1
|
Mohammed BS, Kawawa AR, Wemakor A. Prevalence and determinants of uptake of folic acid in peri‐conceptional period in a rural lower‐middle‐income country, Ghana. Basic Clin Pharmacol Toxicol 2019; 126:254-262. [DOI: 10.1111/bcpt.13331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/23/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Anthony Wemakor
- University for Development Studies School of Allied Health Sciences Tamale Ghana
| |
Collapse
|
2
|
Hill B, Kothe EJ, Currie S, Danby M, Lang AY, Bailey C, Moran LJ, Teede H, North M, Bruce LJ, Skouteris H. A systematic mapping review of the associations between pregnancy intentions and health-related lifestyle behaviours or psychological wellbeing. Prev Med Rep 2019; 14:100869. [PMID: 31011520 PMCID: PMC6465583 DOI: 10.1016/j.pmedr.2019.100869] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 03/11/2019] [Accepted: 04/03/2019] [Indexed: 12/13/2022] Open
Abstract
The aim of this study was to conduct a systematic mapping review of the literature that explored associations of pregnancy intentions with health-related lifestyle behaviours and psychological wellbeing before and during pregnancy. Six databases were searched (May 2017) for papers relating to pregnancy intentions, health-related lifestyle behaviours, and psychological wellbeing. The literature was mapped according to the preconception or pregnancy period; prospective or retrospective variable assessment; and reported lifestyle behaviours and psychological wellbeing outcomes. Of 19,430 retrieved records, 303 studies were eligible. Pregnancy intentions were considered during the preconception period in 103 studies (only 23 assessed prospectively), and during the pregnancy period in 208 studies (141 prospectively). Associations between pregnancy intention and preconception behaviours/psychological wellbeing were primarily reported for supplement use (n = 58) and were lacking for diet/exercise, and psychological factors. For behaviours/psychological wellbeing during pregnancy, associations with pregnancy intention were focused on prenatal care (n = 79), depression (n = 61), and smoking (n = 56) and were lacking for diet/exercise. Only 7 studies assessed pregnancy intentions with a validated tool. Despite a large body of literature, there were several methodological limitations identified, namely assessment of pregnancy intentions with non-validated measures and the reliance on retrospective assessment. Future primary studies are needed to fill gaps in our understanding regarding energy-balance-related behaviours. Future studies (including reviews/meta-analyses) should take care to address the noted limitations to provide a comprehensive and accurate understanding of the relationships between pregnancy intentions and health-related lifestyle behaviours and psychological wellbeing before and during pregnancy. Reliance on the assessment of pregnancy intentions with non-validated measures Reliance on retrospective assessment Studies on preconception pregnancy intentions and diet/exercise lacking
Collapse
Affiliation(s)
- Briony Hill
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Melbourne 3168, Australia.,School of Psychology, Deakin University, Locked Bag 20000, Geelong 3220, Australia.,Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Locked Bag 20000, Geelong 3220, Australia
| | - Emily J Kothe
- School of Psychology, Deakin University, Locked Bag 20000, Geelong 3220, Australia.,Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Locked Bag 20000, Geelong 3220, Australia
| | - Sinéad Currie
- Psychology, Faculty of Natural Sciences, University of Stirling, FK9 4LA, United Kingdom
| | - Meaghan Danby
- School of Psychology, Deakin University, Locked Bag 20000, Geelong 3220, Australia
| | - Adina Y Lang
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Melbourne 3168, Australia
| | - Cate Bailey
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Melbourne 3168, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Melbourne 3168, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Melbourne 3168, Australia
| | - Madelon North
- School of Psychology, Deakin University, Locked Bag 20000, Geelong 3220, Australia
| | - Lauren J Bruce
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Melbourne 3168, Australia
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, Melbourne 3168, Australia
| |
Collapse
|
3
|
da Rosa EB, Silveira DB, Correia JD, Grapiglia CG, de Moraes SAG, Nunes MR, Zen TD, Oliveira CA, Correia EPE, Alcay CT, Lisboa ML, da Cunha AC, Zen PRG, Rosa RFM. Periconceptional folic acid supplementation in Southern Brazil: Why are not we doing it right? Am J Med Genet A 2018; 179:20-28. [PMID: 30569628 DOI: 10.1002/ajmg.a.60699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 09/28/2018] [Accepted: 10/29/2018] [Indexed: 11/06/2022]
Abstract
Several countries, as Brazil, have public policies for periconceptional folic acid supplementation (FAS) in order to prevent unfavorable outcomes. Our aim was to evaluate the FAS situation in a public reference hospital from Southern Brazil. This study included all mothers who had children born at the Hospital Materno Infantil Presidente Vargas, RS, Brazil, in a 1-year period. Data collection was conducted through interviews with application of a clinical protocol and analysis of the patients' records. FAS was defined as the use of folic acid in any period of the periconceptional period, irrespective of the duration and amount. We also classified those mothers who correctly followed the national recommendation proposed by the Health Ministry of Brazil. The sample consisted of 765 mothers evaluated soon after childbirth. Their ages ranged from 12 to 45 years (mean 25.2 years). The overall level of FAS was 51.5%, and the use according to the national recommendation occurred in only 1.6%. Factors associated with non-FAS consisted of lower maternal age (p = .009) and maternal schooling (p = .023), higher number of pregnancies (p = .003), fewer prenatal visits (p = .050) and later prenatal care onset (p = .037). Periconceptional FAS in our midst seems to be very far from the ideal goal. Susceptible groups appeared to be mothers who were younger, less educated, multiparous, and had inadequate prenatal care. We believe that efforts of education and awareness should be especially targeted for these groups. These recommendations should also be strengthened among those who prescribe the FAS.
Collapse
Affiliation(s)
- Ernani B da Rosa
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil
| | - Daniélle B Silveira
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil
| | - Jamile D Correia
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil
| | | | | | | | - Tatiana D Zen
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil.,Pharmacy, Faculdade de Ciências da Saúde, Centro Universitário Ritter dos Reis - UniRitter, Porto Alegre, Brazil
| | - Ceres A Oliveira
- Institute of Education and Research, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | - Cristiane T Alcay
- Nursing Service, Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre, Brazil
| | - Marli L Lisboa
- Nursing Service, Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre, Brazil.,Fetal Medicine, HMIPV, Porto Alegre, Brazil
| | | | - Paulo R G Zen
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil.,Clinical Genetics, UFCSPA and Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre, Brazil
| | - Rafael F M Rosa
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil.,Clinical Genetics, UFCSPA and Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre, Brazil
| |
Collapse
|
4
|
Ishikawa T, Obara T, Nishigori H, Nishigori T, Metoki H, Ishikuro M, Tatsuta N, Mizuno S, Sakurai K, Nishijima I, Murai Y, Fujiwara I, Arima T, Nakai K, Yaegashi N, Kuriyama S, Mano N. 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. J Matern Fetal Neonatal Med 2018; 33:427-436. [PMID: 29950122 DOI: 10.1080/14767058.2018.1494712] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
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.
