Folic Acid Awareness Research Articles

The Japanese Teratology Society declares "Folic Acid Awareness Day" and "Neural Tube Defect Prevention Month".

The Japanese Teratology Society (JTS) is sending an important message to Japanese people through the declaration of Folic Acid Awareness Day and Neural Tube Defect Prevention Month. The purpose of this statement is to prevent the occurrence of Neural Tube Defects (NTDs) as much as possible through folic acid supplementation1 prior to and during conception. Briefly, NTDs, such as myelomeningocele and anencephaly, are congenital anomalies involving defects in the brain and/or spinal cord that develop around gestation week 6 (4 weeks after fertilization). A randomized controlled trial from United Kingdom in 19912 and a cohort study from China in 19993 demonstrated that NTDs are partially folic acid-preventable and that periconceptional folic acid supplementation could decrease the occurrence or recurrence by 40% to 70%. In 2000, the Ministry of Health and Welfare of Japan recommended that women planning a pregnancy should take folic acid 0.4 mg daily, from 4 weeks prior to conception to 12 weeks of gestation.4 Risk factors of NTDs among Japanese women comprise of not taking folic acid supplements, presence of myelomeningocele in patients within third-degree relatives, use of anti-epileptic drugs without folic acid, and low birth weight in the newborn.5 In 2017, JTS stressed on importance of taking folic acid 0.4 mg daily for those who plan to conceive, in order to reduce the risk of NTDs in the developing fetus.6 During the past quarter of century, the prevalence of myelomeningocele has not declined, while that of anencephaly has significantly decreased because the majority of pregnancies involving such fetal defects were terminated. The low awareness rates of the role that folic acid plays in the pregnancy7 and the low rates of folic acid supplementation prior to getting pregnant8 account for the overall trend for a lack of NTD decline in Japan. Hence, the present communication is urgent and important for not only the Japanese people but also people living in countries without folic acid fortification. We have decided that 3 April will be considered Folic Acid Awareness Day, as the pronunciation of “folic acid” in Japanese (You Sann) is similar to that of “3 April” (Yonn Sann). Further, the whole month of April will be remembered as the Neural Tube Defect Prevention Month. It is hoped that through the commemoration of this day and month every year with the character representing folic acid (Figure 1), Japanese people will recognize the importance and necessity of taking folic acid supplementation prior to and during pregnancy.9 We urge those of other academic societies who read or hear of this notice to voice solidarity with our endeavor and co-operate with us by spreading information and educating people regarding the great benefits of folic acid.

Awareness and Use of Folic Acid among Women of Childbearing Age.

Folic acid (FA) given before and during pregnancy reduces the risk of several birth defects, including neurologic, cardiac, urinary and other congenital anomalies in the newborn. Several studies around the world showed less than satisfactory awareness and intake of this important vitamin. We undertook the task of exploring this question among Lebanese women of childbearing age.Between June and November 2014, we conducted this cross-sectional study on women aged 20 to 40 years. The subjects, who agreed to participate, completed a questionnaire, which included questions on sociodemographic characteristics, lifestyle, and knowledge about FA roles during pregnancy, as well as their babies’ health.Seventy-six percent reported having knowledge about FA during pregnancy, but only a small proportion knew the benefits for taking it. Also, 93.9% of women took FA supplements during pregnancy, however only 33.6% of the participants took FA before becoming aware of their pregnancy.Public health interventions to improve awareness of FA’s roles before and during pregnancy are crucial to curtail birth defects. It is our opinion that it is a very fruitful preventive medicine tool in which every community should invest.

Awareness, knowledge, and use of folic acid among non-pregnant Korean women of childbearing age.

