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Research letter

Low rate of adequate folic acid supplementation in well-educated women of high socioeconomic status attending a genetics clinic

Laura E. Dawson, Ba' Pham and Alasdair G.W. Hunter
CMAJ April 17, 2001 164 (8) 1149-1150;
Laura E. Dawson
Ms. Dawson and Dr. Hunter are with the Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ont. Mr. Pham is with the Thomas C. Chalmers Centre for Systematic Reviews, Children's Hospital of Eaastern Ontario Research Institute, Ottawa, Ont.
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Ba' Pham
Ms. Dawson and Dr. Hunter are with the Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ont. Mr. Pham is with the Thomas C. Chalmers Centre for Systematic Reviews, Children's Hospital of Eaastern Ontario Research Institute, Ottawa, Ont.
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Alasdair G.W. Hunter
Ms. Dawson and Dr. Hunter are with the Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ont. Mr. Pham is with the Thomas C. Chalmers Centre for Systematic Reviews, Children's Hospital of Eaastern Ontario Research Institute, Ottawa, Ont.
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Periconceptional folic acid intake can reduce the occurrence of neural tube defects,1 and supplementation or food fortification is now recommended by many professional groups.2 Nonetheless, recently reported rates of optimal folic acid supplementation were low, ranging from zero (South America, 1996 data)3 to 52% (the Netherlands, 1998 data).4 Worldwide, most women of child-bearing age are exposed to an unnecessary risk of having a child affected by a neural tube defect.

We conducted a survey from April to July 1996 among women attending the genetics clinic at an Ottawa pediatric hospital. All women attending the clinic during the study period were given the option of completing the survey. The survey was completed anonymously by 342 (69%) of the 494 women who were approached; 3 of the respondents were beyond reproductive age. Not every question was answered by every respondent. We compared demographic characteristics and knowledge for women who reported taking folic acid supplementation at the optimal time (at least 4 weeks before the last normal menstrual period and continuing to at least 8 weeks after the last menstrual period), those taking supplementation but at a suboptimal time (too late to reduce the risk of neural tube defects) and those not taking any supplementation. The mean age of the respondents was 34.9 years (range 22–57 years). Most of the respondents were in stable relationships and were employed, and these women were 3 times more likely than typical 30- to 34-year-old Ontario women to have completed postsecondary education.5

Although 277/342 (81.0%) of the women were aware of folic acid and 266/342 (77.8%) were taking at least 0.4 mg/day of the vitamin (the minimum recommended dose), only 78 of the 297 pregnant women (26.3%) began supplementation early enough to reduce the risk of neural tube defects.

Our findings confirm that level of education does not correlate with successful folic acid supplementation.6 Contrary to a previous report,7 we found no association between socioeconomic status and the use of folic acid, probably because of the skewed socioeconomic status of our study population.

Women in our study who did not supplement with folic acid believed that dietary intake would be sufficient to meet the recommended daily allowance of folic acid, but it is doubtful that even an optimal nonfortified diet can provide adequate folic acid.2,8

Pregnant women were more likely than nonpregnant women to have taken folic acid (p < 0.01). Women who took folic acid during a suboptimal period were 4.0 times more likely to report their physician as the primary source of information about folic acid rather than the media (Table 1). Although physicians were an important source of information about folic acid, they must shift their emphasis to preconceptional counselling.9

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Table 1.

Women with optimal supplementation were 2.4 times more likely to have received information from multiple sources than from a single source (Table 1). This result supports the views of those who advocate increasing awareness among both the public and health care providers of the benefits of folic acid.4,8 An intense media campaign targeting women in the Netherlands was associated with an increase in optimal folic acid supplementation from less than 1% in 1994 to 52% in 1998.4 Although the campaign was conducted in a country with a high population density (465/km2) and a high rate of planned pregnancies, supplementation remained inadequate for almost 50% of women.10 Similar increases in adequate supplementation are unlikely in Canada, given its multiple jurisdictions, low population density (4/km2) and high rate of unplanned pregnancies.11,12

We join others who support the fortification of staple foods (such as flour) with enough folic acid to maximize the number of women who will receive the recommended daily allowance of folic acid and thus to reduce the occurrence of neural tube defects and possibly other malformations. The protective effect of the current level of folic acid fortification (150 μg/100 g) of some flour products available in Canada is unknown,13 but given that almost 75% of the women who responded to our survey had inadequate or inappropriately timed folic acid supplementation, this effort would be warranted.

