Periconceptional Folic Acid Use Research Articles

Folic acid supplements and perinatal mortality in China.

Periconceptional use of multivitamins containing folic acid prevents external major birth defects, especially neural tube defects. We aimed to explore the effects of maternal folic acid supplementation alone on perinatal mortality with or without external major birth defects plus neural tube defects. From the China-US Collaborative Project for Neural Tube Defects Prevention, we identified 222, 303 singleton pregnancies with detailed information on periconceptional folic acid use, defined as folic acid supplementary before the last menstrual date until to the end of the first trimester. Perinatal mortality included stillbirths after 20 weeks' gestation and early neonatal deaths within 7 days of delivery. Among the fetuses or infants of women who did not take folic acid, the rate of perinatal mortality was 2.99% and 1.62% at least 20 weeks' gestation in the northern and southern regions. Among the fetuses or infants of the women with periconceptional use of folic acid, the rates were 1.85% and 1.39% in the northern and southern region. The estimated relative risk for perinatal mortality [adjusted risk ratio (RR), 0.72; 95% confidence interval (CI), 0.61- 0.85], stillbirth (adjusted RR, 0.78; 95% CI, 0.64-0.96), early neonatal mortality (adjusted RR, 0.61; 95% CI, 0.45-0.82), and neonatal death (adjusted RR, 0.64; 95% CI, 0.49-0.83) in northern China was significantly decreased in association with periconceptional folic acid supplementation. Compared with northern, there was a lesser effect in southern China. Periconceptional intake of 400μg folic acid daily reduces the overall risk perinatal mortality, as well as the risk from external major birth defects and neural tube defects, especially in northern China.

Awareness of Periconceptional use of Folic Acid to Prevent Neural Tube Defects in Young Females of Dakshina Kannada Region, India: A Cross-sectional Study

Introduction: Neural Tube Defects (NTDs) are one of the common congenital anomalies leading to miscarriages and serious disabilities in newborns. NTDs are the second most common type of birth defects. Even though the aetiology of NTDs is multifactorial, Folic Acid (FA) deficiency is the most common cause. There are limited Indian studies on awareness of FA usage in the general public. Aim: To assess the awareness and usage of FA to prevent NTDs in young ladies of Mangaluru, Dakshina Kannada (DK) district, Karnataka, India. Materials and Methods: It was a community-based crosssectional study conducted at Father Muller Medical College in Dakshina Kannada district, Mangaluru, Dakshina Kannada (DK) district, Karnataka, India from August 2023 to October 2023. A total of 300 young Indian females aged 18-35 years, residing in the study district, were randomly chosen as participants. Data were collected by an interviewer using a semistructured questionnaire with two components. Part 1 focused on sociodemographic details, while Part 2 gathered information on the awareness of FA supplements, dietary sources of FA, the best time, and dosage of FA supplements to prevent NTDs. Descriptive analysis of the data was done. Results: The study included 90 married and 210 unmarried females. The average age of the participants was 23.7±5.7 years. The study results observed that only 103 (34%) of the participants had heard about FA supplements. A total of 240 (80%) of them said they were not aware of the preferred time for FA. Only 9 (3%) females could mention the correct dose of FA. Conclusion: The study results indicate a gross lack of awareness about FA supplements to prevent NTDs in the general population of the region.

Periconceptional folic acid usage and its associated factors in eastern Sudan: A cross-sectional study.