BACKGROUND/OBJECTIVESFolic acid supplementation before pregnancy is known to reduce the risk of neural tube defects. The purposes of this study were to investigate the awareness, knowledge, and use of folic acid supplements along with their associated factors among non-pregnant Korean women of childbearing age.SUBJECTS/METHODSFrom August 2012 to March 2013, 704 women aged 19–45 years completed a self-administered questionnaire regarding their awareness, knowledge, and use of folic acid as well as questions to identify risk of inadequate folate intake.RESULTSApproximately 67% of women reported that they had heard of folic acid, and 23.7% had knowledge of both the role of folic acid in preventing birth defects and appropriate time for taking folic acid supplements to prevent birth defects. However, only 9.4% of women took folic acid supplements at the time of the survey. Women aged 19–24 years, unmarried women, and women who had never been pregnant were less likely to be aware and knowledgeable of folic acid or take folic acid supplements. In addition, women at high risk of inadequate folate intake were less likely to take folic acid supplements. In a multivariate analysis, women aged 19–24 years, women with a high school diploma or lower education level, and unmarried women were less likely to be aware and have knowledge of folic acid. The percentage of women taking folic acid supplements was significantly higher among knowledgeable women than among unknowledgeable women.CONCLUSIONSThese results support our hypothesis that women with knowledge of folic acid are more likely to take folic acid supplements. Therefore, educational programs or campaigns to improve knowledge regarding the importance of folic acid and to promote consumption of folic acid supplements as well as folate-rich foods are needed to target young, less educated, and unmarried women.

Knowledge of folic acid and spina bifida among female college students and employees in Asir region, Saudi Arabia

Background: Spina bifida is one of the most challenging and partially preventable congenital diseases that can be prevented with adequate amounts of folic acid (FA) intake before conception and throughout the first few months of pregnancy. Knowledge about the adequate timing and duration of FA intake is critical for prevention. Methods: A questionnaire-based, cross-sectional study was conducted to assess spina bifida and FA awareness among female students at King Khalid University (KKU), Abha, Saudi Arabia. The study included three groups: health-college female students (HCS), non-health-college female students (NHCS), and KKU female employees (others). These three groups were attendants at the Spina Bifida Awareness Week that was held at KKU in March 2017. Results: There were 1,366 participants, of whom 11% were HCS, 59% were NHCS, and 30% were “others”. Across all tested domains (i.e., spina bifida awareness, FA intake time and duration, diseases prevented by folic acid intake, and food rich in folic acid), it was found that statistically significant differences existed. The results showed a highly significant lack of knowledge towards the aforementioned domains in both the NHCS and “others” groups. Marital status and number of children were independent variables and showed statistically significant differences in knowledge toward the tested domains. Conclusion: In Saudi Arabia, more attention should be paid to educate women of childbearing age on the importance of FA intake in preventing spina bifida. These results indicate how FA intake awareness should be embedded in junior-high and secondary school curricula to further educate females on the importance of FA.

Pregnancy-related health behavior of Saudi women and key information sources: A clinic-based study

Background: Topics concerning preconception, prenatal health, and prenatal care-seeking behavior among Arab women have not been sufficiently addressed. This study focuses on these behaviors in Saudi pregnant women as they relate to birth outcomes. Aims: The aim of the study was to characterize preconception and prenatal health behavior concerning nutrition and physical activity and to identify health information sources that may impact their health literacy. Methods: A sample of 258 pregnant Saudi women recruited from two major hospital clinics in Riyadh were interviewed. Factors affecting folic acid (FA) awareness and consumption were examined individually using logistic regression to generate crude odds ratio (OR) and adjusted OR (AOR). Results: An overwhelming majority (>90%) is aware of significance of FA, however, less than half took supplements preconceptionally or consumed foods rich in FA. Younger (<30 years) women (AOR = 0.43; 95% confidence interval [CI] = 0.19, 0.98; P < 0.05) and women with lower education level (AOR = 0.36; 95% CI = 0.15, 0.89; P < 0.05) are less likely to have heard or known about the role of FA in preventing birth defects (AOR = 0.45; 95% CI = 0.23, 0.88; P < 0.05) and less likely to have knowledge of foods rich in FA (AOR = 0.57; 95% CI = 0.32, 1.0; P < 0.05) compared to college-educated women. Conclusion: The results suggest that awareness of folate importance is high, however, the consumption or supplementation of folate is low. The study findings highlight the need for routine preventative health care and educational opportunities for couples. In particular, younger women and women with lower educational level should be targeted for interventions.

Awareness, use and information sources of folic acid supplementation to prevent neural tube defects in pregnant Japanese women.

