Preconceptional Folic Acid Use Research Articles

Pregnant Women's Knowledge on Preconceptional and Conceptional use of Folic Acid in Rania City

Background and objectives: Pregnancy is one of the most important periods in the life of woman. Nutrition plays an essential role in the development of a healthy pregnancy. The importance of the taking adequate essential vitamins such as Folic acid both before and during pregnancy is emphasized for the wellbeing of a developing embryo. The purpose of this use study is to assess the level of pregnant woman’s Information regarding adherence of using folic acid supplementation in Rania City. Methods: In a descriptive cross section study, 100 women were selected. On the basis of questionnaires and interviews, data was obtained during the month of (December, 2020 to March, 2021). Data was analyzed using SPSS Version 23. Result: The obtained information revealed that (71%) of pregnant women had intermediate level of knowledge Although excellent knowledge of folic acid was only (14%). Doctors are major sources for promoting awareness about folic acid. There is a significant relationship between the knowledge, level of education, age group, and monthly income. There were more women with high levels of knowledge among those who had lower parities, had more education, and were looking for health-related information. Conclusion: Results acquired have shown some understanding towards the perception of folic acid among pregnancy. Therefore, it is important to increase the awareness of folic acid supplementation among women who are or planning to become pregnant.

The association of preconceptional folic acid supplementation with gestational age and preterm birth risk in twin pregnancies: a prospective cohort study in China.

This study aims to explore the association of maternal preconceptional folic acid (FA) supplementation with gestational age and preterm birth in twin pregnancies, and whether the association varies by chorionicity or conception mode. From November 2018 to December 2021, the information of FA supplementation and pregnancy outcomes were collected in twin pregnant women. The linear regression models and the logistic regression were used to test the association of preconceptional FA supplementation with gestational age at delivery and preterm birth and premature rupture of membranes (PROM). A total of 416 twin pregnancies were included. Compared with no use in twins, maternal preconceptional FA use was associated with a 0.385-week longer gestational age (95% CI 0.019-0.751) and lower risk of preterm birth < 36weeks (adjusted OR 0.519; 95% CI 0.301-0.895) and PROM (adjusted OR 0.426; 95% CI 0.215-0.845). The protective effect on preterm birth < 36weeks and PROM is similar whether taking FA supplements alone or multivitamins. However, the associations varied by chorionicity and conception mode of twins or compliance with supplementation. The positive associations between preconceptional FA use and gestational age only remained significant among twins via assisted reproductive technology or dichorionic diamniotic twins. Significant protective effects on preterm birth < 36weeks and PROM were only found among women who took FA at least 4 times a week before conception. Maternal preconceptional FA supplementation was associated with longer gestation duration and lower risk of preterm birth < 36weeks and PROM in twin pregnancies. To improve the success of their pregnancies, reproductive women should start taking FA supplements well before conception and with good compliance.

Awareness of folic acid supplimentation in pregnancy questionnaire-based study

Objective: To evaluate the awareness of the need for folic acid supplementation and also the actual intake during the periconceptional period to prevent neural tube defects.Methods: The study involved a questionnaire survey conducted among 100 women attended the antenatal visit in the Department of Obstetrics and Gynecology, Yenepoya Medical College, Mangalore, Karnataka. The data were collected over the period of March 2022 to December 2022Results: Out of 100 participants, 63% women had taken folic acid and, 37% have not taken folic acid. Out of 63% who have taken, 27% were aware about the benefits of folic acid intake and 36% was not aware about the benefits of folic acid. Out of 63% who has taken folic acid, 20.6% has taken folic acid pre-conceptionally and 79.3% has taken at the time of pregnancy.Conclusion: The study showed that despite the fact that most of our respondents knew about Folic acid. But the actual rate of Folic acid use at the appropriate time during the pre-pregnancy period was not high among our population. A public health policy or strategy to increase the preconceptional use of folic acid is needed in our society.