Collapse
Affiliation(s)
- Tomofumi Ishikawa
- Laboratory of Clinical Pharmacy, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan
| | - Taku Obara
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Japan.,Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Hidekazu Nishigori
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Gynecology and Obstetrics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toshie Nishigori
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hirohito Metoki
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.,Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Mami Ishikuro
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Japan.,Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Nozomi Tatsuta
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Mizuno
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kasumi Sakurai
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ichiko Nishijima
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Japan.,Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Yuriko Murai
- Department of Clinical Pharmaceutics, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Ikuma Fujiwara
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takahiro Arima
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kunihiko Nakai
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Nobuo Yaegashi
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Japan.,Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.,Department of Gynecology and Obstetrics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shinichi Kuriyama
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Japan.,Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.,Tohoku University International Research Institute for Disaster Science, Sendai, Japan
| | - Nariyasu Mano
- Laboratory of Clinical Pharmacy, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan.,Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Japan
| |
Collapse
|
5
|
Mukhtar A, Kramer MR, Oakley GP, Kancherla V. Race and ethnicity and preconception folic acid supplement use among pregnant women in Georgia, PRAMS 2009 to 2011. Birth Defects Res 2018; 109:38-48. [PMID: 27905191 DOI: 10.1002/bdra.23597] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 10/11/2016] [Accepted: 10/24/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND The United States Public Health Service recommends that all women of reproductive age consume 400 μg of folic acid daily to prevent major neural tube defects. Hispanics have the highest prevalence of neural tube defects compared with other race/ethnic groups. We studied prevalence of preconception folic acid supplement use, and its association with race/ethnicity among pregnant women in Georgia. METHODS Using state-wide population-based data from 2009 to 2011 Georgia Pregnancy Risk Assessment Monitoring System, we examined the prevalence of preconception folic acid supplement use among pregnant women aged 18 to 45 years. We conducted multivariable logistic regression and estimated adjusted odds ratios and 95% confidence intervals to examine the association between race/ethnicity and supplemental folic acid use among study participants. RESULTS Overall, 25% of all participants reported taking folic acid supplements daily before conception. Only 21% of Hispanic women reported preconception folic acid supplement use. Hispanic women were twice as likely to not take folic acid supplements (adjusted odds ratio = 2.15; 95% confidence interval, 1.35-3.40) compared with non-Hispanic whites, after controlling for maternal age, parity, pregnancy intention, knowledge that folic acid prevents birth defects, and preconception smoking and exercise. CONCLUSION Hispanics are a growing population in the United States with an expected 14 million women of child-bearing age by 2020, and the prevalence of preconception folic acid supplement use is low in this group with a high risk of neural tube defects. Promotion of voluntarily fortified corn masa flour can lower neural tube defects in Hispanics. Mandatory corn masa fortification will be a more effective public health policy.Birth Defects Research 109:38-48, 2017. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Ayesha Mukhtar
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Michael R Kramer
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Godfrey P Oakley
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia.,Center for Spina Bifida Prevention, Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Vijaya Kancherla
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia.,Center for Spina Bifida Prevention, Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| |
Collapse
|
6
|
Obara T, Nishigori H, Nishigori T, Metoki H, Ishikuro M, Tatsuta N, Mizuno S, Sakurai K, Nishijima I, Murai Y, Fujiwara I, Arima T, Nakai K, Mano N, Yaegashi N, Kuriyama S. Prevalence and determinants of inadequate use of folic acid supplementation in Japanese pregnant women: the Japan Environment and Children's Study (JECS). J Matern Fetal Neonatal Med 2016; 30:588-593. [PMID: 27089039 DOI: 10.1080/14767058.2016.1179273] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of the study was to clarify the prevalence and determinants of inadequate use of folic acid supplementation in pregnant Japanese women. METHODS This study was part of the Japan Environment and Children's Study, a nationwide and government-funded birth cohort study. We collected information on the use of folic acid supplementation before and during pregnancy and characteristics of participants using self-administered questionnaire. RESULTS Among 9849 women who completed the data collection for this study, the prevalence of inadequate users was 92.6% of the total population and varied from 84.5% to 96.2% among regions. On the basis of multivariate logistic regression analysis, younger age, not married, lower family income, multipara, natural conception and no history of spontaneous abortion were found to be determinants for inadequate users of folic acid supplementation. CONCLUSION Most Japanese pregnant women show inadequate folic acid supplementation use. Japanese women of child-bearing age need to be specifically informed about the need for periconceptional intake of folic acid to prevent neural tube defects.
Collapse
Affiliation(s)
- Taku Obara
- a Environment and Genome Research Center, Tohoku University Graduate School of Medicine , Aoba-ku, Sendai, Miyagi , Japan.,b Department of Pharmaceutical Sciences , Tohoku University Hospital , Aoba-ku, Sendai, Miyagi , Japan.,c Tohoku University Tohoku Medical Megabank Organization , Aoba-ku, Sendai, Miyagi , Japan
| | - Hidekazu Nishigori
- a Environment and Genome Research Center, Tohoku University Graduate School of Medicine , Aoba-ku, Sendai, Miyagi , Japan.,d Department of Gynecology and Obstetrics , and
| | - Toshie Nishigori
- c Tohoku University Tohoku Medical Megabank Organization , Aoba-ku, Sendai, Miyagi , Japan
| | - Hirohito Metoki
- a Environment and Genome Research Center, Tohoku University Graduate School of Medicine , Aoba-ku, Sendai, Miyagi , Japan.,c Tohoku University Tohoku Medical Megabank Organization , Aoba-ku, Sendai, Miyagi , Japan.,d Department of Gynecology and Obstetrics , and
| | - Mami Ishikuro
- a Environment and Genome Research Center, Tohoku University Graduate School of Medicine , Aoba-ku, Sendai, Miyagi , Japan.,c Tohoku University Tohoku Medical Megabank Organization , Aoba-ku, Sendai, Miyagi , Japan
| | - Nozomi Tatsuta
- a Environment and Genome Research Center, Tohoku University Graduate School of Medicine , Aoba-ku, Sendai, Miyagi , Japan
| | - Satoshi Mizuno
- a Environment and Genome Research Center, Tohoku University Graduate School of Medicine , Aoba-ku, Sendai, Miyagi , Japan
| | - Kasumi Sakurai
- a Environment and Genome Research Center, Tohoku University Graduate School of Medicine , Aoba-ku, Sendai, Miyagi , Japan
| | - Ichiko Nishijima
- a Environment and Genome Research Center, Tohoku University Graduate School of Medicine , Aoba-ku, Sendai, Miyagi , Japan.,c Tohoku University Tohoku Medical Megabank Organization , Aoba-ku, Sendai, Miyagi , Japan
| | - Yuriko Murai
- b Department of Pharmaceutical Sciences , Tohoku University Hospital , Aoba-ku, Sendai, Miyagi , Japan
| | - Ikuma Fujiwara
- a Environment and Genome Research Center, Tohoku University Graduate School of Medicine , Aoba-ku, Sendai, Miyagi , Japan.,e Department of Pediatrics , Tohoku University Graduate School of Medicine , Aoba-ku, Sendai, Miyagi , Japan , and
| | - Takahiro Arima
- a Environment and Genome Research Center, Tohoku University Graduate School of Medicine , Aoba-ku, Sendai, Miyagi , Japan
| | - Kunihiko Nakai
- a Environment and Genome Research Center, Tohoku University Graduate School of Medicine , Aoba-ku, Sendai, Miyagi , Japan
| | - Nariyasu Mano
- b Department of Pharmaceutical Sciences , Tohoku University Hospital , Aoba-ku, Sendai, Miyagi , Japan
| | - Nobuo Yaegashi
- a Environment and Genome Research Center, Tohoku University Graduate School of Medicine , Aoba-ku, Sendai, Miyagi , Japan.,c Tohoku University Tohoku Medical Megabank Organization , Aoba-ku, Sendai, Miyagi , Japan.,d Department of Gynecology and Obstetrics , and
| | - Shinichi Kuriyama
- a Environment and Genome Research Center, Tohoku University Graduate School of Medicine , Aoba-ku, Sendai, Miyagi , Japan.,c Tohoku University Tohoku Medical Megabank Organization , Aoba-ku, Sendai, Miyagi , Japan.,f Tohoku University International Research Institute for Disaster Science , Aoba-ku, Sendai, Miyagi , Japan
| | | |
Collapse
|
7
|
Oliver EM, Grimshaw KEC, Schoemaker AA, Keil T, McBride D, Sprikkelman AB, Ragnarsdottir HS, Trendelenburg V, Emmanouil E, Reche M, Fiocchi A, Fiandor A, Stanczyk-Przyluska A, Wilczynski J, Busacca M, Sigurdardottir ST, Dubakiene R, Rudzeviciene O, Vlaxos GD, Beyer K, Roberts G. Dietary habits and supplement use in relation to national pregnancy recommendations: data from the EuroPrevall birth cohort. Matern Child Health J 2015; 18:2408-25. [PMID: 24752313 DOI: 10.1007/s10995-014-1480-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Assessing maternal dietary habits across Europe during pregnancy in relation to their national pregnancy recommendations. A collaborative, multi-centre, birth cohort study in nine European countries was conducted as part of European Union funded EuroPrevall project. Standardised baseline questionnaire data included details of food intake, nutritional supplement use, exposure to cigarette smoke during pregnancy and socio-demographic data. Pregnancy recommendations were collected from all nine countries from the appropriate national organisations. The most commonly taken supplement in pregnancy was folic acid (55.6 % Lithuania-97.8 % Spain) and was favoured by older, well-educated mothers. Vitamin D supplementation across the cohort was very poor (0.3 % Spain-5.1 % Lithuania). There were significant differences in foods consumed in different countries during pregnancy e.g. only 2.7 % Dutch mothers avoided eating peanut, while 44.4 % of British mothers avoided it. Some countries have minimal pregnancy recommendations i.e. Lithuania, Poland and Spain while others have similar, very specific recommendations i.e. UK, the Netherlands, Iceland, Greece. Allergy specific recommendations were associated with food avoidance during pregnancy [relative rate (RR) 1.18 95 % CI 0.02-1.37]. Nutritional supplement recommendations were also associated with avoidance (RR 1.08, 1.00-1.16). Maternal dietary habits and the use of dietary supplements during pregnancy vary significantly across Europe and in some instances may be influenced by national recommendations.