Folic acid supplementation and folate-rich diets are recommended for women of childbearing age worldwide to prevent congenital anomalies. We aimed to determine the current status of folic acid supplementation among pregnant Japanese women and identify means to increase the intake of these supplements. Cross-sectional study. A total of 1862 pregnant women who consulted the perinatal centre from September 2014 to December 2015 completed a questionnaire concerning knowledge about folic acid, sources of information and the use of folic acid supplements. Osaka Medical Center and Research Institute for Maternal and Child Health (Japan). In our study population, only 20·5 % of pregnant women took folic acid supplements periconceptionally even though 70·4 % knew about the protective effect of folic acid. A multivariate analysis demonstrated that age ≥35 years (OR=2·80; 95 % CI 1·24, 6·29) and knowledge of the benefits of folic acid (OR=2·64; 95 % CI 1·92, 3·62) were associated with periconceptional folic acid use, and multiparity was negatively associated with such use. Compared with those who took folic acid supplements periconceptionally, women who did not take supplements received information through passive and less interactive media. Although folic acid awareness was relatively high among pregnant Japanese women, folic acid supplementation before conception was insufficient. To increase the intake of folic acid supplements in countries in which foods are not fortified with folic acid, an effective public health approach promoting behavioural change is necessary for women of reproductive age.

Folic acid usage and associated factors in the prevention of neural tube defects among pregnant women in Ethiopia: cross-sectional study

BackgroundNeural tube defects are among the most common birth defects, contributing to miscarriage, infant mortality, severe congenital abnormalities and serious disabilities. It is burdensome to patients, caregivers, healthcare systems and society. It could be reduced if women consume a folic acid supplement before and during the early weeks of pregnancy. This study assesses folic acid usage and associated factors for the prevention of neural tube defects among pregnant women in Ethiopia.MethodsInstitution based cross-sectional study was conducted on 417 systematically sampled, consented pregnant women that visited Adama hospital medical college for antenatal care during August to November 2014. Pretested interviewer administered questionnaire was used to collect socio-demographic, obstetric characteristics and folic acid usage of women.ResultAbout 48.4% of women took a folic acid supplement at different period of pregnancy; but, only 1.92% of women took the supplement at a protective period against neural tube defects. Age, the early timing of antenatal registration, was a preconception consulted, previous unsuccessful pregnancies and level of folic acid awareness were significantly associated with folic acid usage for prevention of neural tube defects.ConclusionsFolic acid usage during the protective period against neural tube defects among women in Ethiopia is very low, so healthcare plan to improve intake of folic acid is required.

Survey on awareness of folic acid recognition and intake by female students.

To reduce the risk of neural tube defects, studies have been conducted on female students of medical services, nutritional science, and nursery education that investigated the awareness of folic acid by using questionnaires. Many investigators have suggested the need to provide detailed information about the awareness of folic acid and knowledge about folic acid intake and neural tube defect risk reduction. The dietary habits of female students showed a positive correlation with their estimated folic acid intake, suggesting that improvements in dietary habits are associated with the consumption of folic acid. The importance of folic acid intake must be more aggressively promoted among female students. Thus, many learning opportunities should be provided for such students to help increase their folic acid intake.

Folic Acid Education for Hispanic Women: The Promotora de Salud Model.

Although rates of neural tube defects (NTDs) have declined in the United States since fortification, disparities still exist with Hispanic women having the highest risk of giving birth to a baby with a NTD. The Promotora de Salud model using community lay health workers has been shown to be an effective tool for reaching Hispanics for a variety of health topics; however, literature on its effectiveness in folic acid interventions is limited. An intervention using the Promotora de Salud model was implemented in four U.S. counties with large populations of Hispanic women. The study comprised the following: (1) a written pretest survey to establish baseline levels of folic acid awareness, knowledge, and consumption; (2) a small group education intervention along with a 90-day supply of multivitamins; and (3) a postintervention (posttest) assessment conducted 4 months following the intervention. Statistically significant differences in pre- and posttests were observed for general awareness about folic acid and vitamins and specific knowledge about the benefits of folic acid. Statistically significant changes were also seen in vitamin consumption and multivitamin consumption. Folic acid supplement consumption increased dramatically by the end of the study. The Promotora de Salud model relies on interpersonal connections forged between promotoras and the communities they serve to help drive positive health behaviors. The findings underscore the positive impact that these interpersonal connections can have on increasing awareness, knowledge, and consumption of folic acid. Utilizing the Promotora de Salud model to reach targeted populations might help organizations successfully implement their programs in a culturally appropriate manner.

Preconceptional use of folic acid and knowledge about folic acid among low-income pregnant women in Korea.