Several countries poorly adhere to the World Health Organization's recommendation of folic acid supplementation in the periconceptional period, especially in limited-resource settings. The objective of this study was to investigate the prevalence of and the factors associated with folic acid usage in the periconceptional period among pregnant women at Gadarif Maternity Hospital in eastern Sudan. This is a cross-sectional study. This study was conducted in eastern Sudan from April to September 2022. A total of 720 pregnant women in their first trimester were enrolled. The sociodemographic characteristics and clinical and obstetrical data of pregnant women in their first trimester were assessed using a face-to-face questionnaire. In addition, multivariate regression analysis was performed. In this study, the median (interquartile range) of the age and gravidity of the enrolled women was 26.3 (24.14-29.52) years and 2 (1-4), respectively. Of these 720 women, 423 (58.8%) used folic acid during the periconceptional period, while 27 (3.7%) women used folic acid in the preconceptional period. None of the investigated factors (age, residence, education, employment, body mass index, or gravidity) were associated with periconceptional use of folic acid. The study revealed a low prevalence of folic acid usage in preconceptional period among pregnant women in eastern Sudan. Additional efforts are needed to promote folic acid usage in the preconceptional period as well as in the first trimester.

Knowledge and Practices on Periconceptional use of Folic Acid for the Prevention of Neural Tube Defects Among Women in Childbearing Age in Boralesgamuwa Medical Officer of Health Area, Sri Lanka

Introduction: Neural Tube Defects (NTD) remain a major public health burden globally. It is widely acknowledged that folic acid plays a vital role to reduce the risk of developing NTDs. The study aimed to determine knowledge, and practice regarding periconceptional use of folic acid for the prevention of NTD among women in childbearing age at Boralesgamuwa Medical Officer of Health (MOH) area, Sri Lanka.Methods: A descriptive cross-sectional study was carried out among randomly selected 422 women in childbearing age in the said MOH area. Data were collected through a pre-tested interviewer administered questionnaire. The overall knowledge level was classified as adequate (>75%), moderately adequate (50-75%) and inadequate (<50%).Results: Out of 422 participants, the majority was Sinhalese (95.7%), married (66.8%) and unemployed (62.1%). Mean age was 32.02 ±8.625 years. Nearly 56 % had heard about NTDs and 95.5% had heard about folic acid. A majority (279, 66.1%) had ‘inadequate’ level of knowledge, 120 (28.4%) had ‘moderately adequate’ knowledge and only 5.5% (n=23) had ‘adequate’ knowledge. Approximately 60% had taken folic acid and out of them only 42.4% had started folic acid before pregnancy. Age (p<0.001), marital status (p<0.001), parity (p<0.001), educational qualification of participants (p<0.001), monthly household income (p=0.004) and where health services sought from (p <0.001) were associated with the level of knowledge.Conclusions: Majority of participants had inadequate knowledge regarding periconceptional use of folic acid for the prevention of NTDs. However, out of those who have used FA, majority had started to take it before pregnancy. The study findings warrant more educational programmes on the topic bridging the gap of knowledge among women in childbearing age in the study setting.

Periconceptional Folic Acid Use and Its Effects on Neural Tube Defects - Five Counties, Shanxi Province, China, 2010-2016.

Robust evidence indicates that supplementing with folic acid periconceptionally may decrease the risk of neural tube defects (NTDs) in fetuses. Over half of the mothers in both the NTD case group and the control group utilized folic acid supplements during the periconceptional period, showing no notable variations between the two groups. However, there was a significantly higher percentage of mothers with NTD cases who exhibited poor compliance in folic acid use compared to control mothers. A significantly lowered compliance with folic acid intake was observed among women facing unintended pregnancies and those with lower education levels. Universal education regarding folic acid action for women of childbearing age should be strengthened to improve compliance with folic acid supplementation in the periconceptional period and further reduce the prevalence of NTDs.

Prevalence of neural tube defects at Debre Berhan Referral Hospital, North Shewa, Ethiopia. A hospital based retrospective cross-section study.

