Preconceptional folic acid supplement use in Lebanon

Abstract

Objective: The objective of the present study was to assess the prevalence and determinants of preconceptional folic acid supplement use among pregnant women in Lebanon. Design/setting/subjects: The study was a descriptive epidemiological study. Analysis was performed on 5280 deliveries admitted to twelve member hospitals of the National Collaborative Perinatal Neonatal Network during the period September 2003-January 2005. Information on folic acid intake and maternal and neonatal characteristics were obtained from obstetric charts along with direct interviews performed by trained personnel. Logistic regression was performed to determine the predictors of preconceptional folic acid use. Results: The overall use of preconceptional folic acid supplementation was 14?0 % (18?6 % in urban hospitals v. 2?7 % in rural hospitals). Higher socio-economic status, lower parity and having a history of previous spontaneous abortions were significantly associated with preconceptional folic acid use. Conclusion: Our study shows that Lebanon currently has a low rate of preconceptional folic acid supplement use. Intervention through the means of awareness campaigns needs to be implemented on a national level. Keywords Folic acid Preconception LebanonCongenital anomalies affect an estimated 3 % of newborns worldwide. In the early 1990s, it ranked tenth on the list of disability-adjusted life years lost in the Global Burden of Disease Study (1) . Nearly 50 years ago, it was found that the B-vitamin folic acid plays a role in promoting normal embryonic development (2) . It was advised as a general guideline that all females of childbearing age take a supplement of 0?4 mg folic acid to reduce the risk of congenital malformations, including neural tube defects (NTD) (3) . Periconceptional supplementation with folic acid (before conception and during the first 12 weeks of pregnancy) was found to decrease the risk of NTD by 50-70 %, while also protecting from other birth defects such as those of the heart, limbs, urinary tract, cleft lip and palate, as well as other major structural abnormalities (4,5) . The 1990s and early 2000s witnessed an increase in the worldwide use of periconceptional folic acid supplementation as many developed countries promoted awareness campaigns on the importance of folic acid. Increases in the prevalence of periconceptional folic acid use were seen: from 27 % to 48 % in the UK (6) , from 5 % to 36 % in The Netherlands (6) , from 14 % to 83 % in Ireland (7) , from 19 % to 43 % in Western Australia (8) , from 32 % to 40 % in the USA (3) and from 17 % to 28 % in Canada (9)

Women’s Awareness and Associated Factors on Preconception Folic Acid Supplementation in Adet, Northwestern Ethiopia, 2016: Implication of Reproductive Health

“…The finding of this study is in line with studies done in Lebanon [24], the Netherlands [25], China [29], and France [31]. This is probably due to the fact that women who have a high income may have communication media and they may access information regarding folic acid.…”

“…Women who had primary school education, secondary school education, and college and above were 3.9, 4, and 4.8 times more likely had good awareness on preconception folic acid supplementation than women who had no formal education, respectively (AOR 3.94, CI 2.56–4.78; AOR 4.05, CI 2.79–6.94; and AOR 4.77, CI 1.85–6.98). This finding agrees with studies done in Nigeria, Lebanon, the Netherlands, China, and Pakistan [24, 25, 27–29]. The association may be explained by the fact that when individuals are being educated, they can easily read and understand information regarding folic acid and educated women might have interest to read, listen, and watch any information sources.…”

“…The result of this study is lower than those of many studies conducted in developed countries like Canada (81%) [23], Lebanon (71.9%) [24], the Netherlands (57.3%) [25], China (34.6%) [29], and Nigeria (25.5%) [28]. This difference may be due to the study population difference, in which previous studies were done among pregnant women, whereas this study was carried out in all reproductive age group women.…”

Knowledge and use of folic acid for birth defect prevention among women of childbearing age in Shanghai, China: A prospective cross-sectional study

“…Firstly, this study has revealed that only 14.9% women at childbearing age in Shanghai, China, regularly take folic acid, similar to that in women living in Croatia (14.4%) [19] and Lebanon (14.0%) [20] and lesser than that in women of Israel (34.0%) after a five-year campaign for promoting the use of folic acid [21]. In addition, 49.7% of women at childbearing age were aware of the benefits of folic acid intake compared with 20–52% in the US [19,21,22].…”

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].…”