Collapse
Affiliation(s)
- E M Oliver
- Clinical and Experimental Sciences Academic Unit, Level F, South Academic Block, Faculty of Medicine, Southampton General Hospital, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Abstract
Myelomeningocele has been recognized since ancient times although written descriptions began not before the 17th century. Among all serious congenital malformations, myelomeningocele is unique that is has a steady and considerable prevalence while being compatible with life. It has a dismal prognosis when left untreated where virtually all die within the first year while aggressive treatment have a profound effect on survival and quality of life. Effective surgical treatment became possible parallel to the treatment of hydrocephalus in the late 1950s. Advent of the shunt systems undoubtedly changed the morbidity and mortality rates due to associated hydrocephalus. Aggressive and effective treatment improved survival rates but also those suffering physical and mental disabilities have increased as well. Ethical and socioeconomic concerns have led to proposal for selective treatment criteria which have raised arguments on medical and ethico-legal rounds. After the swing of the pendulum between early treatment in all affected children and selective treatment of those who fulfilled the criteria for good prognosis, early myelomeningocele repair is practiced widely unless the infant is critically ill.Incidence of myelomeningocele has been decreasing especially in the Western world, partly due to prenatal diagnosis and elective terminations, dietary folate supplementation. Still, it is the most common central nervous system malformation and one of the leading causes of paraplegia, worldwide. Unfortunately, gains in the management of myelomeningocele have been mainly on antenatal diagnosis and prevention while efforts on understanding its cause, mechanisms involved are still tentative. Concerning the surgical management, no revolutionary modification improving outcome has been introduced unlike other fields of neurosurgery.Medical management of a child with myelomeningocele requires a lifelong effort of several disciplines including urology, orthopedics physical and social therapy besides neurosurgery. The initial and probably the most crucial step begin with proper repair of the lesion. The aim of surgery, with its simplest definition should be towards maintaining the medical condition of the newborn. In other words, consequences of an open spinal cord segment with associated malformations have to be avoided with appropriate measures. Comparable to the surgical treatment of any congenital malformation, myelomeningocele repair consist of reversing the failed steps of normal neural tube closure. This requires a thorough understanding of the normal and abnormal embryological sequence of events in formation of the spinal cord. Although the purpose of this chapter is to describe the basic concepts and technique of myelomeningocele repair, contemporary information and progress on epidemiology, and etiology and embryology is presented with discussion of controversial issues regarding the selection process, optimal time for surgery and technical modifications.
Collapse
|
9
|
Tort J, Lelong N, Prunet C, Khoshnood B, Blondel B. Maternal and health care determinants of preconceptional use of folic acid supplementation in France: results from the 2010 National Perinatal Survey. BJOG 2013; 120:1661-7. [DOI: 10.1111/1471-0528.12414] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2013] [Indexed: 11/30/2022]
Affiliation(s)
- J Tort
- INSERM UMRS 953; Epidemiological Research Unit on Perinatal and Women's and Children's Health; Paris France
- UPMC University, Paris; France
| | - N Lelong
- INSERM UMRS 953; Epidemiological Research Unit on Perinatal and Women's and Children's Health; Paris France
- UPMC University, Paris; France
| | - C Prunet
- INSERM UMRS 953; Epidemiological Research Unit on Perinatal and Women's and Children's Health; Paris France
- UPMC University, Paris; France
| | - B Khoshnood
- INSERM UMRS 953; Epidemiological Research Unit on Perinatal and Women's and Children's Health; Paris France
- UPMC University, Paris; France
| | - B Blondel
- INSERM UMRS 953; Epidemiological Research Unit on Perinatal and Women's and Children's Health; Paris France
- UPMC University, Paris; France
| |
Collapse
|
10
|
The role of folic acid in fetal programming of birth phenotypes and early human development: a biopsychosocial perspective. J Dev Orig Health Dis 2013; 4:442-57. [DOI: 10.1017/s2040174413000317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Preterm birth, low birthweight, intrauterine growth retardation and small for gestational age are birth phenotypes that significantly contribute to life-long morbidity and mortality. This review examines the epidemiologic and biologic evidence of folic acid (FA) as a potential population-based intervention to curtail some adverse birth phenotypic expressions, and by extension, their later physical and neurodevelopmental consequences. We outlined a feto-placental adaptation categorization taking into account how prenatal insults may be encoded in fetal development, the adaptive success of the feto-placental response, and subsequent expression in the health of the fetus. Although there are plausible biological pathways that can be implicated, we found that the epidemiological evidence on the role of perinatal FA nutriture and fetal programming of adverse birth phenotypes is still inconclusive. Because biologic and epidemiological considerations alone do not suffice in deciphering the utility of FA in averting adverse birth phenotypes, we proposed a biopsychosocial model that takes into account multi-layered psychosocial contexts for improving subsequent research studies in this area.
Collapse
|
11
|
Rabiu TB, Tiamiyu LO, Awoyinka BS. Awareness of spina bifida and periconceptional use of folic acid among pregnant women in a developing economy. Childs Nerv Syst 2012; 28:2115-9. [PMID: 22878662 DOI: 10.1007/s00381-012-1879-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 07/25/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Folate deficiency in pregnant women is a recognized cause of spina bifida. We sought to establish the level of awareness of spina bifida as well as the use of folate supplementation among pregnant women in a developing economy. METHOD Interviewer-administered questionnaires were used to obtain information from 200 to 20 randomly selected pregnant women attending antenatal clinics at the authors' institution. Demographic information and information on parity, folic acid use and knowledge on spina bifida including its cause, prevention and treatment were obtained. Data analyses were done using Epi Info version 6. RESULTS The mean age of the women was 30.3 years (range 17-52 years). Sixty-six of the women (30.0 %) were primigravida. Most of the respondents [208 (94.5 %)] have attained, at least, secondary level of education. The average gestational age at antenatal clinic booking was 20.7 weeks (range 4-38 weeks), while the average gestational age at commencement of folic acid use was 18.5 weeks (range 4-38 weeks). None of them used folic acid in the preconception period. Knowledge about spina bifida is poor and a significant number [103 (46.8 %)] have superstitious belief about its aetiology. Only 56 (25.5 %) of the respondents are aware that folic acid use prevents its occurrence; however, 194 (88.2 %) are willing to receive periconceptional folate supplementation. CONCLUSION There is paucity of knowledge about spina bifida among Nigerian pregnant women despite their high level of formal education. We advocate an aggressive public health campaign to enlighten the women about spina bifida and encourage periconceptional folate supplementation.