BackgroundNeural tube defect (NTD) is a structural defect of the central nervous system of the developing embryo during the first month of developmental process. Most congenital malformations are potentially preventable cause of perinatal morbidity and mortality. Worldwide, around 10% of infant mortalities are due to nervous system defects. In Ethiopia there are limited published data regarding the prevalence and established preventive strategy of NTDs. The purpose of this study was to assess the prevalence of NTDs among pregnancy outcomes in Debre Berhan Referral Hospital (DBRH), Ethiopia.MethodsHospital based retrospective cross sectional, descriptive study was conducted on registration of all pregnancy outcomes from August 30, 2017 to August 30, 2019 at DBRH, Ethiopia. The collected data were checked for completeness and consistencies, and cleaned, coded and entered using Epi data version 4.2 and exported to Statistical Package for Social Sciences (SPSS) software version 20 for analysis. Variables were interpreted per 1000 pregnancies and those variables having p<0.05 was considered as statistically significant.ResultsThe total prevalence of NTDs was 10.9 (95% CI 8.9 to 13.3) per 1000 pregnancies and the prevalence of each NTD type was anencephaly 5.6 (95% CI 4.2 to 7.4) per 1000 pregnancies, spina bifida 3.5 (95% CI 2.4 to 4.9) per 1000 pregnancies, encephalocele 1.1 (95% CI 0.6 to 2.0) per 1000 pregnancies, and both spina bifida and anencephaly 0.7(95% CI 0.3 to 1.4) per 1000 pregnancies. Among livebirths, aborted, stillbirths and medically terminated pregnancies (n = 8862), there were 50 anencephaly cases, 31 spina bifida cases, 10 encephalocele cases, and 6 cases affected by both spina bifida and anencephaly.ConclusionThe prevalence of NTDs in this study was among the highest globally reported. The total prevalence was 10.9 per 1000 pregnancies. Increased periconceptional folic acid use, counseling for women with certain medical illnesses at higher risk for NTDs, and early maternal screening for genetic factors are possible approaches to reduce in NTDs in the population.

Periconceptional folic acid use prevents both rare and common neural tube defects in China.

Neural tube defects (NTDs) encompass a variety of distinct types. We assessed if the preventive effect of folic acid (FA) varied by NTD type and infant sex. We examined all pregnancies with NTD status confirmation from a pregnancy-monitoring system in selected locations in northern and southern regions of China between 1993 and 1996. Women who took 400 μg of FA daily during 42 days after last menstrual period were considered FA users. We analyzed NTD prevalence by FA use status, NTD type, geographic region, and infant sex. Among 626,042 pregnancies, 700 were affected by an NTD. Among FA nonusers, 65 pregnancies (8.8 per 10,000) in the north and 51 pregnancies (1.2 per 10,000) in the south were affected by one of the two rare NTDs, that is, craniorachischisis, iniencephaly. FA use prevented occurrence of these two rare NTDs and reduced the prevalence of spina bifida (SB) by 78% (from 17.9 to 3.9 per 10,000) in the north and 51% (from 2.4 to 1.2 per 10,000) in the south. Among FA users, SB prevalence, including SB with high lesion level, was significantly reduced in both geographic regions. FA use reduced prevalence of anencephaly and encephalocele by 85% and 50%, respectively in the north, while it did not reduce the prevalence of these two NTDs in the south. There was a greater reduction in NTD prevalence in female than in male infants and fetuses. This is the first study to show that FA prevents the entire spectrum of NTD types.

Prenatal folic acid supplementation and folate status in early pregnancy: ECLIPSES study.

