A Village-Based Intervention: Promoting Folic Acid Use among Rural Chinese Women Randomized trial of a physician-based intervention to increase the use of folic acid supplements among women. A survey of preconceptional folic acid use in a group of Canadian women. Effects of once-a-week or daily folic acid supplementation on red blood cell folate concentrations in women Determinants of folic acid use in early pregnancy in a multi-ethnic urban population in The Netherlands: the Generation R study. Effect of supplementation with folic acid throughout pregnancy on plasma homocysteine concentration. Fortification of flour with folic acid Pregnancy intendedness and the use of periconceptional folic acid. The influence of folic acid supplement on the outcome of pregnancies in the county of Funen in Denmark. Part II. Congenital anomalies. A randomised study. "Folate before pregnancy": the impact on women and health professionals of a population-based health promotion campaign in South Australia. Weekly Iron and Folic Acid Supplementation with Counseling Reduces Anemia in Adolescent Girls: A Large-Scale Effectiveness Study in Uttar Pradesh, India Reduction of Incidence of Prematurity by Folic Acid Supplementation in Pregnancy A randomised trial of low dose folic acid to prevent neural tube defects. The Irish Vitamin Study Group. Prospective randomized trial of multiple micronutrients in subfertile women undergoing ovulation induction: a pilot study. Effect of folic acid supplementation on small-for-gestational-age infants born at term An Investigation of Folic Acid Requirements in Pregnancy. II Concomitant supplemental vitamin A enhances the response to weekly supplemental iron and folic acid in anemic teenagers in urban Bangladesh.
Background : Folic acid supplementation is effective in reducing the risk of neural tube defects ( NTDs ) . However , the use of folic acid is low among rural women in China . Nutrition education can provide information about folic acid and encourage its use . The primary objective of this study was to test the effectiveness of a village-based nutrition intervention on folic acid use among rural women . Methods : Sixty villages were r and omly selected using multiple-stage sampling and were divided into control and intervention groups . The intervention included nutritional education at village clinics , written material s , and text messages ( SMS ) .  Folic acid use knowledge and behavior was assessed at baseline and after the intervention . Results : Self-reported compliance with folic acid supplement use increased from 17.0%–29.2 % at baseline to 41.7%–59.2 % one year post-intervention . During the same period , the folic acid knowledge score in the intervention group increased from 3.07 to 3.65 , significantly higher than the control group ( 3.11 to 3.35 ) . Multivariate binary logistic regression showed that the women who received folic acid education and SMS intervention were more likely to comply with folic acid supplement recommendations . Conclusions : The results indicated that an integrated village-based folic acid education intervention may be an effective way of promoting folic acid use for the prevention of NTDs in rural women 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 r and omly 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 % BACKGROUND R and omized controlled trials have demonstrated that periconceptional folic acid supplementation has a dramatic effect in reducing neural tube defects , one of the most serious congenital anomalies . Unfortunately , supplementation tends to be suboptimal in disadvantaged population s. OBJECTIVE The primary objective was to determine patient factors associated with a lack of use of periconceptional folic acid among Canadian women in a multi-ethnic , urban setting . Our secondary objective was to assess patient knowledge about folic acid tablet supplementation and its link to reduced birth defects . METHODS We undertook a cross-sectional study to survey postpartum Toronto women on their use and knowledge of periconceptional folic acid . RESULTS Of the 383 women surveyed , only 28 % took folic acid or a multivitamin containing folic acid during the periconceptional period . Multivariate analysis revealed that the use of periconceptional folic acid  was more common among women of Jewish descent ( adjusted relative risk [ RR ] 0.3 ; 95 % confidence interval [ CI ] , 0.04 - 0.9 ) and those who had 1 or no children ( adjusted RR 0.6 ; 95 % CI , 0.4 - 0.8 ) . Not taking folic acid was associated with unplanned pregnancy ( adjusted RR 1.5 ; 95 % CI , 1.4 - 1.6 ) and a lack of knowledge about when folic acid should be taken ( adjusted RR 1.8 ; 95 % CI , 1.6 - 1.8 ) . CONCLUSION Ethnic background is an independent predictor of periconceptional folic acid use Objective : Our aim was to determine if a once-a-week folic acid supplement increases women 's red blood cell folate to concentrations ( > 905 nmol/l ) that are associated with a low risk of bearing a child with a neural tube defect . Design : R and omized control trial . Setting : General community . Subjects : In total , 114 nonpregnant women ( 18–40 y ) volunteers , with red blood cell folate concentrations between 295 and 905 nmol/l at screening . Interventions : Women were r and omized to receive a once-a-week 2800 μg folic acid supplement , a daily 400 μg folic acid supplement or a daily placebo for 12 weeks . Results : The mean ( 95 % CI ) red blood cell folate concentrations increased during the 12-week