Knowledge, Attitude and Practices (KAP) of Preconceptional Folic Acid supplementation among pregnant women (18-45years) attending antenatal clinic in Alex Ekwueme Federal University Teaching hospital Abakaliki, Ebonyi State, 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. Folic acid intake prior to, and during, the first months of pregnancy significantly reduces the risk of fetal neural tube defects. Maternal folate status has been associated with other adverse pregnancy outcomes such as preeclampsia, malformations (orofacial clefts, Neural tube defects, anencephaly and encephalocele resulting from incomplete neural tube closure during early embryogenesis), spontaneous abortion, fetal death, fetal growth restriction and preterm delivery. Methods: The study embraced a cross-sectional study that assess Knowledge, Attitude and Practice of preconceptional folic acid supplementation among pregnant women (18-45years) attending antenatal clinic in Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State. 152 women attending antenatal clinics in Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State were interviewed using structured questionnaire. Data collected were analyzed using SPSS version 21 for frequency and percentage at P &lt; 0.05 significance level. Results: 98.7% of the participants had heard about folic acid, but an analysis of data shows that 26.6% of them knew that folic acid is a vitamin. In addition, very few (29.6%) knew that folic acid could prevent neural tube defects. The main source of information about folic acid supplementation among the surveyed women were through the health workers. Incidence of at least one episode of adverse pregnancy outcome was noted in about 35.5% of the population under study though a majority indicated the form for their loss were miscarriage and stillbirth. Finding showed that 37.5% of the respondent claimed to have used folic acid before pregnancy while 40.1% of the women in this study were aware of the right time to start using folic acid. 46% of the women took folic acid during Antenatal care and their reason were attributed to late presentation for antenatal care, delayed prescription of the folic acid for women during pregnancy, unplanned pregnancy while others claimed they are getting enough folate from food. Approximately 40.8% of the respondents had started supplementation on antenatal booking and from analysis of data on the preferred/normal booking time of the respondents it shows that a high percentage of them attended antenatal from the third month of pregnancy this shows that the majority of the respondents started supplementation too late which is inconsistent with the ideal time to start folic acid supplementation in prevention of neural tube defect. In this study it has been revealed that 48% of the respondents could identify green leafy vegetable as the only source of folate in local foods and 0.7% could identify other food sources like legumes and fruits as sources of folate. Conclusion: There is a low overall level of awareness of folic acid among pregnant women including lack of understanding of its natural sources, usefulness in preventing Neural Tube Defects and preconceptional intake recommendation. Health education regarding the preconceptional use of folic acid among women of reproductive age is recommended.

Association between maternal prepregnancy diabetes mellitus and preconception folic acid supplement use by Hispanic ethnicity: Findings from Georgia, New York City, and Puerto Rico PRAMS 2016–2018

AbstractBackgroundMaternal ethnicity, prepregnancy diabetes, and preconception folic acid intake, are all associated with increased risk of neural tube defects in the United States. We assessed the association between prepregnancy diabetes and preconception folic acid use by Hispanic ethnicity.MethodsWe used population‐based, cross‐sectional survey data from New York City, Georgia and Puerto Rico's 2016–2018 Pregnancy Risk Assessment Monitoring System (PRAMS). Prepregnancy Type 1 or Type 2 diabetes was self‐reported. Adequate preconception folic acid intake was defined as intake of a multivitamin, a prenatal vitamin, or a folic acid vitamin 4–7 times/week during the month before pregnancy. Multivariable logistic regression was used to calculate adjusted prevalence odds ratio (aPORs) and 95% confidence intervals (CI), stratified by Hispanic ethnicity.ResultsPrepregnancy diabetes was reported by 2.9% of Hispanic and 3.6% of non‐Hispanic participants. Adequate preconception folic acid use was reported by 25.9% and 39.9% of Hispanics and non‐Hispanics, respectively. There was an inverse association between prepregnancy diabetes and preconception folic acid use among Hispanics (aPOR = 0.75; 95% CI = 0.31, 1.81), while the association was positive among non‐Hispanics (aPOR = 1.26; 95% CI = 0.70, 2.26); however, the 95% confidence intervals for both groups contained the null value.ConclusionsThe association between prepregnancy diabetes and folic acid intake varied by Hispanic ethnicity. Our hypothesis that reproductive‐aged women with prepregnancy diabetes may receive timely diabetic care, including health counseling to take preconception folic acid, was not supported by our study data. Future studies should examine the association in additional PRAMS sites. Preconception health screening, and folic acid intake among Hispanics, should be strengthened.