This research evaluates the prevalence of inadequate folate status in early pregnancy, the pattern of prenatal folic acid (FA) supplementation and associated factors in Spanish pregnant women from the ECLIPSES study, which included 791 participants prior gestational week 12. A cross-sectional evaluation of erythrocyte folate levels was performed at recruitment and used to calculate the prevalence of folate deficiency (erythrocyte folate < 340 nmol/l) and insufficiency (erythrocyte folate < 906 nmol/l). Sociodemographic and lifestyle data as well as information on prenatal FA supplementation were recorded. Descriptive and multivariate statistical analyses were performed. The prevalence of folate deficiency and insufficiency were 9·6 % and 86·5 %, respectively. Most of women used prenatal FA supplements, but only 6·3 % did so as recommended. Supplementation with FA during the periconceptional period abolished folate deficiency and reduced folate insufficiency. Prenatal FA supplementation with ≥1000 µg/d in periconceptional time and pregnancy planning increased erythrocyte folate levels. The main risk factor for folate insufficiency in early pregnancy was getting prenatal FA supplementation out of the periconceptional time (OR 3·32, 95 % CI 1·02, 15·36), while for folate deficiency they were young age (OR 2·02, 95 % CI 1·05, 3·99), and smoking (OR 2·39, 95 % CI 1·30, 4·37). In addition, social and ethnic differences according to folate status were also identified. As conclusion, periconceptional FA use is crucial for achieving optimal folate levels in early pregnancy. Pregnancy planning should focus on young women, smokers, those with low consumption of folate-rich foods, low socio-economic status or from ethnic minorities.

EARLY OUTCOME ANALYSIS OF NEURAL TUBE DEFECTS PRESENTING IN NEONATAL PERIOD: OUR EXPERIENCE

Background: Neural tube defects (NTDs) are congenital malformation resulting from failure of complete or partial closure of the neural tube in developing embryo. Aims and Objectives: The aim of this study is to present our experience, management and early outcomes (one month post-operatively) of neural tube defects presenting in neonatal period at our high volume tertiary care teaching Institutions. Materials and methods: This retrospective cohort study was conducted over a period of 10 years from January 2007 to December 2016. Medical records of neonates treated for neural tube defects were recorded in a pre-designed Performa. Results: A total of 286 patients with clinically diagnosed neural tube defects presenting in the neonatal period were studied. Male: female ratio was 1.11. The mean birth weight was 2350g. History of peri-conceptional use of folic acid was found in 15 (5.24%) mothers. One hundred seventeen (40.90%) of the patients had multiple system involvement. Most common was orthopedic deformities. Associated hydrocephalus was appreciated in 259 (90.56%) patients. Meningomyelocele was the most common anomaly seen in 239 (83.57%), 24 (8.39%) as meningocele and 23 (8.04%) were diagnosed as having Encephalocele. Surgery with decapping and repair was performed in 277 (96.85%) of the patients. Ventriculoperitoneal (VP) shunt operation before repair of meningomyelocele was performed in 9 (3.15%) patients, while in 19 (6.64%) patients, VP shunt operation was performed after the repair of NTD's in the early (one month) postoperative period. Clinical sepsis developed in the postoperative period in twenty one (7.58%) out of 277 patients, for which antibiotics were stepped up. Thirteen patients (4.69%) died postoperatively due to sepsis and associated anomalies. Conclusions: We present our retrospective report on neural tube defects from Indian subcontinent with accurate baseline data. Meningomyelocele was the most common type of NTD's. We recommend that folic acid supplementation should begin before marriage to raise its serum levels before the conception. Antenatal care especially antenatal ultrasonography must be contemplated as early as possible in early detection of NTDs.

Maternal use of folic acid and multivitamin supplements and infant risk of birth defects in Norway, 1999-2013.

The association between folic acid supplementation and birth defects other than neural tube defects (NTD) remains unclear. We used a log-binomial regression model to investigate if periconceptional folic acid and/or multivitamin use was associated with birth defects in Norway with prospectively collected data from the Medical Birth Registry of Norway (MBRN) during 1999-2013. We used the European Surveillance of Congenital Anomalies (EUROCAT) classification system to define eleven organ-specific major birth defect groups (nervous system, eye, ear-face-neck, cardiovascular system, respiratory system, oral clefts, digestive system, abdominal wall, urinary system, genital organs and limb), with additional subgroups. Fetuses or infants whose mothers used folic acid and/or multivitamin supplements before and during pregnancy were classified as exposed. During the years 1999-2013, 888 294 (99·0 %) live-born infants, 6633 (0·7 %) stillborn infants and 2135 (0·2 %) fetuses from terminated pregnancies due to fetal anomalies were registered in the MBRN. Among the live- and stillborn infants of women who used vitamin supplements compared with infants of non-users, the adjusted relative risk (aRR) was 0·94 (95 % CI 0·91, 0·98) for total birth defects (n 18 382). Supplement use was associated with reduced risk of abdominal wall defects (aRR 0·58; 95 % CI 0·42, 0·80, n 377), genital organ defects (aRR 0·81; 95 % CI 0·72, 0·91, n 2299) and limb defects (aRR 0·81; 95 % CI 0·74, 0·90, n 3409). Protective associations were also suggested for NTD, respiratory system defects and digestive system defects although CI included the null value of 1. During the full study period, statistically significant associations between supplement use and defects in the eye, ear-face-neck, heart or oral clefts were not observed.

