Abstract
Background: Folate plays an essential role in the prevention of neural tube defects, yet little is known about the folate status of women of reproductive age or to what degree the general population is aware of the importance of folate in early-life development. We aimed to determine folate status in women of reproductive age and pregnant women in Switzerland, and to assess folate awareness in the Swiss population. Methods: In a convenience sample of 171 women of reproductive age and 177 pregnant women throughout Switzerland, we measured red blood cell (RBC) folate concentration. In a second convenience sample (n = 784, men and women) we assessed folate knowledge with an online survey. Results: RBC folate concentration (median interquartile range) was 442 (366, 564) nmol/L in women of reproductive age and 873 (677, 1177) nmol/L in pregnant women. Folate deficiency (RBC folate <340 nmol/L) was found in 19.9% of women of reproductive age and 2.8% of pregnant women, while 91.8% of women of reproductive age and 52.0% of pregnant women showed folate concentrations indicating an elevated risk of neural tube defects (RBC folate <906 nmol/L). The online survey showed that a high proportion (≥88%) of participants were aware of folate’s role in neural tube defect (NTD) prevention and fetal development, yet knowledge about dietary sources and national recommendations of folate supplementation when planning pregnancy were limited. Conclusion: The high prevalence of folate inadequacy in Swiss women suggests an elevated risk of neural tube defects and calls for urgent measures to increase folate intakes.
Highlights
IntroductionIt is widely acknowledged that adequate folate status during the periconceptional period is critical and folic acid supplementation before conception helps to substantially reduce the risk for neural tube defects (NTDs) [1]
It is widely acknowledged that adequate folate status during the periconceptional period is critical and folic acid supplementation before conception helps to substantially reduce the risk for neural tube defects (NTDs) [1]. Based on this reduction in risk, most health organizations recommend that women of reproductive age (WRA) and especially those planning a pregnancy take daily folic acid supplements at levels of 400 μg or higher, beginning at least four weeks before conception and continuing throughout the first 12 weeks of pregnancy [2,3]
In our convenience sample of WRA and pregnant women (PW), we identified a respectively, were informed prior to pregnancy, and 31% and 35% were informed during pregnancy
Summary
It is widely acknowledged that adequate folate status during the periconceptional period is critical and folic acid supplementation before conception helps to substantially reduce the risk for neural tube defects (NTDs) [1]. Despite convincing evidence for NTD preventive effects associated with folic acid, a major problem is low adherence to the folic acid supplement recommendation, as reported in many countries [5,9] This is partly caused by unplanned pregnancies, and by overall low awareness of folate/folic acid and its role in the correct formation of the neural tube of the fetus. This development occurs during the first 28 days of pregnancy, the correct timing of supplements is a critical aspect of the recommendation but is challenging to communicate to the general public. Folate deficiency (RBC folate
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