Folic acid usage and associated factors among pregnant women attending a tertiary health facility in Nigeria

Background: Folic acid (FA) is an essential water-soluble vitamin that cannot be synthesized in the human body; hence its major source is from diet. It plays a key role in embryonic development. FA supplementation in pregnancy reduces the risk of megaloblastic anaemia, preterm delivery and neural tube defects. The aim of the current study was to evaluate the use of FA and factors associated with uptake amongst pregnant women at the University of Port Harcourt Teaching Hospital.Methods: A descriptive cross-sectional study involving 451 antenatal attendees at the University of Port Harcourt Teaching Hospital from 1 January to 31 March 2020. After consent was obtained, a structured interviewer-administered questionnaire was used to collect information from the women. Data was entered into a spread sheet and analyzed with SPSS version 25. The results are presented in means and percentages. The confidence interval was set at 95% and a p value of &lt;0.05 was deemed statistically significant. Chi square test and Pearson’s correlation were used to determine association between usage of FA and variables.Results: Most of the women, 258 (57.21%) were between the ages of 30 and 39 years and were primarily nulliparous 122 (27.1%). Moreover, two-thirds of them 330 (73.2%) had post-secondary education and nearly all 409 (90.7%) of the women were married. Majority 370 (82.0%) of the pregnant women were currently taking folic acid but only 109 (24.2%) commenced before pregnancy. Use of FA was significantly associated with socio-demographic characteristics such as age, marital status, level of education and occupation (p&lt;0.05). In addition, parity, planned pregnancy, history of having a child with neural tube defect, and timing of commencement of folic acid were all significantly associated with folic acid usage (p&lt;0.05).Conclusions: Only a small proportion of pregnant women have used FA before their pregnancies. A public health policy or strategy to increase the pre-conceptional use of folic acid is needed.

Awareness, knowledge and the factors that affect the use of folic acid among pregnant and non-pregnant women in the reproductive age in a selected area in Colombo district, Sri Lanka

<strong>Background: </strong>The prevalence of neural tube defects in Sri Lanka is estimated to be 1.21 per 1000 births. According to the WHO, programs to increase folic acid (FA) consumption among women of reproductive age may benefit countries where the NTD rate is higher than 0.6/1,000 live births. Food fortification is an effective method but there is still no mandatory fortification policy in Sri Lanka. Therefore, improving knowledge and voluntary use of FA remains a high priority. The study aimed to determine the awareness and knowledge on FA among pregnant and non pregnant women. <strong> </strong> <strong>Methods: </strong>A comparative cross-sectional study was conducted among 400 pregnant and 400 non-pregnant women aged 18-45 years from Colombo District in Sri Lanka. Data were collected using an anonymous, standardized, interviewer administered questionnaire, which included questions about socio-demographic data, obstetric history, FA knowledge and use. <strong> </strong> <strong>Results: </strong>FA awareness and knowledge on its pre-conceptional use were significantly low among non-pregnant women younger than 25 years (OR=0.120, 95% CI=0.068-0.211, p=0.000; OR=0.153, 95% CI=0.090-0.262, p=0.000). Pregnant women with knowledge that FA prevents birth defects were significantly more likely to take FA during pregnancy (OR=10.760, 95% CI=1.244-93.068, p=0.007) and the pre-conceptional period (OR=1.807, 95% CI=1.172-2.786, p=0.007). Women who received information from field clinics were significantly more likely to have FA awareness (OR=4.779, 95% CI=0.913-25.021, p=0.042), knowledge on pre-conceptional use of FA (OR=2.972, 95% CI=1.179-7.491, p=0.016) and took FA during pregnancy (OR=39.773, 95% CI=4.542-348.271, p=0.000). Those who received information from home visits were significantly more likely to have knowledge on the role of FA in preventing birth defects (OR=1.958, 95% CI=1.133-3.384, p=0.015), took FA during their pregnancy (OR=15.102, 95% CI=1.743-130.841, p=0.001) and in the pre-conceptional period (OR=2.117, 95% CI=1.316-3.405, p=0.002). Women who got information through media were also significantly more likely to have knowledge on the role of FA in preventing birth defects. (OR=2.487, 95% CI=1.006-6.149, p=0.042). <strong> </strong> <strong>Conclusions: </strong>Health education campaigns have to be specifically targeted for younger women from ethnic minorities and from low household income families. Field clinics and home visits from public health midwives have been a significant sources of information and media campaigns can be an effective means of promoting health education regarding use of preconceptional folic acid.