Evaluations of pregnancy admitted to perinatology clinics that pregnants have fetal anomalies

Objective Our objective was to investigate the most common anomalies in our region with a retrospective evaluation of the congenital anomaly cases, who applied to the outpatient department of perinatology Materials and Methods: We was reviewed file of congenital anomaly cases, who applied to the outpatient department of perinatology in the Medical Faculty at Ondokuz Mayıs University between May 2014 and May 2019,and to determine the risk factors related to these anomalies. Seven hundred twenty-five pregnant women, whose infants were diagnosed with congenital anomalies in our center, were included in the present study. Parameters like the mother's age, consanguineous parents, history of previous habitual abortions, history of siblings with anomalies, number of parity and abortus history, gestational week at diagnosis, smoking, alcohol and drug consumption in the first trimester, periconceptional folic acid use, co-morbidities, ultrasonographic findings, presence of the karyotype analysis, double and triple screening tests, termination decisions were compared with the anomaly types. Results: In our study, we determined the incidence of anomalies in our region with some limitations. Except for the central nervous system anomalies (most common anomaly group), the incidence ranking of the anomalies in our region was different from the rankings reported in other national studies The CVS anomalies were the second most common anomaly group. Conclusion: An education program prepared for the pregnant women in our region about the goal of the diagnostic and screening tests and routine pregnancy controls will increase the chance of early diagnosis. We believe that the conduction of region-based prenatal and postnatal studies instead of hospital-based studies will contribute more to a clear understanding of the anomaly incidences in our region.

Language impairment in children aged 5 and 8 years after antiepileptic drug exposure in utero - the Norwegian Mother and Child Cohort Study.

The purpose was to examine the consequences of antiepileptic drug (AED) exposure during pregnancy on language abilities in children aged 5 and 8years of mothers with epilepsy. The study population included children of mothers with and without epilepsy enrolled in the Norwegian Mother and Child Cohort Study 1999-2008. Mothers prospectively provided information on epilepsy diagnosis, AED use during pregnancy and the child's language abilities at age 5 and 8years, in questionnaires with validated language screening tools. AED concentrations in gestation week 17-19 and in the umbilical cord were measured. The study population included 346 AED-exposed and 388 AED-unexposed children of mothers with epilepsy, and 113674 children of mothers without epilepsy. Mothers of 117 and 121 AED-exposed children responded to the questionnaires at age 5 and 8years, respectively. For AED-exposed children, the adjusted odds ratio for language impairment was 1.6 [confidence interval (CI) 1.1-2.5, P=0.03] at age 5years and 2.0 (CI 1.4-3.0, P<0.001) at age 8years, compared to children of mothers without epilepsy. Children exposed to carbamazepine monotherapy had a significantly increased risk of language impairment compared to control children at age 8years (adjusted odds ratio 3.8, CI 1.6-9.0, P=0.002). Higher maternal valproate concentrations correlated with language impairment at age 5years. Periconceptional folic acid supplement use protected against AED-associated language impairment. Foetal AED exposure in utero is associated with an increased risk of language impairment in children aged 5 and 8years of mothers with epilepsy. Periconceptional folic acid use had a protective effect on AED-associated language impairment.