Collapse
Affiliation(s)
- T B Rabiu
- Division of Neurological Surgery, Department of Surgery, Federal Medical Centre, Ido-Ekiti, Nigeria.
| | | | | |
Collapse
|
12
|
Use of folic acid supplements and risk of cleft lip and palate in infants: a population-based cohort study. Br J Gen Pract 2012; 62:e466-72. [PMID: 22781994 DOI: 10.3399/bjgp12x652328] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Orofacial clefts occur when the lips or the roof of the mouth do not fuse properly during the early weeks of pregnancy. There is strong evidence that periconceptional use of folic acid can prevent neural tube defects but its effect on oral clefts has generated debate. AIM To identify factors associated with suboptimal periconceptional use of folic acid and its potential effect on oral clefts. DESIGN AND SETTING The population-based infant cohort of the national Growing Up in Ireland study, which consists of 11 134 9-month-old infants. METHOD Data collection comprised questionnaires conducted by interviewers with parents in parents' homes. Characteristics of mothers who did or did not take folic acid before and during pregnancy, as well as the effect of folic acid use on the prevalence of cleft lip and palate were recorded. RESULTS The prevalence of cleft lip and palate was 1.98 (95% confidence interval [CI] = 1.31 to 2.99) per 1000 9-month-olds. The odds ratio for cleft lip was 4.36-fold higher (95% CI = 1.55 to 12.30, P = 0.005) for infants of mothers who did not take folic acid during the first 3 months of pregnancy, when compared with those who did have a folate intake during the first trimester. Folic acid use was suboptimal in 36.3% (95% CI = 35.4 to 37.2) of the sample. CONCLUSION These findings support the hypothesis that taking folic acid may partially prevent cleft lip and palate. They are particularly relevant for GPs, because they are usually the first port of call for women before and during early pregnancy.
Collapse
|
13
|
Bjørke-Monsen AL, Roth C, Magnus P, Midttun Ø, Nilsen RM, Reichborn-Kjennerud T, Stoltenberg C, Susser E, Vollset SE, Ueland PM. Maternal B vitamin status in pregnancy week 18 according to reported use of folic acid supplements. Mol Nutr Food Res 2012; 57:645-52. [PMID: 23001761 PMCID: PMC3774931 DOI: 10.1002/mnfr.201200114] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 04/13/2012] [Accepted: 06/20/2012] [Indexed: 11/08/2022]
Abstract
SCOPE Epidemiological studies on the association between pregnancy outcomes and use of periconceptional folic acid are often based on maternal reported intake. Use of folic acid during pregnancy is associated with a higher socioeconomic status known to have an impact on diet quality. We have studied plasma B vitamin status according to reported use of folic acid supplements during the periconceptional period in Norwegian women. METHODS AND RESULTS Plasma levels of folate, cobalamin, pyridoxal 5'-phosphate (vitamin B6), riboflavin, and the metabolic markers total homocysteine, methylmalonic acid and 3-hydro-xykynurenine were measured in pregnancy week 18 and related to reported intake of folic acid from 4 weeks prior to conception throughout week 18 in 2911 women from the Norwegian Mother and Child Cohort Study (MoBa) conducted by the Norwegian Institute of Public Health. Being a folic acid user during the periconceptional period was associated with a better socioeconomic status, and a higher intake of several micronutrients, including vitamins, trace-metals, and omega 3 fatty acids. Folic acid users had a significantly better plasma B vitamin status. CONCLUSION Epidemiological data based on maternal reported intake of folic acid supplements during pregnancy, should take into account the numerous nutritional implications, in addition to higher blood folate levels, of being a folic acid user.
Collapse
|
14
|
Hoyo C, Murtha AP, Schildkraut JM, Forman MR, Calingaert B, Demark-Wahnefried W, Kurtzberg J, Jirtle RL, Murphy SK. Folic acid supplementation before and during pregnancy in the Newborn Epigenetics STudy (NEST). BMC Public Health 2011. [PMID: 21255390 DOI: 10.n86/1471-2458-11-46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Folic acid (FA) added to foods during fortification is 70-85% bioavailable compared to 50% of folate occurring naturally in foods. Thus, if FA supplements also are taken during pregnancy, both mother and fetus can be exposed to FA exceeding the Institute of Medicine's recommended tolerable upper limit (TUL) of 1,000 micrograms per day (μg/d) for adult pregnant women. The primary objective is to estimate the proportion of women taking folic acid (FA) doses exceeding the TUL before and during pregnancy, and to identify correlates of high FA use. METHODS During 2005-2008, pre-pregnancy and pregnancy-related data on dietary supplementation were obtained by interviewing 539 pregnant women enrolled at two obstetrics-care facilities in Durham County, North Carolina. RESULTS Before pregnancy, 51% of women reported FA supplementation and 66% reported this supplementation during pregnancy. Before pregnancy, 11.9% (95% CI = 9.2%-14.6%) of women reported supplementation with FA doses above the TUL of 1,000 μg/day, and a similar proportion reported this intake prenatally. Before pregnancy, Caucasian women were more likely to take FA doses above the TUL (OR = 2.99; 95% = 1.28-7.00), compared to African American women, while women with chronic conditions were less likely to take FA doses above the TUL (OR = 0.48; 95%CI = 0.21-0.97). Compared to African American women, Caucasian women were also more likely to report FA intake in doses exceeding the TUL during pregnancy (OR = 5.09; 95%CI = 2.07-12.49). CONCLUSIONS Fifty-one percent of women reported some FA intake before and 66% during pregnancy, respectively, and more than one in ten women took FA supplements in doses that exceeded the TUL. Caucasian women were more likely to report high FA intake. A study is ongoing to identify possible genetic and non-genotoxic effects of these high doses.
Collapse
Affiliation(s)
- Cathrine Hoyo
- Department of Community and Family Medicine and Program of Cancer Detection, Prevention and Control, Duke University, PO Box 104006, Durham, NC 27710, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Hoyo C, Murtha AP, Schildkraut JM, Forman MR, Calingaert B, Demark-Wahnefried W, Kurtzberg J, Jirtle RL, Murphy SK. Folic acid supplementation before and during pregnancy in the Newborn Epigenetics STudy (NEST). BMC Public Health 2011; 11:46. [PMID: 21255390 PMCID: PMC3038155 DOI: 10.1186/1471-2458-11-46] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 01/21/2011] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Folic acid (FA) added to foods during fortification is 70-85% bioavailable compared to 50% of folate occurring naturally in foods. Thus, if FA supplements also are taken during pregnancy, both mother and fetus can be exposed to FA exceeding the Institute of Medicine's recommended tolerable upper limit (TUL) of 1,000 micrograms per day (μg/d) for adult pregnant women. The primary objective is to estimate the proportion of women taking folic acid (FA) doses exceeding the TUL before and during pregnancy, and to identify correlates of high FA use. METHODS During 2005-2008, pre-pregnancy and pregnancy-related data on dietary supplementation were obtained by interviewing 539 pregnant women enrolled at two obstetrics-care facilities in Durham County, North Carolina. RESULTS Before pregnancy, 51% of women reported FA supplementation and 66% reported this supplementation during pregnancy. Before pregnancy, 11.9% (95% CI = 9.2%-14.6%) of women reported supplementation with FA doses above the TUL of 1,000 μg/day, and a similar proportion reported this intake prenatally. Before pregnancy, Caucasian women were more likely to take FA doses above the TUL (OR = 2.99; 95% = 1.28-7.00), compared to African American women, while women with chronic conditions were less likely to take FA doses above the TUL (OR = 0.48; 95%CI = 0.21-0.97). Compared to African American women, Caucasian women were also more likely to report FA intake in doses exceeding the TUL during pregnancy (OR = 5.09; 95%CI = 2.07-12.49). CONCLUSIONS Fifty-one percent of women reported some FA intake before and 66% during pregnancy, respectively, and more than one in ten women took FA supplements in doses that exceeded the TUL. Caucasian women were more likely to report high FA intake. A study is ongoing to identify possible genetic and non-genotoxic effects of these high doses.