Sonographic diagnosis of fetal meningomyelocele in an obese patient: Report of a case

Meningomyelocele and meningocele are common neural tube defects in developing countries. Risk factors include poor sensitization of intending mothers on preconception folic acid use, maternal obesity, hyperthermia from malaria, and high pollution levels. Some of the problems associated with this condition include lack of dedicated spinal bifida clinics, expensive treatment, the social stigma associated with the condition, and poor awareness about the condition among local physicians. This has led to poor management outcomes. A multidisciplinary approach involving neonatologists/pediatricians, obstetricians, neurosurgeons, radiologists, psychologists, and physiotherapists is necessary to optimize patient outcome.

Update on the prevalence and determinants of folic acid use in Japan evaluated with 91,538 pregnant women: the Japan Environment and Children’s Study

Objective: To provide the latest and most promising evidence on the prevalence and determinants for folic acid supplementation in pregnant women in Japan, including differences in prevalence between interview years and determinants across regions.Materials and methods: The study participants were enrolled from 15 regional centers across Japan between January 2011 and March 2014. Information on the use of folic acid supplementation before and during pregnancy and the characteristics of the participants were collected using questionnaires, medical chart reviews, and interviews by research coordinators.Results: Data for 91,538 women who provided sufficient data on folic acid supplementation were analyzed. The prevalence of adequate users was 8.0%, which, although low, tended to improve over the 4-year recruitment period. Various kinds of sociodemographic factors, lifestyle habits, and obstetrical and medication use history were significant and independent determinants for folic acid use. Associations between adequate preconception folic acid use and its major determinants tended to be similar across regions.Conclusions: Although the prevalence of adequate folic acid use was low, it increased from 2011 to 2014. Reproductive-aged women who have determinants for inadequate folic acid use should be informed about the need for preconception folic acid supplementation to help prevent neural tube defects.

Fertility intentions, current practices and associated factors among co-habiting women in a medical officer of health area in the district of Nuwara Eliya

Background: Identifying the prevailing intentions and practices related to fertility among females is important in promoting pre-pregnancy care service delivery to eligible families. Objective: To describe the fertility intentions regarding conception; awareness and current practices related to pregnancy preparedness; and factors associated with current fertility practices among fertile women in the district of Nuwara Eliya Methods: The current study was carried out as a community-based cross-sectional study among 476 cohabiting women in the reproductive age (15-44 years) living in the medical officer of health area, Ambagamuwa. Future and current pregnancy intentions were ascertained. Among the current intenders, their awareness and practices on pre-pregnancy fertility (rubella vaccination, folic acid use, adequate sexual exposure, nutritionally acceptable dietary habits) and factors associated with such practices were assessed. Those not intending a current pregnancy were assessed for family planning practices and associated factors. Results: Of the women, 300 (63.0%; 95% CI=58.5, 67.4) wanted a pregnancy. Current intention of child bearing was present among 142 (29.8%; 95% CI=25.8, 34.2) women. The awareness on rubella vaccine was observed to be higher (81.0%) compared to the awareness on healthy dietary habits during pre-pregnancy period (62.0%), on the use of folic acid (51.4%) and adequate level of sexual exposure for pregnancy (43.7%). The prevalence of related practices of vaccination with rubella (75.4%), pre-conceptional use of folic acid (12.7%), adequate sexual exposure for pregnancy (42.2%) and adherence to a healthy diet (21.8%) indicated a gap between awareness and practice. Certain socio-demographic factors were related to poor practices. Among those currently not intending to get pregnant, 264 (79.0%) were using a contraceptive method. Conclusions: The identified modifiable socio-demographic factors should be addressed in planning for improvement in pre-pregnancy care in the local setting.

