discussionsupporting

confidence: 83%

Effects of a simple educational intervention in well-baby clinics on women’s knowledge about and intake of folic acid supplements in the periconceptional period: a controlled trial

Smit¹,

Weinreich

Cornel

2014

Public Health Nutr.

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“…In the Netherlands, 37% of women in a multi-ethnic population in Rotterdam in 2002-06 and 65% of women attending some antenatal clinics in 2009 in the northern region started folic acid use before pregnancy. 13,14 In national birth cohorts, this proportion was 30% in Denmark 6 and 20% in Norway. 7 However, these studies may have overestimated folic acid use because of selection bias with a higher likelihood of inclusion for women with higher educational levels and those with a strong interest in health issues.…”

Section: Discussionmentioning

confidence: 98%

“…This resulted progressively in a high level of folic acid use. 13,18,25 It also The campaigns to promote folic acid should target specifically women planning their pregnancies. 28 They accounted for about three-quarters of the women who gave birth in our study and also for a substantial proportion of women in other European countries.…”

Section: 16mentioning

confidence: 99%

Maternal and health care determinants of preconceptional use of folic acid supplementation in France: results from the 2010 National Perinatal Survey

Tort

Lelong

Prunet

et al. 2013

BJOG

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Objectives To estimate the national prevalence and analyse the factors associated with preconceptional folic acid supplementation, including maternal sociodemographic characteristics, region of residence, birth control use and chronic diseases requiring medical care before conception.Design Cross-sectional population-based study.Setting All maternity units in France.Population A nationally representative sample of women giving birth in 2010 (n = 12,646).Methods Data came from mothers' interviews 2-3 days after delivery. Statistical analyses included multivariable logistic regressions.Main outcome measure Folic acid supplementation starting at least 1 month before conception.Results 14.8% (95% confidence interval [95% CI] 14.2-15.4) of women used folic acid before pregnancy; this percentage varied from 10.4% to 18.7% across regions. Supplementation was more frequent in primiparae, French citizens, women with higher educational levels and those needing medical monitoring or treatment before conception. Women who stopped contraception to become pregnant (75% of our population) used folic acid more often (intrauterine device or implant: 19%, pill: 17%, other methods which did not need medical monitoring: 17%) than other women (7%). The adjusted odds ratios were 3.3 (95% CI 2.6-4.3) for intrauterine device and implant, 2.2 (95% CI 1.8-2.6) for pill and 1.9 (95% CI 1.5-2.4) for other methods, compared with women who did not use birth control. ConclusionThe absence of preconceptional folic acid supplementation for most women, even those needing consultations with healthcare professionals before pregnancy, shows that campaigns to promote folic acid supplementation should address not only women but also healthcare professionals involved in birth control and obstetric care before pregnancy.

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“…A possible cause for this may be the high percentage of unplanned pregnancies in Poland. A study of Woude et al showed that periconceptional folic acid supplementation during the recommended period was used significantly more often by women who planned pregnancy [15]. Low compliance with periconceptional folic acid intake recommendations may also be associated with inadequate knowledge of young women about the character and the complications of NTDs.…”

Section: Discussionmentioning

confidence: 99%

“…For the purpose of this survey we have intentionally selected women with higher education since several studies revealed that such population is most compliant with recommendation of folacin supplementation [15,33]. This data suggests that efficacy of the folic acid education campaign in women without university education can be even less satisfactory.…”

Section: Discussionmentioning

confidence: 99%

Intake of folic acid by Polish women with higher education — a survey research: can we do more?

Pietrzykowska-Kuncman¹,

Zasina-Olaszek

Łukasz

et al. 2017

Ginekol Pol

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Objectives: The objective of the study is to determine efficacy of the Primary Prevention Program of Neural Tube Defects in Polish women with higher education in 5-year interval. Material and methods:Survey research was conducted twice (in 2008 and 2013) in 630 female students of universities: 305 female medical students and 325 female non-medical students. The survey was also done among women aged 27--35 who graduated from medical or non-medical universities and have at least one child. Questions concerned knowledge about prophylaxis and periconceptional folic acid intake. Chi square test was used to assess the significance. There was no significant difference in preconceptional folic acid intake among mothers with medical and non-medical education (53.3% vs. 45% p = 0.4). However, the highest folic acid intake was among mothers -medical doctors who treat children with neural tube defect. Conclusions:Difference between medical and non-medical students shows that better educational programs may improve knowledge about prophylaxis. Aside from knowledge, compliance with recommendations of Primary Prevention Program of Neural Tube Defects is unsatisfactory.

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Periconceptional folic acid use: Still room to improve

Cited by 17 publications

References 78 publications

Effects of a simple educational intervention in well-baby clinics on women’s knowledge about and intake of folic acid supplements in the periconceptional period: a controlled trial

Effects of a simple educational intervention in well-baby clinics on women’s knowledge about and intake of folic acid supplements in the periconceptional period: a controlled trial

Maternal and health care determinants of preconceptional use of folic acid supplementation in France: results from the 2010 National Perinatal Survey

Intake of folic acid by Polish women with higher education — a survey research: can we do more?

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