Poor adherence to folic acid and iodine supplement recommendations in preconception and pregnancy: a cross‐sectional analysis

Abstract

Objective: To determine pregnant women's knowledge of and adherence to the recommendations for periconceptional folic acid supplementation (PFS) and iodine supplementation (IS). Secondary objectives include determining predictors of adherence, and identifying influential nutrition information sources. Methods:A cross-sectional online survey was completed by 857 pregnant women, including a national cohort (n=455) recruited using an online panel provider and a South Australian cohort (n=402) recruited from a public maternity hospital.Results: Adherence to PFS and IS recommendations was 27% and 23%, respectively. Planning pregnancy and awareness of the correct timing of recommendations were predictors of adherence for both recommendations. Not consuming any alcohol during pregnancy and living in metropolitan areas also predicted adherence to the IS recommendation. Awareness of the recommendation was greater for folic acid (more than 90%) than iodine (56-69%). Knowledge of the importance of folic acid and iodine was greater than knowledge regarding the recommended dose and timing of supplementation. Main healthcare providers were considered the most influential nutrition information sources. Conclusions and implications:Knowledge of and adherence to supplement recommendations for preconception and pregnancy needs improvement. While main healthcare providers may play an important role, further research is needed to explore strategies for increasing adoption of recommendations.

Iodine‐containing food practices of Western Australian pregnant women and ethnicity: An observational study

“…A strength of the present study is the capture of ethnic background. In 2013, 75% of pregnant women in a country‐wide survey were born in Australia but only 48% reported their ethnic background as Australian . Thus ethnic background is likely to be more amenable to understanding cultural influences on iodine‐containing food practices.…”

“…In response to the re‐emergence of mild iodine deficiency in some states of Australia, two strategies were implemented to ensure that all segments of the population obtained sufficient iodine: in 2009, the addition of iodised salt to bread and, in 2010, pregnant and lactating women were advised to take a supplement containing 150 μg iodine per day because of their higher requirements . Studies conducted since 2010 indicate that reported use of iodine‐containing supplements in pregnancy is not universal, ranging from 66 to 81% in WA, Victoria, NSW and SA, with strict adherence to dose and regularity appearing to be lower . Therefore many pregnant women rely exclusively or partially on dietary intake to meet their iodine requirement, thus an understanding of the consumption patterns, changes in these patterns and knowledge of food sources of iodine during pregnancy is important.…”

“…Although dairy products supplied half the food iodine of pregnant women in SA, increased consumption of non‐dairy milks because of, for example, self‐diagnosis of lactose intolerance, may reduce mean iodine intake. Indeed milk consumption by Australian adults declined by an average of 7% between the 1995 National Nutrition Survey (NNS95) and the Australian Health Survey 2011‐2012 .…”

Contemporary challenges to iodine status and nutrition: the role of foods, dietary recommendations, fortification and supplementation

“…Women reported rarely discussing iodine with their HCP, and lacking knowledge of dietary sources and importance of iodine for fetal development (43) . In Australia, a country with mild iodine insufficiency in pregnancy and mandatory iodine fortification of salt and bread as well as recommendations for iodine supplementation in pregnancy, knowledge regarding the adverse outcomes of ID and the importance of iodine has been found to be consistently poor in pregnant women (52,(57)(58)(59)(60) . Low self-confidence on whether women met the iodine requirements (20 %) could be explained from the lack of knowledge of dietary sources of iodine.…”

Vitamin and mineral supplementation during pregnancy: is more necessarily better?

“…Identifying the subtherapeutic potential of some products in the setting of an identified nutrient deficiency represents an important opportunity for intervention. The potential value of pharmacists contributing towards improved awareness around the use of supplements in pregnancy is further emphasised by a recent Australian study examining pregnant women's knowledge of and adherence to the recommendations for periconceptional folic acid and iodine supplementation . Although most women were aware of the importance of folic acid and iodine during pregnancy, only one in five women adequately adhered to the recommended intakes, even among those with planned pregnancies.…”