Prevalence and determinants of uptake of folic acid in peri-conceptional period in a rural lower-middle-income country, Ghana.

Folate is a vitamin B-related substance needed by expectant mothers during the period right before and after conception (peri-conceptional period) to help protect foetuses against neural tube defects (NTDs). Despite efforts to promote the peri-conceptional uptake of folic acid (FA), adherence remains low. The aim of this study was to assess the prevalence and determinants of peri-conceptional FA uptake among childbearing women in northern Ghana. In a cross-sectional study, data from 303 women accessing antenatal care services in the Upper East Region of Ghana between February and July 2017 were collected and analysed in Stata (Version 12.1). Chi-square and logistic regression analysis were used to identify the independent determinants of peri-conceptional uptake of FA. The mean age of the study population was 27.4 (±5.73) years. The prevalence of uptake of peri-conceptional FA was 28.7% (95% confidence interval: 26.7%-34.2%); 66% of the women were aware of FA and 52% had acceptable knowledge about FA. Initiating ANC after 3months of pregnancy was associated with 91% less chance of peri-conceptional FA use [adjusted odds ratio (AOR) 0.09; 95% confidence interval (CI) 0.04-0.22; P<.001]. Not knowing the frequency of dosing of FA was associated with a 58% less likelihood of uptake of peri-conceptional FA (AOR 0.42; 95% CI 0.23-0.76; P=.004). There is low uptake of peri-conceptional FA among women of childbearing age accessing antenatal services in Northern Ghana, and this uptake is determined by the time of initiation of ANC visit and knowledge of dosage regimen of FA.

Neural Tube Defects: A Retrospective Study of 69 Cases.

Objective:Neural tube defects (NTDs) are congenital disorders that significantly increase the risk of death and disability in the 1st year of life. The aim of this study was to retrospectively evaluate the patients admitted to our neonatal intensive care unit because of NTD.Materials and Methods:We retrospectively examined the demographic features, familial risk factors, physical examination and radiological findings, and accompanying diseases of 69 patients with NTD.Results:Of the 69 patients hospitalized in a 5-year period, 38 were female and 31 were male. The median birth weight was 3150 g and the median delivery week was 38 weeks. Forty-nine of the patients (71%) had meningomyelocele, 11 patients (16%) had encephalocele, and nine patients (13%) had meningocele. Forty-five of the patients (65.2%) had Arnold–Chiari type 2 malformation. Twenty-five percent of the mothers had a history of periconceptional use of folic acid. The median time of making a diagnosis of NTD by prenatal ultrasonography was 20 (16–24) weeks. Thirty-nine of the patients (56.5%) had other organ disorders, some with multiple systemic disorders.Conclusion:The use of periconceptional folic acid in mothers and a decision for termination in selected cases may be effective in reducing the frequency of NTD.

Association Between Maternal Folic Acid Supplementation and Congenital Heart Defects in Offspring in Birth Cohorts From Denmark and Norway.

BackgroundEvidence linking individual‐level maternal folic acid supplementation to offspring risk of congenital heart defects is lacking. We investigated whether folic acid supplementation in early pregnancy reduces offspring risk of heart defects in 2 large birth cohort studies.Methods and ResultsWomen recruited in early pregnancy within the DNBC (Danish National Birth Cohort), 1996–2003, and MoBa (Norwegian Mother and Child Cohort Study), 2000–2009, were followed until delivery. Information on periconceptional intake of folic acid and other supplements was linked with information on heart defects from national registers. Among 197 123 births, we identified 2247 individuals with heart defects (114/10 000). Periconceptional (4 weeks before through 8 weeks after conception) use of folic acid plus other supplements (54.8%), folic acid only (12.2%), and non–folic acid supplements (5.0%) were compared with no supplement use (28.0%); the adjusted relative risks of heart defects were 0.99 (95% CI, 0.80–1.22), 1.08 (95% CI, 0.93–1.25), and 1.07 (95% CI, 0.97–1.19), respectively. For initiation of folic acid in the preconception period weeks −4 to −1 (33.7%) and the postconception periods 0 to 4 weeks (15.5%), 5 to 8 weeks (17.8%), and 9 to 12 weeks (4.6%), compared with no or late folic acid intake (29.1%), relative risks of heart defect were 1.11 (95% CI, 1.00–1.25), 1.09 (95% CI, 0.95–1.25), 0.98 (95% CI, 0.86–1.12), and 0.97 (95% CI, 0.78–1.20), respectively. Relative risks of severe defects, conotruncal defects, and septal defects showed similar results.ConclusionsFolic acid was not associated with offspring risk of heart defects, including severe defects, conotruncal defects, or septal defects.