intervention from 608 ( 553–668 ) to 900 ( 828–978 ) in the weekly folic acid group ( P<0.05 ) and from 615 ( 560–677 ) to 1053 ( 957–1158 ) nmol/l in the daily group ( P<0.05 ) during the trial . At week 12 , 49 % of women ingesting the weekly folic acid supplement had red blood cell folate concentrations greater than 905 nmol/l compared to 74 % of women ingesting the daily supplement . Conclusions : A once-a-week 2800 μg folic acid supplement can increase women 's red blood cell folate to concentrations associated with a reduced risk of bearing a child with a neural tube defect , but is less effective than a 400 μg daily supplement . Use of a weekly folic acid supplement over at least 12 weeks before conception by women of child-bearing age may prevent neural tube defects . Funding : The Otago Medical Research Foundation ( Laurenson Award ) . Healtheries ( New Zeal and ) provided the supplements OBJECTIVE Recommendations on folic acid use to prevent neural tube defects have been launched in several countries . Adequate folic acid use seems to be low . This study assesses the prevalence of folic acid use and identifies its determinants . METHODS The study was embedded in the Generation R Study Rotterdam , the Netherl and s , a population -based prospect i ve cohort study between 2002 and 2006 . Complete information of 6940 women was available . Information on folic acid use and potential determinants was obtained by question naires and physical examination . RESULTS Of all women 37 % adequately used folic acid during the preconception period . Most important risk factors for inadequate use were unplanned pregnancy ( OR 9.5 , CI 7.2 - 12.4 , p<0.001 ) , low educational level ( OR 2.5 , CI 1.8 - 3.6 , p<0.001 ) and non-western ethnicity , ( OR 3.5 , CI 2.9 - 4.3 , p<0.001 ) . After stratification for ethnicity , unplanned pregnancy remained the most important risk factor for inadequate use . Other risk factors for inadequate use were younger age , single marital status , smoking , multiparity ( all p<0.001 ) and alcohol use ( p<0.05 ) . In contrast , previous spontaneous abortion decreased the risk of inadequate folic acid use ( p<0.001 ) . CONCLUSION Adequate preconception folic acid supplementation is still too low . Implementation of preconception programs and other public health strategies are strongly needed It is well established that folic acid supplementation in early pregnancy significantly reduces the incidence of neural tube defects ( NTDs ) [ 1 ] . Consistent with national guidelines [ 2 ] , it is current practice in the UK to advise pregnant women to take folic acid supplementation until 12 weeks gestation . A recent report , however , suggests that supplementation with folic acid throughout pregnancy may effect a reduction in adverse pregnancy outcomes [ 3 ] , although this is not yet confirmed . If folic acid supplementation throughout pregnancy led to a reduction in such outcomes , it would be a safe , simple , and inexpensive therapeutic intervention Thirty three years ago Hibbard and Smithells linked folate deficiency in pregnancy with neural tube defects.1 Smithells then led a series of observational and intervention studies which showed that improving folic acid status early in the pregnancy of mothers who had previously had a child with neural tube defects reduced the recurrence in that pregnancy.2 A r and omised trial by Britain 's Medical Research Council confirmed that finding3 and a Hungarian trial showed a reduction in the first occurrence too . 4 To reach almost all women in the very early stages of pregnancy , when few would be sure they were pregnant , folic acid fortification of a staple food has been advocated , and a Department of Health committee has now recommended universal fortification of flour in the United Kingdom . Though the benefits are clear , the possible harms of such a policy are not . We need to be cautious in implementing a universal policy . After the initial British and Hungarian studies several others gave mostly similar results . 5 6 As a result a campaign led by the Health Education Authority in the UK aim ed to improve folate status from before conception to 12 weeks of pregnancy by increasing folic acid intake from foods and supplements . A third of OBJECTIVE Periconceptional use of folic acid can prevent birth defects , including at least 50 % of neural tube defects . This study used an ongoing surveillance system to explore the association between pregnancy intendedness and women taking periconceptional folic acid .  METHODS Oregon Pregnancy Risk Assessment Monitoring System ( PRAMS ) surveys a stratified r and om sample of women after a live birth . In 1998 - 1999 , 1867 women completed the survey ( 64.0 % response rate ) ; responses were weighted for nonresponse . Women were asked whether they took folic acid most days in the month before becoming pregnant . RESULTS Overall , 33.2 % of women took  folic acid most days in the month before becoming pregnant , and 39.9 % said that their pregnancy was unintended .  