Collapse
Affiliation(s)
- Cathrine Hoyo
- Department of Community and Family Medicine and Program of Cancer Detection, Prevention and Control, Duke University, PO Box 104006, Durham, NC 27710, USA
| | - Amy P Murtha
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Duke University, 4022 Hospital South, Durham, NC 27710, USA
| | - Joellen M Schildkraut
- Department of Community and Family Medicine and Program of Cancer Detection, Prevention and Control, Duke University, PO Box 104006, Durham, NC 27710, USA
| | - Michele R Forman
- Department of Epidemiology, MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1340, Houston, TX 77030-4009, USA
| | - Brian Calingaert
- Department of Community and Family Medicine and Program of Cancer Detection, Prevention and Control, Duke University, PO Box 104006, Durham, NC 27710, USA
| | - Wendy Demark-Wahnefried
- Department of Behavioral Science, MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1340, Houston, TX 77030-4009, USA
| | - Joanne Kurtzberg
- Department of Pathology and Carolinas Cord Blood Banking Project, Duke University, 1430 N. Pavilion Bldg, Durham, NC 27705, USA
| | - Randy L Jirtle
- Department of Radiation Oncology, 139 Env Safety Bldg., Durham, NC 27710, USA
| | - Susan K Murphy
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Department of Pathology Duke University, 226 B Wing LSRC Research Drive Durham, NC 27708, USA
| |
Collapse
|
16
|
Auriel E, Biderman A, Belmaker I, Freud T, Peleg R. Knowledge, Attitudes, and Practice among Women and Doctors Concerning the Use of Folic Acid. ISRN OBSTETRICS AND GYNECOLOGY 2010; 2011:946041. [PMID: 21647220 PMCID: PMC3100598 DOI: 10.5402/2011/946041] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 09/26/2010] [Indexed: 11/23/2022]
Abstract
Background and Objective. Daily folic acid intake, prior to conception and in early pregnancy, significantly reduces neural tube defects (NTDs). We compared folic acid consumption among Jewish and Bedouin women and the recommendations of family physicians and gynecologists.
Methods. We compared 64 Muslim Bedouin women and 65 Jewish women. We also compared 39 gynecologists and 60 family physicians. Results. Fifty-one Jewish women (78.5%) took folic acid during pregnancy, but only seven (10.8%) before conception. Sixty Bedouin women (93.75%) took folic acid during pregnancy, but only four (6.25%) before conception (P < .05). Five Jewish women (7.7%) and two Bedouin women (3.1%) took folic acid three months before conception. Thirty-three gynecologists (87%) recommend preconception folic acid compared with thirty-six family physicians (60%) (P < .05). Conclusions. The majority of women use folic acid during pregnancy, but only few do so to prevent NTDs. There is a significant difference between doctors' recommendations and actual practice.
Collapse
Affiliation(s)
- Eithan Auriel
- Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of the Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 84105, Israel
| | | | | | | | | |
Collapse
|
17
|
McGuire M, Cleary B, Sahm L, Murphy D. Prevalence and predictors of periconceptional folic acid uptake--prospective cohort study in an Irish urban obstetric population. Hum Reprod 2009; 25:535-43. [DOI: 10.1093/humrep/dep398] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
18
|
Callaway LK, O’Callaghan MJ, McIntyre HD. Barriers to addressing overweight and obesity before conception. Med J Aust 2009; 191:425-8. [DOI: 10.5694/j.1326-5377.2009.tb02876.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Accepted: 08/06/2009] [Indexed: 11/17/2022]
Affiliation(s)
- Leonie K Callaway
- Royal Brisbane and Women's Hospital, Brisbane, QLD
- Royal Brisbane Clinical School, School of Medicine, The University of Queensland, Brisbane, QLD
| | | | - H David McIntyre
- Mater Clinical School, School of Medicine, The University of Queensland, Brisbane, QLD
- Departments of Endocrinology and Obstetric Medicine, Mater Health Services, Brisbane, QLD
| |
Collapse
|
19
|
Williams P, McHenery J, McMahon A, Anderson H. Impact evaluation of a folate education campaign with and without the use of a health claim. Aust N Z J Public Health 2009. [DOI: 10.1111/j.1467-842x.2001.tb00281.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
20
|
Lunet N, Rodrigues T, Correia S, Barros H. Adequacy of prenatal care as a major determinant of folic acid, iron, and vitamin intake during pregnancy. CAD SAUDE PUBLICA 2008; 24:1151-7. [PMID: 18461244 DOI: 10.1590/s0102-311x2008000500022] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Accepted: 10/08/2007] [Indexed: 11/22/2022] Open
Abstract
This study aimed to quantify the association between adequacy of prenatal care and prevalence of folic acid, iron, and multivitamin intake during pregnancy. Data were obtained on socio-demographics, prenatal care, pregnancy complications, and use of vitamin/mineral supplements for 836 women, using a postpartum interview. Associations with the use of vitamin/mineral supplements were quantified with risk ratios (RR), computed by generalized binomial regression. A high proportion of women reported the use of folic acid (81.9%), iron (55.4%), and multivitamins (76.2%) as supplements during pregnancy. Use of supplements was independently associated with adequacy of prenatal care (adequate vs. inadequate: folic acid, RR = 2.28; 95%CI: 1.58-3.29; iron, RR = 1.99; 95%CI: 1.57-2.52, multivitamins, RR = 1.97; 95%CI: 1.54-2.51). Higher schooling was also associated with increased use of folic acid (RR = 1.42; 95%CI: 1.18-1.70), but not multivitamins (RR = 0.87; 95%CI: 0.77-0.98). Use of folic acid was less prevalent in single women (RR = 0.67; 95%CI: 0.48-0.95) and during unplanned pregnancies (RR = 0.81; 95%CI: 0.71-0.92). Adequacy of prenatal care is a major determinant of vitamin/mineral intake during pregnancy.
Collapse
Affiliation(s)
- Nuno Lunet
- Faculdade de Medicina, Universidade do Porto, Al. Prof. Hernâni Monteiro, Porto, Portugal.
| | | | | | | |
Collapse
|
21
|
Hassan AS, Al-Kharusi BM. Knowledge and use of folic acid among pregnant Arabian women residing in Qatar and Oman. Int J Food Sci Nutr 2008; 59:70-9. [PMID: 18097845 DOI: 10.1080/09637480701668770] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The objective of this study was to assess the knowledge and use of folic acid among pregnant Arabian women in Qatar and Oman. Three hundred pregnant women were interviewed during their second trimester based on a questionnaire developed for the study. Results of the survey indicated that 94% of the women knew about folic acid, 41.3% knew it should be taken periconceptionally, 58.5% knew that it prevents birth defects and 34.4% were able to identify five or more food sources of folic acid. The majority (88.7%) of women was taking the supplement, 85.0% were taking it regularly and 13.2% took it before getting pregnant. Knowledge and use were significantly influenced by ethnicity, age, education level, employment and family income. Periconceptional use of supplement was lowest among younger women (4.9%) and illiterate and least educated women (5.3%). It was concluded that high level of knowledge of folic acid was not reflected as successful use of the folic acid supplement.