Maternal exposures and risk of oral clefts in South Vietnam.

Oral clefts are among the most common congenital anomalies. Most studies on risk factors of oral clefts have been carried out in developed countries. We investigated the associations between maternal exposures in the first trimester and oral clefts in South Vietnam. We conducted a hospital-based case-control study during October 2014-November 2015. Cases included 170 patients with nonsyndromic cleft lip with or without cleft palate and those with cleft palate only. Controls were 170 children without oral clefts, matched to each case by age and gender. Mothers were interviewed using structured questionnaire. We performed conditional logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Passive smoking was associated with increased risk of oral clefts in univariate analysis, but not in multivariable analysis (adjusted OR [aOR] = 1.68; 95% CI, 0.53-5.37). No association was observed between liver intake and oral clefts. Compared with nondrinkers, mothers who reported consumption of caffeine-containing beverages were more likely to have an infant with oral cleft (aOR = 5.89; 95% CI, 1.08-32.00). Periconceptional use of folic acid and multivitamins supplementation was associated with reduced risk of oral clefts (aOR = 0.01; 95% CI, 0.00-0.09 and aOR = 0.03; 95% CI, 0.01-0.13, respectively). The results suggest no associations of maternal passive smoking or liver intake with oral clefts. Periconceptional use of folic acid or multivitamins may protect against oral clefts. Further studies are warranted to examine the roles of caffeine consumption in pregnant mothers on occurrence of oral clefts in offspring.

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.

Knowledge and uptake of folic acid among pregnant women attending a secondary health facility in Nigeria

Background Folate deficiency is associated with poor pregnancy outcomes and is one of the most common vitamin deficiencies in women, especially those of reproductive age. Aims This study aimed to determine the level of knowledge and uptake of folic acid among a sample of pregnant women. Method A descriptive cross-sectional study, using a structured questionnaire, was carried out among 300 pregnant women attending antenatal clinics in one hospital in Oluyoro, Ibadan, Nigeria. Findings All participants claimed to have heard of folic acid and major source of information was health workers (77.3%). Only 11.8% knew that folic acid can prevent birth defects and just 22.7% knew the best time to start using folic acid. Almost all the women (98.3%) reported using folic acid in the current pregnancy, of whom 54.2% used it as prescribed. Education (P=0.002), marital status (P=0.001), plan of pregnancy (P=0.022), and maternal age (P=0.046) were significantly associated with knowledge of folic acid. Employment status was significantly associated with uptake of folic acid (P=0.004). Conclusions In this study, knowledge and uptake of folic acid was low among young, single and low education status women. Campaigns promoting periconceptional use of folic acid will be very useful in reaching women of child-bearing age particularly those pregnant and not registered for antenatal care.