Adolescent mothers were less likely to take periconceptional folic acid  ( 9.2 % ) and more likely to report unintended pregnancy ( 62.0 % ) than older women . Overall , women who said that their pregnancy was intended were more likely to report that they had taken periconceptional folic acid  ( odds ratio : 4.75 ; 95 % confidence interval : 3.16 - 7.14 ) ; after controlling for maternal age and income the odds ratio was 3.70 ( 95 % confidence interval : 2.38 - 5.56 ) . CONCLUSIONS Women whose pregnancies were intended were more likely to have been taking  periconceptional folic acid  than women whose pregnancies were unintended . The importance of fertile women 's taking daily multivitamins that contain 400 microg ( 0.4 mg ) of folic acid should be stressed among women who are not contemplating pregnancy , especially adolescents and low-income women OBJECTIVE The effect of folic acid supplement on the prevalence of congenital anomalies was studied in a Danish population . MATERIAL AND METHODS From 1983 to 1986 all Danish women resident in the county of Funen were offered free folic acid when pregnant or planning a pregnancy . Folic acid dose was r and omised to 2.5 or 1.0 mg . A r and omised control group was not feasible for ethical reasons . Hospitals , midwives and most general practitioners cooperated to procure information on close to all pregnancies and congenital anomalies were recorded . RESULTS AND CONCLUSIONS In a total of 14,021 pregnancies result ing in child birth 8184 women ( 58.4 % ) had folic acid with r and omisation . Supplement was started in the r and omised group before the last menstrual period in 1359/8184 ( 16.6 % ) and in the first 19 weeks of pregnancy in 6825/8184 ( 83.4 % ) . The prevalence of congenital anomalies was 224 in 8293 children ( 27.0/1000 ) . No dose-dependent differences were found in either total anomalies or in those specific malformations which have been reported to occur with reduced prevalence with periconceptional folic acid . The result was probably influenced by a start of supplement too late to affect malformation development in many cases and by the high level of both  folic acid doses given compared to usual recommendations . Pregnancies without folic acid supplement showed prevalences similar to the supplemented groups 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 r and om dialling throughout the State before and after the campaign , and by self-administered question naires 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 Background Weekly iron – folic acid supplementation in small-scale research trials and as administered in institutions has been demonstrated to be effective in reducing anemia in adolescent girls . Objective To assess the effectiveness of weekly iron – folic acid supplementation in a large-scale project in reducing the prevalence of anemia in adolescent girls . Methods The project provided weekly iron – folic acid tablets , family life education , and deworming tablets every 6 months to 150,700 adolescent school girls and non-schoolgirls of a total district population of 3,647,834 . Consumption of the iron – folic acid tablets was supervised for schoolgirls but not for non-schoolgirls . Hemoglobin levels were assessed in a r and om sample of non-schoolgirls at 6 and 12 months and schoolgirls at 6 months . The effect of supplementation on the prevalence of anemia and the compliance rate were assessed over a 4-year period . Results In 4 years , the overall prevalence of anemia was reduced from 73.3 % to 25.4 % . Hemoglobin levels and anemia prevalence were influenced significantly at 6 months . No difference in the impact on hemoglobin or anemia prevalence was observed between supervised and unsupervised girls . Counseling on the positive effects of regular weekly iron – folic acid intake contributed to a high compliance rate of over 85 % . The cost of implementation was US$ 0.36 per beneficiary per year . Conclusions Weekly iron – folic acid supplementation combined with monthly education sessions and deworming every 6 months is cost-effective in reducing the prevalence of anemia in adolescent girls . Appropriate counseling , irrespective of supervision , is critical for achieving positive outcomes Folic acid administered to pregnant Bantu , whose diet is low in folate , was associated with a significant reduction in the incidence of prematurity . No such effect could be demonstrated in White patients subsisting on an average Western diet . This suggests that folate deficiency may contribute to the “ pregnancy wastage ” in population s whose dietary folate intake is low , and is a further indication for folic acid supplementation during pregnancy in these groups A r and omised trial was initiated in Irel and in 1981 to determine if periconceptional supplementation with either folic acid alone or a multivitamin preparation alone could reduce the recurrence risk of neural tube defects ( NTDs ) in women with a previously affected pregnancy from 5.0 % to 1.0 % or less . The trial was concluded before the initial target number of study subjects was reached and without a clear treatment effect being observed . A total of 354 women were r and omised to receive one of three treatments : folic acid , multivitamins without folic acid , and folic acid plus multivitamins . At the end of the trial 257 women had had a first trial pregnancy outcome ( 261 infants/fetuses ) where the presence or absence of NTDs was ascertainable . There was one NTD recurrence in the 89 infants/fetuses of women in the multivitamin group and no recurrence in the 172 infants/fetuses of women in the folic acid groups , a non-significant difference . Otherwise eligible women who were pregnant when first contacted constituted a non-r and omised control group ; there were three recurrences among the 103 infants in this group . The difference in the recurrence rate between the folic acid groups and the non-r and omised controls was statistically significant but we have