Footnotes

  • This article has been peer reviewed.

    Contributors: Ms. Dawson developed and revised the survey, collected the data, conducted the literature searches and contributed to writing and revising the manuscript. Mr. Pham contributed to analyzing and interpreting the data and reviewed the manuscript. Dr. Hunter reviewed the survey and contributed to analyzing and interpreting the data and to writing and revising the manuscript.

    Competing interests: None declared.

    Reprint requests to: Laura E. Dawson, Department of Genetics, Children's Hospital of Eastern Ontario, 401 Smyth Rd., Ottawa ON K1H 8L1; fax 613 738-4822; [email protected]

References

  1. 1.↵
    Czeizel AE, Dudas I. Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation. N Engl J Med 1992;327:1832-5.
    OpenUrlCrossRefPubMed
  2. 2.↵
    Hunter AGW. Fortification of foods with folic acid and vitamin B12: definitive action is overdue. Ann R Coll Physicians Surg Can 2000;33:172-5.
    OpenUrl
  3. 3.↵
    Castilla EE, da Graca Dutra M. Folate awareness among South American women [letter]. Lancet 1997;349:735.
    OpenUrl
  4. 4.↵
    Bekkers RLM, Eskes TKAB. Periconceptional folic acid intake in Nijmegen, Netherlands [letter]. Lancet 1999;353:292.
    OpenUrl
  5. 5.↵
    1996 census of population. Ottawa: Statistics Canada; 1996.
  6. 6.↵
    Marsack CR, Alsop CL, Kurinczuk JJ, Bower C. Pre-pregnancy counselling for the primary prevention of birth defects: rubella vaccination and folate intake. Med J Aust 1995;162:403-6.
    OpenUrlPubMed
  7. 7.↵
    McDonnell R, Johnson Z, Doyle A, Sayers G. Determinants of folic acid knowledge and use among antenatal women. J Public Health Med 1999;21:145-9.
    OpenUrl
  8. 8.↵
    Cuskelly GH, McNulty H, Scott JM. Effect of increasing dietary folate on red-cell folate: implications for prevention of neural tube defects. Lancet 1996;347:657-9.
    OpenUrlCrossRefPubMed
  9. 9.↵
    Brandenburg H, Traas MAF, Laudy J, Ursem N, Westerveld AM, Wladimiroff JW. Periconceptional use of folic acid amongst women of advanced maternal age. Prenat Diagn 1999;19:132-5.
    OpenUrlCrossRefPubMed
  10. 10.↵
    Population, 2000. In: StatLine [database]. Voorburg (NL): Statistics Netherlands; 2000. Available: www.cbs.nl/en/statline/index. htm (accessed 2001 Mar 6).
  11. 11.↵
    Organisation for Economic Co-operation and Development. Labour force statistics, 1988–1998. Paris: The Organisation; 1999. Available: www.statcan.ca/english/Pgdb/People/Population/demo01.htm (accessed 2001 Mar 6).
  12. 12.↵
    Forrest JD. Epidemiology of unintended pregnancy and contraceptive use. Am J Obstet Gynecol 1994;170:1485-9.
    OpenUrlCrossRefPubMed
  13. 13.↵
    Turner LA, McCourt C. Folic acid fortification: What does it mean for patients and physicians? CMAJ 1998;158(6):773-4. Available: www.cma.ca/cmaj/vol-158/issue-6/0773.htm
    OpenUrlFREE Full Text
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Low rate of adequate folic acid supplementation in well-educated women of high socioeconomic status attending a genetics clinic
Laura E. Dawson, Ba' Pham, Alasdair G.W. Hunter
CMAJ Apr 2001, 164 (8) 1149-1150;

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Low rate of adequate folic acid supplementation in well-educated women of high socioeconomic status attending a genetics clinic
Laura E. Dawson, Ba' Pham, Alasdair G.W. Hunter
CMAJ Apr 2001, 164 (8) 1149-1150;
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