Unzureichende Umsetzung der perikonzeptionellen Folsäureeinnahme zur Prävention von Neuralrohrdefekten

Periconceptional folic acid supplement use among women of reproductive age and its determinants in central rural Germany: Results from a cross sectional study

BACKGROUND

Prevalence of neural tube defects (NTD) has not decreased in Germany despite longstanding recommendations for folic acid supplementation. To examine the prevalence of periconceptional folic acid supplement use and associated factors among German women of reproductive age.

METHODS

Cross-sectional survey was conducted in hospital-based maternity units in rural Germany. A sample of 1,004 women of reproductive age, either pregnant or in their early postpartum period, took interviewer/self-administered paper-based survey questionnaire. Prevalence of periconceptional folic acid supplement use was assessed, where periconception was defined as 1 month prior to and 3 months post-conception. Prevalence odds ratios (POR) and 95% confidence intervals (CI) using crude and adjusted logistic regression analysis were estimated to examine determinants of folic acid supplement use.

RESULTS

Prevalence of folic acid supplement use was 41.5% (95% CI: 37.7%, 45.7%). Multivariable analysis showed lack of educational qualifications, unplanned pregnancy, later diagnosis of pregnancy, increased parity, and not having an awareness of importance of folic acid for optimal pregnancy outcomes were associated with not taking periconceptional folic acid supplements. Books, doctors, friends, media, were sources of information.

CONCLUSION

Periconceptional folic acid is sub-optimal in rural Germany and thus failing to prevent NTDs. Targeted promotion of folic acid supplement use should be conducted periodically by gynecologists and primary care physicians during annual medical screenings. Mandatory folic acid fortification of staple foods is a complementary approach to overcome limitations of individual behaviors of folic acid supplement intake, and should be considered as it has been proven effective in multiple countries.

Dietary surveys indicate vitamin intakes below recommendations are common in representative Western countries

Vitamins play a crucial role in health, but modern lifestyles may lead to suboptimal intakes even in affluent countries. The aim of the present study is to review vitamin intakes in Germany, the UK, The Netherlands and the USA and to compare them with respective national recommendations. Data on adults from the most recently published national dietary intake surveys for the first three countries and data for adults from the US National Health and Nutrition Examination Survey from 2003 to 2008 for the USA were used as a basis for the analysis. The proportions of the populations with intakes below recommendations were categorised as < 5, 5–25, >25–50, >50–75 and >75 % for each vitamin. The data generated are presented in a ‘traffic light display’, using colours from green to red to indicate degrees of sufficiency. The trends found were compared with the results from the European Nutrition and Health Report 2009, even though in that report, only information on mean intakes in the different countries was available. We showed that, although inter-country differences exist, intakes of several vitamins are below recommendations in a significant part of the population in all these countries. The most critical vitamin appears to be vitamin D and the least critical niacin. The variation between the countries is most probably due to differences in recommendations, levels of fortification and local dietary habits. We show that a gap exists between vitamin intakes and requirements for a significant proportion of the population, even though diverse foods are available. Ways to correct this gap need to be investigated.