Collapse
Affiliation(s)
- Abdelmonem S Hassan
- Human Nutrition Program, Department of Health Sciences, Qatar University, Qatar.
| | | |
Collapse
|
22
|
Use of folic acid supplements, particularly by low-income and young women: a series of systematic reviews to inform public health policy in the UK. Public Health Nutr 2008; 11:807-21. [PMID: 18457601 DOI: 10.1017/s1368980008002346] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To provide a basis for making recommendations on the potential to improve use of folic acid supplements in the UK, particularly among low-income and young women. DESIGN Systematic reviews of relevant research from 1989 to May 2006 in Europe, the USA, Canada, Australia and New Zealand. RESULTS Twenty-six systematic reviews and/or meta-analyses were identified from the wider public health literature, and eighteen studies on the effectiveness of preconception interventions were included. Ninety studies were identified which were directly relevant to folic acid supplement intake. There were factors that are particularly associated with lower rates of use of folic acid supplements. One of the most important of these is the link with unintended pregnancy, followed by age, socio-economic and ethnic group. Integrated campaigns can increase the use of folic acid supplements to some extent. Research trials indicated that: (i) printed resources and the mass media used in isolation are not effective in the longer term; and (ii) health-care-based initiatives can be effective and are more likely to be successful if they include making supplements easily available. CONCLUSIONS Campaigns and interventions have the potential to exacerbate socio-economic inequalities in folic acid use. One way of addressing this is to include elements that specifically target vulnerable women. To achieve and maintain an effect, they need to be based on good health promotion practice and to be sustained over a long period. However, even high-quality campaigns that increase use result in under half of women in the target group taking supplements.
Collapse
|
23
|
Knudsen VK, Orozova-Bekkevold I, Rasmussen LB, Mikkelsen TB, Michaelsen KF, Olsen SF. Low compliance with recommendations on folic acid use in relation to pregnancy: is there a need for fortification? Public Health Nutr 2007; 7:843-50. [PMID: 15482608 DOI: 10.1079/phn2004630] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AbstractObjective:As a means to prevent neural tube defects (NTDs), women planning pregnancy in Denmark are recommended to take a dietary supplement of 400 μg folic acid daily during the periconceptional period. We examined compliance with this recommendation in a national survey.Design:Cohort study on pregnant women in Denmark.Setting:The Danish National Birth Cohort (DNBC).Subjects:From November 2000 to February 2002, 22 000 pregnant women were recruited for DNBC. Use of dietary supplements was recorded at enrolment. Compliance with the recommendation was related to an information campaign that took place during the second half of 2001, and to lifestyle factors provided in a telephone interview by the end of the first trimester of pregnancy.Results:An increase was seen in the proportion of women complying with the recommendation in the study period and this coincided with the information campaign events. However, even at the end of the period, only 22.3% of the women who had planned their pregnancy fully complied with the recommendation. No increase at all was seen in periconceptional folic acid use among women with unplanned pregnancies. Young age, low education and smoking were identified as factors that determined non-compliance.Conclusions:Alternative and more effective strategies are needed if the Danish population is to benefit fully from the knowledge that folic acid prevents NTDs. Future strategies should not only target vulnerable groups, such as the less educated and the young, but also women who get pregnant without planning this. The only possible way to reach the last group may be through fortification of foods with folic acid.
Collapse
Affiliation(s)
- Vibeke K Knudsen
- Maternal Nutrition Group, Danish Epidemiology Science Centre, Statens Serum Institut, Copenhagen S, Denmark.
| | | | | | | | | | | |
Collapse
|
24
|
Nilsen RM, Vollset SE, Gjessing HK, Magnus P, Meltzer HM, Haugen M, Ueland PM. Patterns and predictors of folic acid supplement use among pregnant women: the Norwegian Mother and Child Cohort Study. Am J Clin Nutr 2006; 84:1134-41. [PMID: 17093167 DOI: 10.1093/ajcn/84.5.1134] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Patterns and predictors of maternal folic acid supplement use have not been examined in large prospective studies of pregnant women. OBJECTIVE We examined the patterns and predictors of maternal folic acid supplement use from 2 mo before pregnancy through the eighth month of pregnancy. DESIGN Data from 22 500 women in the Norwegian Mother and Child Cohort Study with deliveries recorded in 2000-2003 were analyzed. RESULTS Folic acid supplement use increased from 11.8% at 2 mo before pregnancy to 46.9% at gestational month 3, but decreased to 26.0% at gestational month 8. Of 16 116 women (71.6%) who had taken folic acid supplements at some time before or during pregnancy, 72.4% had started use after becoming pregnant. Ten percent of the women had used supplements regularly from 1 mo before pregnancy throughout the first trimester. These women more frequently reported higher maternal and paternal education, planned pregnancies, infertility treatments, or chronic diseases. They were also more likely to be older, married, and nonsmokers and to have higher income and lower parity. CONCLUSIONS Most women started folic acid supplementation too late with respect to the prevention of neural tube defects. More effective intervention programs to improve periconceptional intakes of folic acid are needed and should consider both demographic and socioeconomic factors.
Collapse
Affiliation(s)
- Roy M Nilsen
- Section for Epidemiology and Medical Statistics, Department of Public Health and Primary Health Care and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.
| | | | | | | | | | | | | |
Collapse
|
25
|
Robbins JM, Hopkins SE, Mosley BS, Casey PH, Cleves MA, Hobbs CA. Awareness and Use of Folic Acid Among Women in the Lower Mississippi Delta. J Rural Health 2006; 22:196-203. [PMID: 16824162 DOI: 10.1111/j.1748-0361.2006.00032.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CONTEXT National and state efforts to increase folic acid awareness and use may not be reaching large segments of the population. PURPOSE This study examines folic acid awareness and use among women of childbearing age in a representative, economically at-risk rural sample and identifies factors that influence awareness and use. METHODS A cross-sectional random digit dialing telephone survey was completed with a representative sample of 646 women aged 14-45 years in 36 counties of the lower Mississippi Delta. Folic acid awareness and supplement use were estimated by percentages weighted to reflect the 36-county population. Pregnancy intentions and the ability to become pregnant were used to predict awareness and use among a subsample of sexually active women. FINDINGS Compared to national samples, Delta women were less likely to have heard of folic acid (75% vs 64%) or to take a regular (5-7 days/wk) folic acid supplement (34% vs 22%). The proportion of women who took regular folic acid supplements was very low among some subgroups: African Americans (14%), those 14-19 years of age (12%), and those with low incomes (13%) and low educational levels (14%). Of the women who reported being sexually active, the ability to become pregnant more than doubled their likelihood of regular supplement use. CONCLUSIONS The national folic acid campaign has not reached many women in the rural Mississippi Delta. A new mode of folic acid education is needed that is focused on low-income and young women and women not planning pregnancies. In the Delta and similar geographic regions, health care providers, black church leaders, and youth group leaders could be valuable advocates for folic acid.
Collapse
Affiliation(s)
- James M Robbins
- Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72202, USA.
| | | | | | | | | | | |
Collapse
|
26
|
Ludwig AK, Katalinic A, Steinbicker V, Diedrich K, Ludwig M. Antenatal care in singleton pregnancies after ICSI as compared to spontaneous conception: data from a prospective controlled cohort study in Germany. Hum Reprod 2005; 21:713-20. [PMID: 16311297 DOI: 10.1093/humrep/dei390] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The aim was to compare the antenatal care and the intake of vitamins and medications of infertility patients with singleton pregnancies after ICSI to women with a spontaneously conceived singleton pregnancy. METHODS The data on the antenatal care of 2055 singleton pregnancies after ICSI from a prospective controlled multicentre study in Germany were analysed. The prospectively collected data of the control group of 7861 singletons were retrospectively assessed for the present analysis. RESULTS The ICSI patients were significantly older (32.9 versus 27.0 years, P<0.019) and more likely to be obese (body mass index>or=30 kg/m2: 13.9 versus 4.8%, P<0.001) than the controls. The control mothers were significantly more likely to smoke (19.2%) or to consume alcohol (23.5%) during pregnancy than the ICSI mothers (7.4 and 0.6% respectively). Only 38.1% of ICSI patients took folic acid before conception. Only 61.7% of ICSI patients received an iodine supplementation at some point during pregnancy. ICSI patients went more regularly to the routine antenatal care consultations at the gynaecologist and had ultrasound examinations performed more regularly than the controls. The absolute number of ultrasound examinations was significantly higher in the ICSI group (13.6+/-6.0 versus 4.1+/-2.4). CONCLUSION In spite of the intensive use of antenatal medical care by patients pregnant after ICSI, simple methods, such as the use of supplementary iodine and periconceptional folic acid, were used rarely. This indicates that counselling pregnant patients after ICSI about periconceptional and antenatal care seems to be insufficient in Germany and must be improved.