BACKGROUND/OBJECTIVESFolic acid supplementation before pregnancy is known to significantly reduce the risk of having a baby with neural tube defects (NTDs). Therefore, it is important for women to be aware of the effects of folic acid supplementation before pregnancy. The purpose of this study was to investigate the awareness and preconceptional use of folic acid and to assess the current knowledge about folic acid among low-income pregnant women in Korea.SUBJECTS/METHODSA questionnaire survey was conducted in 2012. Five hundred pregnant women were selected from the waiting list for the Nutriplus program implemented in public health centers using a multistage clustered probability sampling design. Data from 439 women were analyzed after excluding ones with incomplete answers.RESULTSAmong women who responded to the questionnaire, 65.6% had heard of folic acid before pregnancy, and 26.4% reported on the preconceptional use of folic acid. Women with a university degree or higher education were more likely to be aware of folic acid and to take folic acid in the preconception period. In a multivariate logistic regression, when age, education level, household income, employment status, gravidity, parity, and folic acid awareness were included in the model, folic acid awareness was a strong predictor of preconceptional folic acid use. As of interview, 85.4% and 77.7% of women were aware of the NTD-preventive role of folic acid and the appropriate time to take folic acid, respectively. The main sources of information on folic acid were healthcare professionals (41.2%), friends and family members (31.2%), and the media (26.5%).CONCLUSIONSOur results suggest that public health strategies are needed to increase the preconceptional use of folic acid among Korean women.

Folate deficiency and utilization of folic acid fortified flour among pregnant women attending antenatal clinic at Pumwani Maternity Hospital, Kenya, 2015.

Introductionin 2012, the Government of Kenya amended the Food, Drug and Chemical Substances Act to make the fortification of maize and wheat flour with folic acid mandatory. We assessed folate deficiency, awareness and use of folic acid fortified flour among pregnant women receiving antenatal care (ANC) at a clinic at Pumwani Maternity Hospital, Kenya, 2015.Methodswe conducted a cross-sectional survey at Pumwani Maternity Hospital between October and November 2014. We enrolled pregnant women who received ANC and interviewed them using a semi-structured questionnaire after obtaining informed consent. Blood samples were collected from all study participants and serum folate level was analyzed by electrochemiluminescence immunoassay. Folate deficiency was defined as serum folate of < 10nmols/L and borderline folate deficiency was defined as serum folate of between 10nmols/L and 15nmols/L.Resultsamong the 247 study participants, two (1%) had folate deficiency. One hundred and seventy-nine (73.4%) had heard about folic acid, but only 56 (23%) had heard about folic acid fortified flour. Overall, 198 (80%) study participants consumed fortified brands of maize flour and 205 (84%) consumed fortified brands of wheat flour; only four (2%) and two (1%) of study participants consumed specific brands of maize and wheat flour respectively because they were fortified.Conclusionthe prevalence of folate deficiency was low and this may have been because of the availability of fortification programs. Although there was limited knowledge of fortified flour, utilization was high. The Kenyan Ministry of Health should enforce implementation of the legislation on maize flour and wheat flour fortification by all milling industries.

Announcement: National Birth Defects Prevention Month and Folic Acid Awareness Week — January 2016

Announcement: National Birth Defects Prevention Month and Folic Acid Awareness Week — January 2016

Awareness and use of folic acid in a clinic-based Saudi pregnant population

Background: Neural tube defects are amongst the most common birth defects worldwide. Many of the patients in our primary care clinic at King Faisal Specialist Hospital and Research Center Riyadh, Saudi Arabia, were not aware of the importance of folic acid supplementation in the prevention of. Objective: Our aim was to evaluate current level of awareness, use and understanding of FA supplementation in pregnant Saudi women. Materials and Methods: This was a questionnaire-based cross-sectional study. Two hundred and fifty four Saudi pregnant women were surveyed. They were asked about the use and benefits of folic acid before and during pregnancy. This information was collected during regular office visits to the Family Medicine Department at our hospital over a period of 1-year. Questionnaires were completed by the physicians at the patient's initial clinic visit. Results : 85.4% of the pregnant women were under 35 and 14.6% were over 35. 66% of the studied group started folic acid when they realized they were pregnant; only 22% started before conception. Around 50% of the women gave the correct reason for taking folic acid. Conclusion: There is a definite need to increase the level of awareness in Saudi ladies of the importance of taking folic acid in the preconception period. This can be done during visits for premarital screening and well-woman checks.