Knowledge, attitude and practice regarding folic acid among pregnant women in Benghazi, Libya

Periconceptional folic acid supplementation has been shown to decrease the occurrence of neural tube defects (NTD’s). In a cross-sectional study, the knowledge attitude and practice regarding the peri-conceptional use of folic acid were assessed among the pregnant women in Benghazi, Libya. 131 women attending antenatal clinics in three main polyclinics were interviewed through three polyclinics. Seventy-three percent of the participants had heard about folic acid, and only 37% could correctly identify the effect of folic acid when used periconceptionally. 27% of the pregnant women did not take folic acid during their present pregnancy. Only 6% of the women who took folic acid were taking it consistently before pregnancy with the aim of preventing NTDs. This study shows that the interviewed pregnant women reveal high positive attitude (88%) toward retaking folic acid supplements in their next pregnancy. The overall knowledge regarding the periconceptional use of folic acid was relatively low when compared to other studies worldwide. Health education regarding the periconceptional use of folic acid among newly married couples is recommended.

Folic acid supplementation, birth defects, and adverse pregnancy outcomes in Chinese women: a population-based mega-cohort study

BackgroundPericonceptional folic acid use has been widely recommended to reduce risk of neural tube defects. However, the effect on other birth defects and adverse pregnancy outcomes, as well as the time window of folic acid use, needs further investigation. Our study aimed to comprehensively assess the effect of periconceptional folic acid use on pregnancy outcomes in a mega-cohort of women of reproductive age. MethodsThe China National Free Preconception Health Examination Project (NFPHEP) was established in 2010 to assess couples who planned to get pregnant within 4–6 months for pre-pregnancy risk factors for birth defects, and was a national project for all couples in 31 provinces. We obtained data on folic acid use before and during pregnancy and pregnancy outcomes from women in the project who became pregnant within 1 year after baseline examinations between 2010 and 2015. Women aged 20–49 years who completed pregnancy outcome follow-up in 220 selected counties were included in the study. Multivariate logistic regression models were used to estimate odds ratios (ORs) and 95% CIs with adjustment for covariates. The current study was approved by the Institutional Research Review Board at the National Health and Family Planning Commission and National Research Institute for Family Planning, and all participants gave written consent. FindingsOur cohort consisted of 1 535 066 women. Compared with the 352 099 (22·9%) women who did not take folic acid supplements before and during early pregnancy, 1 182 967 (77·1%) women who did take folic acid supplements had lower odds of total birth defects (OR 0·88, 95% CI 0·78–0·99), neural tube defect (OR 0·45, 0·33–0·61), preterm birth (OR 0·70, 0·69–0·71), miscarriage (OR 0·59, 0·58–0·61), stillbirth (OR 0·75, 0·69–0·81), and neonatal mortality (OR 0·77, 0·70–0·85). Particularly, those who started folic acid use 3 months before their last menstrual period had a significantly lower risk of total birth defects (OR 0·66, 95% CI 0·58–0·76), neural tube defect (OR 0·42, 0·30–0·60), cleft lip (OR 0·48, 0·28–0·81), face malformation (OR 0·62, 0·41–0·98), preterm birth (OR 0·67, 0·66–0·67), low birthweight (OR 0·74, 0·71–0·78), miscarriage (OR 0·53, 0·52–0·54), stillbirth (OR 0·70, 0·64–0·77), and neonatal mortality (OR 0·70, 0·63–0·78) than did those who did not take folic acid. Subgroup analyses also suggested that the protective effects of folic acid supplementation on preterm birth were significantly stronger among women who resided in the south, were of Han ethnicity, had not been exposed to maternal passive smoking, had a body-mass index of less than 24·0 kg/m2, and were free of pre-pregnancy hypertension or diabetes (all p<0·001). InterpretationThe findings from this mega-cohort of Chinese women of reproductive age demonstrate the protective effect of periconceptional folic acid supplementation on birth defects and adverse pregnancy outcomes, particularly if supplements are taken early before conception. FundingFive-twelfth National Science and Technology Support Program (number 2013BAI12B01), the operation funds for basic scientific research of the central authorities (number 2015GJM09). We are thankful for the support of all the investigators and participants who contributed to the National Free Preconception Health Examination Project.