Collapse
Affiliation(s)
- A K Ludwig
- Department of Gynaecology and Obstetrics, Institute of Cancer Epidemiology, University of Schleswig-Holstein, Campus Lübeck, Germany.
| | | | | | | | | |
Collapse
|
27
|
Robbins JM, Cleves MA, Collins HB, Andrews N, Smith LN, Hobbs CA. Randomized trial of a physician-based intervention to increase the use of folic acid supplements among women. Am J Obstet Gynecol 2005; 192:1126-32. [PMID: 15846191 DOI: 10.1016/j.ajog.2004.10.620] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Fewer than one third of American women take folic acid daily, although many women report that they would take folic acid if their physicians advised them to do so. This study determined the impact of a physician intervention during routine gynecologic visits on folic acid supplementation. STUDY DESIGN Patients were assigned randomly to receive brief folic acid counseling, a reminder phone call, and 30 folic acid tablets (n = 162 women; intervention group) or to receive counseling about other preventive health behaviors and a folic acid informational pamphlet (n = 160 women; control group). Self-reported folic acid use was compared at baseline and at 2 months. RESULTS Of the 279 patients who completed the study, weekly folic acid intake increased in the intervention group by 68%, compared with 20% in the control group ( P =.008). No significant differences were found in daily intake. The women who were most influenced by the intervention were black and lower income and not planning pregnancies. CONCLUSION With little effort expended to encourage folic acid use, gynecologists could potentially reduce the risk of folate-preventable birth defects among their patients by as much as 11%.
Collapse
Affiliation(s)
- James M Robbins
- Department of Pediatrics, Arkansas Center for Birth Defects Research and Prevention, University of Arkansas for Medical Sciences College of Medicine, and Arkansas Children's Hospital, Little Rock, AR, USA
| | | | | | | | | | | |
Collapse
|
28
|
Abstract
OBJECTIVE To systematically summarise the available evidence concerning the rate of folic acid supplement use pre- and periconceptionally, to identify those characteristics associated with low rates of use and to assess whether folic acid public awareness campaigns are associated with higher folic acid use. DESIGN Systematic overview. SETTING Survey studies. POPULATION Women of reproductive age, most of whom were currently or recently pregnant. METHODS Two investigators searched MEDLINE, Embase and Nutriotiongate databases between 1990 and 2003. Bibliographies of retrieved references were scanned for other relevant publications, and authors were contacted if necessary. Studies were included that evaluated the rate of folic acid supplement use either before conception or in early pregnancy. MAIN OUTCOME MEASURES Rate of preconceptional and/or periconceptional folic acid use, rate of planned pregnancy in each study, as well as significant characteristics differentiating non-users from users of folic acid, including the effect of folic acid awareness campaigns. RESULTS A total of 52 studies were included. In 34 studies, reported preconceptional folic acid use varied from 0.9% to 50%. In 49 studies, the reported rate of periconceptional supplement use ranged from 0.5% to 52%. Significant predictors of reduced periconceptional folic acid use were a low level of formal education, immigrant status, young maternal age, lack of a partner and an unplanned pregnancy. Four studies examined the effect of mass media campaigns on periconceptional folic acid use; the reported rates increased significantly, by a factor of 1.7 to 7.2, but in no study was the post-campaign rate above 50%. CONCLUSIONS In many countries, fewer than 50% of women take periconceptional folic acid supplements. Consideration should be given to the practical advantages of folic acid fortification of centrally processed foods, such as wheat, corn and rice flour, while further promoting vitamin tablet supplement use and planned pregnancy.
Collapse
Affiliation(s)
- Joel G Ray
- Inner City Health Programme, Department of Medicine, St Michael's Hospital, University of Toronto, Ontario, Canada
| | | | | |
Collapse
|
29
|
Cleves MA, Hobbs CA, Collins HB, Andrews N, Smith LN, Robbins JM. Folic Acid Use by Women Receiving Routine Gynecologic Care. Obstet Gynecol 2004; 103:746-53. [PMID: 15051568 DOI: 10.1097/01.aog.0000117084.02395.a0] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Many health professional groups recommend folic acid supplementation for all women able to become pregnant. In this study, we document folic acid supplement use among a sample of women receiving routine gynecologic care. METHODS A short questionnaire was administered to 322 women aged 18-45 years who were seeking routine gynecologic care at participating clinics in Little Rock, Arkansas. Questions covered knowledge and use of folic acid supplements, pregnancy intention, and demographic and socioeconomic characteristics. Primary study outcomes were self-reported folic acid awareness, daily or weekly use of folic acid supplements, and intention to begin taking folic acid. Factors affecting study outcomes were examined individually by computing crude odd ratios and adjusted for other covariates using unconditional logistic regression. RESULTS Although 61.8% of women reported awareness of the association between folic acid and birth defects prevention, only 27.1% of these women, and 22.7% of all study participants, reported daily use of a folic acid supplement. Substantially more women (39.8%) were taking a folic acid supplement at least once per week. Age, race, educational level, folic acid awareness, marital status, pregnancy intent, and other preventive health behaviors were the most important predictors of compliance. CONCLUSION The results indicate a need for targeted interventions directed toward minority women, young women, and those of lower socioeconomic and educational status. The routine gynecologic visit is an ideal opportunity to counsel women of reproductive age to take folic acid daily. LEVEL OF EVIDENCE III
Collapse
Affiliation(s)
- Mario A Cleves
- Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, Arkansas 72202-3591, USA.
| | | | | | | | | | | |
Collapse
|
30
|
Bélanger MCR, Grégoire J. [Periconceptional intake of a folic acid supplement: evaluation of a promotional program]. CAN J DIET PRACT RES 2004; 64:189-94. [PMID: 14723233 DOI: 10.3148/64.4.2003.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This study evaluates the efficacy of a regional program promoting periconceptional folic acid intake. Data were collected through a self-administrated questionnaire among 721 (405 for phase I; 316 for phase II) primiparous women. For phase I, 26.1% (CI [Confidence Interval] 95%: 21.9%-30.4%) of respondents took an adequate periconceptional folic acid supplement, whereas this proportion was 31.6% (CI 95%: 26.5%-36.7%) for phase II (p>0.05). For phase I, 62.0% (CI 95%: 57.3%-66.7%) of women recognized the role of folic acid. For phase II, this proportion significantly rose to 70.9% (CI 95%: 65.9%-75.9%). Regional activities promoting periconceptional folic acid intake, if maintained, should be modified to significantly increase the proportion of women taking an adequate amount of folic acid.
Collapse
|
31
|
Abstract
This article thoroughly updates the authors' previous review of nutritional assessment and support during pregnancy. After briefly reviewing nutrient metabolism and requirements, the authors discuss the nutritional assessment of the pregnant woman and review the nutritional support principles in hyperemesis gravidarum and other conditions that can compromise the nutritional health of mother or fetus.
