Folic acid and prevention of neural-tube defects

Abstract

Sir—In their study of pregnant women's knowledge and behaviour, in relation to folic acid Jennifer Wild and co-workers (July 5, p 30)1Wild J Sutcliffe M Schorah CJ Levene MI Prevention of neural-tube defects.Lancet. 1997; 350: 30-31Summary Full Text Full Text PDF PubMed Google Scholar report that 35·9% of the pregnancies were unplanned. This is an important statistic, the implications of which they do not explore. The figure concurs with findings from a 1997 Health Education Authority (HEA) survey of 299 pregnant women, 30% of whom had not planned their pregnancy.2Health Education AuthorityFolic acid and folates: survey among pregnant women and recently pregnant women. Health Education Authority, London1997Google Scholar One of the greatest challenges the HEA faces in the final year of its education campaign is to make all women of childbearing age aware of the importance of folic-acid supplementation by positioning it as a general women's health issue. In a recent HEA study, 95% of general practitioners knew that folic acid should be taken before conception, but only 42% gave this advice to women of childbearing age.3Health Education AuthorityFolic acid awareness tracking among health professionals—wave 2. Health Education Authority, London1997Google Scholar For more women to take supplements at the correct time, information about folic acid needs to reach them before they are planning to be pregnant. This is why the HEA is now calling on general practitioners, nurses, family-planning specialists, and other health professionals to broaden their approach to women by giving advice on folic acid as part of other related consultations, such as discussions about contraception or dietary advice. Women should be advised of the benefits of eating more foods rich in folic acid, particularly fortified foods such as breads and breakfast cereals. If this can be achieved, concentrations of this important B vitamin will be boosted before pregnancy. This would not only be of benefit to women whose pregnancies are unplanned, but also to those who have not taken supplements before conception. The HEA recently introduced a new folic-acid flash labelling scheme so that women can identify foods fortified with folic acid. The ideal is for all pregnancies to be planned, and for all women to take a daily 400 ug folic-acid supplement as soon as they start trying to conceive until the 12th week of pregnancy. The HEA is working with the commercial and education sectors, the media, voluntary groups, and other healthpromotion specialists to make women aware of this advice. In the first year of the HEA campaign, awareness of folic acid trebled, from 9% in 19954Department of Health/Central Office of InformationFolic acid—knowledge in the general female population. Department of Health, London1995Google Scholar to 27% in 1996.5Health Education AuthorityFolic acid awareness tracking among women aged 16 to 45. Health Education Authority, London1996Google Scholar In addition, sales of over-the-counter folic-acid supplements increased by 50% in the first 8 months of the public education campaign (unpublished observation). Supporting, maintaining, and improving this work is a challenge for all health professionals who work with women of childbearing age, and one to which we hope they will continue to rise ever more imaginatively.