962: Comparative use and knowledge of preconceptional folic acid among obstetrics patients in Phoenix, Arizona- 2017

We sought to determine use and knowledge of folic acid, and assess whether educational efforts within our community have led to an improvement in awareness regarding the benefits of folic acid, as a prior study (2001) found critical knowledge deficits. Following determination of IRB-exempt status, a survey similar to that given to participants in the original 2001 study was administered to willing participants presenting for prenatal care. Those who answered affirmative to the question “Taking vitamins helps prevent birth defects” were given part II of the survey, which asked more in depth questions about this topic. Results were analyzed to assess vitamin use and awareness of the benefits of preconceptional folic acid. Demographic variables were analyzed to determine if differences in knowledge existed within the study population. Half of patients surveyed had not consumed a multivitamin preconceptionally. Women with at least a high school degree (p < 0.001), Caucasian race (p < 0.001), and those identifying the pregnancy as “planned” (p<0.001) were more likely to take a vitamin before pregnancy. By ethnicity, 86%, 76%, 71%, 67%, 50%, and 43% of Caucasian, Hispanic, African American, Asian, Native American, and Other ethnicities, respectively, were aware of nonspecific benefits of vitamin intake and prevention of congenital malformations. Even among participants who indicated general awareness of vitamins preventing birth defects, 71.5% could not identify neural tube defects (NTDs) as the malformation prevented, and 52.3% were unable to identify folic acid as the correct vitamin. Only 16.3% of total survey participants were aware of the association between folic acid intake and the prevention of NTDs, and they were more likely to have completed high school (P=0.007) and identify as Caucasian (P=0.03). There has been a modest improvement in knowledge regarding folic acid use. Patients are more likely to take a multivitamin prior to pregnancy, even if they don’t understand the potential benefit. However, there appears to have been little improvement in those who correctly identify folic acid as the vitamin that prevents NTDs. Given the well known benefits of NTD prevention, educational efforts should be intensified, and particularly targeted towards ethnic minority women with lesser degrees of education.

Folic acid use by women with epilepsy: Findings of the Epilepsy Birth Control Registry.

To determine the prevalence and predictors of folic acid (FA) use by women with epilepsy (WWE) at risk of unintended pregnancy. These retrospective data come from the Epilepsy Birth Control Registry (EBCR) web-based survey of 1144 WWE in the community, 18-47years, who provided demographic, epilepsy, AED, contraception, pregnancy, healthcare visits and FA data. We report prevalence and predictors of FA use in relation to risk of pregnancy (not at risk, at risk, seeking pregnancy, pregnant), demographics, seizure types and AED and contraception categories. 368 (47.6%) of the 773 WWE at risk of unintended pregnancy in the EBCR took FA supplement. Being at risk was a significant predictor in comparison to WWE not at risk (OR=1.464 [1.103-1.944], p=0.008). In comparison to WWE at risk, FA use trended greater for WWE actively seeking pregnancy (29/47, 61.7% v 368/773, 47.6%; p=0.0605) and was greater for pregnant WWE (17/19, 89.5% v 368/773, 47.6%; p=0.0007). Demographic predictors for WWE at risk were race (p=0.003), education (p=0.012) and income (0.043) with significantly greater FA use by Caucasians than minorities and direct correlations between FA use and levels of education and household income. Seizure type, AED use, category and dosage, polytherapy and contraceptive category were not predictors. A healthcare provider visit during the year prior to the survey was not a predictor. Prevalence of FA use was similar following visits with gynecologists - 51.7%, neurologists - 48.7% and primary care - 48.6%. FA supplementation by prescription was greater for WWE at risk on AED versus no AED (190/355, 53.5% v 3/13, 23.1%; p=0.045). Low prevalence of preconception FA use may reflect a need for more education. In addition, further research is needed to provide definitive evidence that FA reduces congenital malformations in the offspring of WWE.

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.

Prevalence and determinants of preconception folic acid use: an Italian multicenter survey.

BackgroundWomen in many countries are advised to use folic acid supplements before and early during pregnancy to reduce the risk of neural tube defects in their infants. This study aimed to update the prevalence and to identify possible determinants of preconception folic acid supplement use in Italian women.MethodsThe study was based on cross-sectional data from seven maternity clinics located in six Italian regions from January to June, 2012. Data on maternal characteristics and supplement use were collected for 2,189 women using a self-administered questionnaire.ResultsPreconception folic acid use was reported by 23.5 % (n = 515) of the participants. Of these, 479 (93 %) women had taken folic acid supplements on a daily basis as recommended by the health authorities. Women who both had intended their pregnancy and had requested a preconception health visit to a doctor/gynecologist were substantially more likely than the reference group to initiate folic acid supplementation before their pregnancy (48.6 versus 4.8 %). Preconception folic acid use was also associated with higher maternal age, higher education, marriage/cohabitation, lower parity, infertility treatments, and chronic disease.ConclusionsData from seven maternity clinics located in six Italian regions indicate that preconception folic acid supplement use in many Italian women is low. Women who do not plan their pregnancy or do not request a preconception health visit to their doctor have among the lowest prevalence of preconception folic acid use. Improving folate status in these and other supplemental non-users may have important disease preventive effects.

