Supplementation in pregnancy: determinants of the compliance with guidelines in Portugal, 2019

Abstract

Abstract Background Folic acid (FA) and iodine supplementation in pregnancy are nutritional interventions recommended by the World Health Organization, which are widespread in Portugal. Since there isn`t available reimbursed medicine containing only 400µg of FA and the increasing evidence that excessive supplementation in FA can lead to adverse outcomes for mothers and their offspring, make interesting to assess the clinical practice. Therefore, it`s important to understand the actual adherence to FA and iodine supplementation in periconceptional period, as well as to identify its determinants. Methods Telephonic interviews (n = 140) were conducted with mothers enrolled in Primary Health Centers, recruited in their children's vaccination appointment (aged 0-6 months). Among the variables studied are sociodemographic, medical and obstetric history, diet and supplements used during pregnancy. Data were analyzed using the Statistical Package for Social Sciences® program. Results The prevalence of iodine and FA supplementation among mothers was high (98%). About 3/4 of the interviewees reported having planned their pregnancy, and of these, 1/4 did not have a preconception consultation. The first pregnancy consultation took place at 6-10 weeks, on average. FA supplementation has the greatest discrepancies with the guidelines: only 29% (n = 40) started at the recommended time, 3% (n = 4) stopped at 12 weeks of pregnancy, and only 33% (n = 34) had 400µg of FA. Fifty one percent of the mothers indicated that they were unaware that they should start supplementation before the interruption of the contraceptive method. Conclusions These results suggest the need for enhanced antenatal care and interventions that increase women's health literacy. Public Health strategies in order to increase preconception consultations are needed as well as a national joint effort towards the homogenization of clinical practices regarding the prescription of supplementation in pregnancy. Key messages Folic acid (FA) and iodine supplementation in pregnancy are widespread practices in Portugal despite the fact that no available reimbursed medicine containing the recommended 400 µg of FA is available. Antenatal care and women's health literacy should be improved in order to comply with the recommendations, as well as the availability of a reimbursed medicine containing 400µg of folic acid.