Collapse
Affiliation(s)
- Elie Hamaoui
- Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219, USA.
| | | |
Collapse
|
32
|
Preconception Counseling Improves Folate Status of Women Planning Pregnancy. Obstet Gynecol 2002. [DOI: 10.1097/00006250-200201000-00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
33
|
Williams P, McHenery J, McMahon A, Anderson H. Impact evaluation of a folate education campaign with and without the use of a health claim. Aust N Z J Public Health 2001. [DOI: 10.1111/j.1467-842x.2001.tb00646.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
|
34
|
Sen S, Manzoor A, Deviasumathy M, Newton C. Maternal knowledge, attitude and practice regarding folic acid intake during the periconceptional period. Public Health Nutr 2001; 4:909-12. [PMID: 11527515 DOI: 10.1079/phn2001123] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To study the knowledge, attitude and practice of pregnant women regarding periconceptional folic acid (FA) intake. DESIGN Questionnaire-based prospective study. SETTING Antenatal clinic of a District General Hospital. SUBJECTS Three-hundred pregnant women in an antenatal clinic. RESULTS Nearly all (298/300) had heard of FA. A majority (275/300, 91%) knew that FA could prevent neural tube defects, and married women those with higher education those of Social Classes 1-3 and women over 30 years of age were more likely to be thus aware. Knowledge about the correct timing of FA intake was seen in 76% and was more likely in those with higher education married women and women age over 30 years Intake of FA in the periconceptional period was seen in 134/300 (44.6%) women and was most likely in the married, Social Classes 1-3, women with higher education (all P<0.001), non-smokers women with a planned pregnancy and women aged 30 years and over CONCLUSIONS The knowledge of the correct timing of FA intake was present in only 76%. Less than half (44.6%) had taken FA in the periconceptional period, and this was far more common in the more 'privileged' classes. Low socio-economic status, age less than 30 years, lower educational status and unplanned pregnancy were high risk factors for not taking FA. The challenge to the medical profession for targeting this group cannot be over-emphasised.
Collapse
Affiliation(s)
- S Sen
- Department of Paediatrics, Queen's Hospital, Burton, Belvedere Road, Burton on Trent, Staffordshire, DE13 0RB, UK.
| | | | | | | |
Collapse
|
35
|
Chan A, Pickering J, Haan E, Netting M, Burford A, Johnson A, Keane RJ. "Folate before pregnancy": the impact on women and health professionals of a population-based health promotion campaign in South Australia. Med J Aust 2001; 174:631-6. [PMID: 11480683 DOI: 10.5694/j.1326-5377.2001.tb143471.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate a South Australian campaign to promote and implement knowledge that taking adequate folate/folic acid in the periconceptional period can reduce the risk of having a baby with a neural tube defect. DESIGN AND SETTING The campaign, conducted in October 1994--August 1995, targeted women of reproductive age and health professionals. Evaluation was by computer-assisted telephone interviews undertaken by random dialling throughout the State before and after the campaign, and by self-administered questionnaires to health professionals and women in the postnatal period. PARTICIPANTS Women of reproductive age and four groups of health professionals. MAIN OUTCOME MEASURES Knowledge about folate, folate-rich foods and the periconceptional period; participation of health professionals in advising women about folate; use of periconceptional folic acid supplements; sales of folic acid tablets; and prevalence of neural tube defects. RESULTS Significant increases in knowledge about folate followed the campaign. Health professionals and women in the postnatal period had higher initial levels of knowledge about folate, which also increased significantly. The proportions of women taking periconceptional folic acid supplements, and of health professionals advising women planning a pregnancy about folate, also increased significantly, and folic acid tablet sales doubled. Total prevalence of neural tube defects declined between 1966 and 1999 from a baseline of 2.0 per 1,000 births to 1.1 per 1,000 births (Poisson regression, P= 0.03; average decline of 1.0% per year). CONCLUSIONS A short educational campaign with a limited budget ($40,000) can promote folate successfully, but alternative strategies such as food fortification are likely to be needed to achieve adequate periconceptional folate intake for a very high proportion of women.
Collapse
Affiliation(s)
- A Chan
- Pregnancy Outcome Unit, Department of Human Services, Adelaide, SA.
| | | | | | | | | | | | | |
Collapse
|
36
|
Watson MJ, Watson LF, Bell RJ, Halliday JL, Burford N, Brennecke SP. A randomized community intervention trial to increase awareness and knowledge of the role of periconceptional folate in women of child-bearing age. Health Expect 1999; 2:255-265. [PMID: 11281902 PMCID: PMC5080945 DOI: 10.1046/j.1369-6513.1999.00064.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES: To determine the effect of a consumer-directed information campaign to increase knowledge of folate for the prevention of neural tube defects among women of child-bearing age, and to measure women's recall of sources of information and knowledge about folate. DESIGN: A community randomized trial. SETTING: Three matched pairs of geographically distinct Local Government Areas in the state of Victoria, Australia. INTERVENTION: Printed information recommending folate intake to decrease the risk of neural tube defects was disseminated to women of child-bearing age in three of the Local Government Areas selected randomly. MAIN OUTCOME MEASURE: The proportion of women aware of the association between folate and spina bifida. RESULTS: Of 1197 women interviewed prior to the intervention, 12.4% (adjusted for the cluster and population sampling unit) were aware of folate and neural tube defects. After the intervention, there was not only a significant background increase of 3.4% (P=0.02) in folate awareness since the pre-intervention survey (n=603), but also a significant additional increase of 4.0% (P=0.04) owing to the intervention itself (n=603). Only 70% of women who were aware of folate knew the correct timing. CONCLUSIONS: The provision of printed educational material can increase folate awareness among women of child-bearing age. A comprehensive, long-term and ongoing health promotion campaign including such material, together with initiatives by relevant health service providers and the food industry, could best address the current low levels of folate awareness among women of child-bearing age.
Collapse
Affiliation(s)
- Maxwell J. Watson
- Department of Perinatal Medicine, The Royal Women's Hospital, Carlton, Victoria, Australia; Centre for the Study of Mothers' and Children's Health, La Trobe University, Carlton, Victoria, Australia; Murdoch Institute for Research into Birth Defects, Royal Children's Hospital, Parkville, Victoria, Australia; Public Health and Development, Department of Human Services, Melbourne, Victoria, Australia
| | | | | | | | | | | |
Collapse
|
37
|
McDonnell RJ, Johnson Z, Delaney V, Dack P. East Ireland 1980-1994: epidemiology of neural tube defects. J Epidemiol Community Health 1999; 53:782-8. [PMID: 10656087 PMCID: PMC1756811 DOI: 10.1136/jech.53.12.782] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVE The objective of the study was to describe the epidemiology of neural tube defects (NTD) in the eastern region of Ireland using the EUROCAT register of congenital malformations. DESIGN, SETTING AND PATIENTS EUROCAT registries monitor the prevalence of congenital anomalies in defined populations using multiple sources for case ascertainment. All cases of NTD on the Dublin EUROCAT register born between 1980 and 1994 were extracted and analysed. The crude birth prevalence rate for all NTD, spina bifida, anencephaly and encephalocoele were calculated for each year. Parameters measured were: sex ratio, stillbirth rate, proportion of low birth-weight babies (< 2500 g) and the proportion who were premature (< 37 weeks gestation). MAIN RESULTS Of 821 NTD cases, 419 (51.0%) had spina bifida, 322 (39.2%) had anencephaly, 69 (8.4%) had encephalocoele and 11 (1.3%) were iniencephalic. The crude birth prevalence of NTD decreased fourfold from 46.9/10,000 births in 1980 to 11.6/10,000 in 1994. The downward trend ceased during the early 1990's. Younger mothers had significantly higher rates of NTD affected births. Twenty two per cent of NTD cases had additional non-central nervous system anomalies. In 40 cases, there was a previous family history of NTD in siblings. Seasonal effects in birth prevalence were observed. Birth notification was the most frequent mechanism of ascertainment. CONCLUSION There was a marked fall in the birth prevalence of NTD during the 15 year period. This change was real and not accounted for by pre-natal screening and diagnostic practises with termination of pregnancy, which is not legally permissible in Ireland. Dietary factors may have had an influence. Rates of NTD in this region are still higher than many other parts of Europe. Primary prevention strategies through increased folic acid intake are necessary to further reduce NTD affected births.
Collapse
Affiliation(s)
- R J McDonnell
- Health Information Unit, Dr Steeven's Hospital, Dublin
| | | | | | | |
Collapse
|