Folic acid and neural tube defects: are Jordanian pregnant women aware?

Objectives: To assess Jordanian pregnant women’s awareness of folic acid and its contribution to neural tube defects (NTDs) prevention and to their folic acid intake. Materials and Methods: One thousand pregnant women were interviewed about their knowledge of folic acid for NTDs prevention and their folic acid intake using a questionnaire. Results: Of 1,000 women surveyed, 93.4% reported hearing of folic acid and 30.3% of NTDs. Only 16.2% knew that folic acid can reduce NTDs risk; 42.0% of those aware of folic acid believed it should be taken periconceptionally but only 16.9% did so. The most common information sources on folic acid were physicians (82.8%). Conclusions: Whereas a large percentage of pregnant Jordanian women were aware of folic acid, only a small proportion are aware that it prevents NTDs and should be taken periconceptionally. Also, there was a gap between awareness, knowledge, and intake of folic acid. Awareness and knowledge of NTDs was less prevalent among Jordanian women. Despite the efforts that have been undertaken, further effort is required to educate Jordanian women about folic acid contribution to NTDs prevention.

Promotora de Salud: Promoting Folic Acid Use Among Hispanic Women

The U.S. Public Health Service recommends that all women in the United States capable of becoming pregnant consume 400 μg of folic acid daily to reduce their risk of having a pregnancy affected by a neural tube defect (NTD). However, disparities exist in the consumption of folic acid, with Hispanic women having lower rates of folic acid consumption than non-Hispanic white women. A community-based feasibility study was designed to assess the utility of the promotora de salud model to promote consumption of multivitamins containing folic acid for the prevention of NTDs among Spanish-speaking Hispanic women in North Carolina. The study consisted of an educational intervention given by a promotora (a lay, community health worker), with data collection occurring at baseline and four months post-intervention to measure changes in knowledge and behavior. Overall, 52% (n=303) of participants completed all components of the study. Self-reported daily multivitamin consumption increased from 24% at baseline to 71% four months post-intervention. During the same time frame, awareness of folic acid increased from 78% to 98% and knowledge of the role of folic acid in the prevention of birth defects increased from 82% to 92%. The results of this study indicate that the promotora de salud model may be effective in reaching a subpopulation of women with the folic acid message. Additional studies with larger population sizes are warranted to validate these findings.

The relationship between awareness and supplementation: which Canadian women know about folic acid and how does that translate into use?

Although the benefit of folic acid (FA) to prevent neural tube defects (NTD) is well established, not all women take supplements in the periconceptional period. This study used data from the Public Health Agency of Canada's Maternity Experiences Survey to evaluate determinants of awareness of FA among recently pregnant women in Canada, and the extent to which that translated into actual supplement usage. Telephone interviews took place between October 23, 2006 and January 31, 2007 with women who were 5 to 14 months postpartum to survey their experiences during pregnancy, birth and the postpartum period. These analyses were conducted on women who responded to questions relating to FA supplementation. The 6,421 respondents were weighted to represent 76,508 women using weights which corresponded to the sampling strata, the mother's first language and Aboriginal status. Overall, 77.6% of surveyed women knew that taking FA periconceptionally could help protect against NTD. Women who were younger, single or separated reported less awareness and use of FA, while higher maternal age, level of education and income were positively associated with both knowledge and use. Despite longstanding national guidelines for supplementation, there were regional variations in knowledge and use of FA. The data indicate clear socio-demographic differences among Canadian women with respect to their knowledge and use of FA. Although most women understood the benefits of FA supplementation, a little over a third of them did not take FA supplements prior to becoming pregnant, and less than half supplemented according to national guidelines. Identification of those subpopulations whose use of supplements is suboptimal may allow for targeted educational or other interventions to further encourage FA use.

Use of folic acid among pregnant women attending antenatal care clinic at Al-Hejrah primary health care center, Makkah Al-Mokarramah, Saudi Arabia.