Pre-conceptional intake of folic acid supplements is inversely associated with risk of preterm birth and small-for-gestational-age birth: a prospective cohort study.

Associations of folic acid supplementation with risk of preterm birth (PTB) and small-for-gestational-age (SGA) birth were unclear for the Chinese populations. The aim of the present study was to investigate the associations in a large Chinese prospective cohort study: the Jiaxing Birth Cohort. In the Jiaxing Birth Cohort, 240 954 pregnant women visited local clinics or hospitals within their first trimester in Southeast China during 1999-2012. Information on anthropometric parameters, folic acid supplementation and other maternal characteristics were collected by in-person interviews during their first visit. Pregnancy outcomes were recorded during the follow-up of these participants. Multinomial logistic regression was used to examine the association of folic acid supplementation with pregnancy outcomes. The prevalence of folic acid supplementation was 24·9% in the cohort. The prevalence of PTB and SGA birth was 3·48 and 9·2%, respectively. Pre-conceptional folic acid supplementation was associated with 8% lower risk of PTB (relative risk (RR) 0·92; 95% CI 0·85, 1·00; P=0·04) and 19% lower risk of SGA birth (RR 0·81; 95% CI 0·70, 0·95; P=0·008), compared with non-users. Higher frequency of pre-conceptional folic acid use was associated with lower risk of PTB (P trend=0·032) and SGA birth (P trend=0·046). No significant association between post-conceptional initiation of folic acid supplementation and either outcome was observed. In conclusion, the present study suggests an association between pre-conceptional, but not post-conceptional, folic acid supplementation and lower risk of PTB and SGA birth in the Jiaxing Birth Cohort. Further research in other cohorts of large sample size is needed to replicate these findings.

The risk of menstrual abnormalities after preconceptional use of folic acid or a folic acid–containing multivitamin in Chinese women

ABSTRACTThe associations of preconceptional folic acid use with menstruation-related changes were examined by a retrospective study through 219 questionnaires. The kind of folic acid (alone or with other vitamins), the using time and frequency, the menstrual regularity, the cycle length before and after use, and other menstruation-related changes after use were obtained. Two hundred of 219 participants were users, and menstruation-related changes occurred in 32 women, with abnormalities of involvement being longer cycles (increase of 3–20 days, 7.7 ± 4.8 days), shorter cycles (decrease of 3–7 days, 5.7 ± 2.3 days), irregular cycles, less blood loss, bleeding or spotting between cycles, and algomenorrhea. Seventeen women stopped using folic acid or folic acid–containing multivitamin, and sixteen of the seventeen women experienced at least one menstruation before conception. Fifteen of sixteen women found complete recovery, indicating the high possibility that these changes were attributed to the use of folic acid or folic acid–containing multivitamin.

An analysis of folic acid supplementation in women presenting for antenatal care.

Neural tube defects (NTDs) are major congenital malformations that are potentially preventable if the woman takes periconceptional folic acid (FA) supplements. A recent report found that NTD incidence had increased in Ireland. This study examined the usage of FA supplementation in women presenting for antenatal care in a maternity hospital. Women were recruited at their convenience in the first trimester. Their clinical and sociodemographic details were computerized. Maternal weight and height were measured before calculating body mass index. Detailed FA questionnaires were completed under supervision of a trained researcher. While 96.1% (n = 564) out of 587 reported that they took FA after they became pregnant, only 24.7% (n = 145) took it for >12 weeks preconceptionally as recommended. Only 5.7% (n = 6) of obese women took high-dose FA as recommended. On univariate analysis, the strongest predictors of preconceptional FA usage were higher maternal age, higher education and income, being married, being nulliparous, not smoking, infertility treatment and planned pregnancy. On multivariate analysis, both planned pregnancy and nulliparity were the most important predictors of preconceptional FA use. Our study shows that current recommendations to prevent NTDs by FA supplementation pre-pregnancy are not being fully implemented in Ireland. We recommend a review of current public health policies on FA supplementation.