reservations about the validity of this comparison . Although our findings do not provide clear evidence of a protective effect of folic acid supplementation they are consistent with those of the Medical Research Council ( MRC ) trial which demonstrated the efficacy of folic acid in preventing recurrence of NTDs and they raise the possibility that folic acid may be protective at a much lower dosage than that used in the MRC trial This study investigated whether subfertile women undergoing ovulation induction using st and ard treatment regimens with clomiphene citrate/gonadotrophins  have higher pregnancy rates when on an adjuvant multiple micronutrient ( MMN ) nutritional supplement compared with folic acid alone . A prospect i ve r and omized controlled trial was conducted in a teaching-hospital fertility clinic on 58 subfertile women , of which 56 women completed the study . Women undergoing ovulation induction were allocated to either receive adjuvant MMN supplementation or folic acid .  Clinical pregnancy rates and blood nutrient concentrations were assessed after the third treatment attempt or as soon as the women achieved pregnancy . Using intention-to-treat analysis , it was observed that women on adjuvant MMN supplementation had a significantly higher cumulative clinical pregnancy rate ( 66.7 % ) compared with those on folic acid ( 39.3 % ; P = 0.013 ) . The ongoing pregnancy rate in women on MMN supplementation was 60.0 % versus 25.0 % ( P < 0.02 ) in the folic-acid group . Further , women who were on MMN supplementation had significantly fewer attempts to achieve pregnancy compared with women on folic acid ( P < 0.001 ) . The results of this pilot study suggest that women who take adjuvant MMN supplementation during ovulation induction have a higher chance of pregnancy compared with women on folic acid The effect of 250 μg folic acid (FA)/day or placebo given to 21 small-for-gestational-age infants born at term was studied during the first 3 months of life . The design of the study was double blind with r and om allocation . No r and omization was performed in respect of breast-feeding or formula-feeding with a folate content of 60–70 μg/l . No significant differences were observed in haemoglobin concentration , haematocrit , weight and length between FA-supplemented and non-supplemented infants . A negative correlation was demonstrated between gestational age and erythrocyte folate ( E-folate ) concentration at 1 week . E-folate content was higher when no supplement was given in breast-fed than in formula-fed infants IN a previous investigation of the effects of grade d micro-doses of folic acid ( pteroyl glutamic acid ) in pregnancy suggestive evidence has been obtained that the minimal oral requirement may lie in the region of 300 pg./day . This conclusion was based largely upon the measurement of the fasting post-partum serum folate or L. casei activity in a group of patients from a population where poor dietary intake of folic acid was common . In patients receiving no prophylactic folic acid or IOO pg./day the median post-partum serum folate level was subnormal , in those receiving 3oo , ug./day it was normal and in those receiving 4sopg./day it was supranormal ( Willoughby and Jewell , 1966 ) . As an extension of this investigation the incidence of maternal anaemia has now been assessed among a population of 3599 patients r and omly allocated at their first ante-natal BACKGROUND Iron deficiency is the most common micronutrient deficiency and affects > 2 billion persons worldwide , leading to anemia in > 40 % of women of reproductive age in the developing world . OBJECTIVE The objective was to determine whether weekly supplementation with iron and folate would reduce the frequency of anemia in teenage women in urban Bangladesh before they became pregnant . DESIGN Participants with a hemoglobin concentration of 80 - 120 g/L were entered into a r and omized , double-blind , placebo-controlled trial and received supplements of placebo , vitamin A , iron + folic acid , or iron + folic acid + vitamin A weekly for 12 wk . The supplements contained 2.42 mg vitamin A ( retinol ) as retinyl palmitate , 120 mg elemental Fe as ferrous sulfate , and 3.5 mg folic acid . RESULTS Hemoglobin concentrations increased significantly more after supplementation with iron + folic acid or iron + folic acid + vitamin A than after either the placebo or vitamin A alone . There was a significantly greater increase in hemoglobin after iron + folic acid + vitamin A than after iron + folic acid , but the additional effect disappeared after adjustment for baseline hemoglobin , serum vitamin A , and ferritin and the number of supplements taken . Those with the lowest baseline hemoglobin had the greatest increase in hemoglobin . Compared with the placebo , iron + folic acid + vitamin A reduced anemia by 92 % , iron deficiency by 90 % , and vitamin A deficiency by 76 % . CONCLUSION There may be significant health benefits from a program that enhances the nutritional status of iron , folate , and vitamin A in poor urban young women before they become pregnant
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 re sources 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 .
Campaigns and interventions have the potential to exacerbate socio-economic inequalities in folic acid use .
However , even high- quality campaigns that increase use result in under half of women in the target group taking supplements
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 .