Background: In KSA, there was an apparent decline in the incidence of NTDs after the folic acid flour fortification. However, the incidence is still high, and usually associated with serious morbidity. Aims & Objective: To assess the level of knowledge about folic acid supplements and its associated factors as well as to estimate the prevalence folic acid intake during first trimester of pregnancy among pregnant women attending antenatal care clinic at Al-Hejrah primary health care center, Makkah Al-Mokarramah, 2012. Materials and Methods: It was a cross-sectional analytic study included a systematic random sample of pregnant women who attended Al-Hejrah primary health care center, Makkah at the time of conducting the study in 2012. An interview Arabic questionnaire to assess maternal knowledge and use of folic acid was prepared by the researcher and revised by supervisor. Validation during pilot study was assaulted. It is consists of 17 questions covering 2 parts; socio demographic features and general knowledge of folic acid with its coexisting conditions. Results: The study included 66 pregnant women. Their age ranged between 18 and 41 years with a mean of 29±6.7 years. All were Saudi. Among more than two-thirds of them (69.7%), physician was the source of information followed by internet (33.4%) and TV (19.7%). Almost two-thirds (65.2%) of participated pregnant women had sufficient knowledge about the importance of folic acid supplementation during pregnancy. Pregnant women who read about folic acid and those having more sources of information about importance of folic acid intake during pregnancy had sufficient knowledge about it. The majority of pregnant women had taken folic acid during pregnancy (81.8%). Conclusion: The results of this study showed that the level of knowledge about folic acid and its importance during pregnancy among pregnant women attended Al-Hejrah primary health care center are satisfactory. However, additional measures directed at understanding folic acid usefulness and promoting folic acid awareness and consumption among all non-pregnant Saudi women of childbearing age are warranted.

Awareness and use of folic acid among reproductive age and pregnant women.

Folic acid supplementation during the pre-conception period and first trimester of pregnancy reduces the incidence of neural tube defects (NTDs). In this study, our aim is to investigate knowledge and use of folic acid among women attending our clinic. Between January 2012 and June 2012, 817 participants, consisting of 345 pregnant and 472 non-pregnant women, were enrolled in this survey. A questionnaire including socio-demographic information, knowledge and use of folic acid was applied. 48.2% of participants were aware of folic acid for the prevention of congenital anomalies. Knowledge and use of folic acid increase with socio-economic status and educational level. Participants who were already knowledgeable about folic acid cited health care professionals as common sources of information. Although 88.2% of the pregnancies were planned among the currently pregnant women, only 14.2% of them stated that they had used folic acid in the pre-conception period. The use of folic acid during the first trimester among pregnant women was 48.6%. Furthermore, 18.4% of participants had not used folic acid and 29.3% of them had not remembered whether they had or not. Even though 94.4% of health care professionals had heard about folic acid, 28.3% reported that they had used folic acid before pregnancy. It is thought that there is a relatively high incidence of NTD in Turkey, which is due to inadequate information about NTDs and the use of folic acid. Primarily health care professionals such as midwives, nurses and family physicians should aim to inform all reproductive age women about folic acid for the prevention of NTDs, who should be encouraged to take the supplement when planning pregnancy.

Folic Acid Awareness vs. Supplementation: A New Tool to Bridge the Gap

This Report from the Field describes a folic acid awareness event hosted by a College of Pharmacy in conjunction with a local YWCA in observation of National Birth Defects Prevention Month and includes a discussion of the disparity between folic acid awareness and consumption and proposes a new tool to decrease this gap.

Women&amp;rsquo;s awareness and periconceptional use of folic acid: data from a large European survey

ObjectiveTo investigate the awareness and use of folic acid in European women of child-bearing age, particularly in the setting of pregnancy and pregnancy planning.MethodsBetween November 2009 and December 2009, women aged 15–49 years old from 18 European countries completed a 30-minute structured questionnaire either online or via face-to-face interviews. To achieve nationally representative samples for each country quotas were set for age, education, income, and regional distribution.ResultsA total of 22,925 women participated in the survey. Of the respondents, 58% had at least one biological child, and of these 38% reported that their first pregnancy was not planned. Nearly 60% of women who planned their pregnancy indicated that they had stopped using their method of contraception without first consulting a doctor or another health care professional. Overall, 70% reported that they had heard of folic acid and 40% stated that they knew the benefits of folic acid. However, when prompted to indicate which diseases and/or birth defects folic acid can protect against, only 17% knew that folic acid can reduce the risk of neural tube defects/spina bifida.ConclusionsA large proportion of European women of child-bearing age in this survey were unaware that periconceptional folic acid supplementation reduces the risk of birth defects.