Association Between Preconception Counseling and Folic Acid Supplementation Before Pregnancy and Reasons for Non-Use.

To examine the relationship between folic acid preconception counseling (PCC) and folic acid use and reasons for non-use among women with a recent live birth. We analyzed Maryland Pregnancy Risk Assessment Monitoring System (PRAMS) survey responses from 2009 to 2011 (n = 4,426, response rate = 67%). Multivariable weighted logistic regression models were used to explore associations between folic acid PCC receipt and folic acid use and reasons for non-use. Approximately 30% of women reported daily folic acid use the month before pregnancy, with lower rates among those who were <30, non-white, or unmarried; received WIC during pregnancy; had suffered a stressful event prepregnancy; smoked prepregnancy; had a previous live birth; or had an unintended pregnancy (all p < 0.05). The most common reasons for folic acid non-use were "not planning pregnancy" (61%) and "didn't think needed to take" (41%). Folic acid PCC receipt was reported by 27% of women and was associated with three times the odds of folic acid use (adjusted odds ratio [aOR] 3.15, 95% CI 2.47-4.03) and half the odds of reporting "didn't think needed to take" (aOR 0.47, 95% CI 0.28-0.78) as a reason for non-use. Less than one-third of recent Maryland mothers reported using folic acid daily before pregnancy and only 27% reported receiving folic acid PCC. However, folic acid PCC was associated with increased folic acid use and decreased reporting that women did not think they needed to take folic acid. Our data support initiatives to promote provision of folic acid PCC to all women of childbearing age.

When should we prescribe high-dose folic acid to prevent congenital heart defects?

Provide a rationale for attempting prevention of congenital heart defects (CHDs). Prevention of neural-tube defects can be achieved with preconceptional use of folic acid. Extrapolating results from animal studies to human pregnancy shows that folate deficiency as well as one-time exposure to environmental factors in the first 2 to 3 weeks of human gestation can result in severe CHD. Considering that approximately 50% of pregnancies are unplanned, this period of pregnancy can be considered high risk for cardiac, as well as neural, birth defects, as the woman usually is not aware of her pregnancy and may not yet be taking precautionary actions to protect the developing embryo. In mammals, folate supplementation prevents CHD induced by alcohol, by lithium, or by elevation of the metabolite homocysteine. Optimal protection of cardiogenesis was observed to occur with folate supplementation provided on the morning after conception and at higher doses than currently available in prenatal vitamin supplementation. Clinical studies show a similar pattern with high doses of folic acid required to prevent CHD. Today, all patients with a family history of CHD should discuss the prenatal use of folate supplementation with their obstetricians prior to becoming pregnant.

Preconceptional use of folic acid in the region of the Kantonsspital Münsterlingen/Thurgau: has it changed over the past 10 years?

Numerous studies have shown that the preconceptional use of folic acid prevents neural tube defects. We created a study to find out whether the preconceptional use of folic acid has improved in the past 10 years, in the area of Münsterlingen, Switzerland. We interviewed 2 groups of patients who delivered at our Institution, namely between 2000 and 2002 (period A) involving 287 women and from 2009 to 2010 (period B) involving 305 pregnant women. We asked them whether they used folic acid by means of a standardised questionnaire. In period B significantly more women have taken folic acid preconceptionally (period A: 27.5% vs. period B: 40.7%; p=0.001). A significant increase in folic acid intake was seen in the German speaking group from period A to B (30.3% vs. 52.7%; p=0.0005), while this was not the case in the non-German speaking group (21.4% in both periods). More multiparaé women were taking folic acid compared to nulliparae. A significant increase from period A to B was noted only in the German speaking group. Unexpectedly, in nulliparae non-German speaking women, folic acid supplementation decreased from 14% to 6.1%. We have found a significant increase in preconceptional folic acid supplementation from 2001 to 2010. The percentage of women taking folic acid is disappointingly low in all groups, particularly in nulliparae women of non-German ethnicity.