计划生育技术人员有关增补叶酸预防胎儿神经管缺陷的KAP调查分析

目的:调查四川省基层计划生育技术人员对育龄妇女增补叶酸预防神经管缺陷的知晓率, 对增补叶酸的态度、是否愿意向育龄妇女推荐的行为等情况, 为实施叶酸预防神经管缺陷的干预措施提供科学依据。方法: 调查指标包括叶酸的知识、增补叶酸的方法、时间和剂量以及相应的态度和行为, 设计调查问卷, 对507名计划生育专业技术人员进行现场调查, 收集有效答卷485份, 数据录入计算机, 进行统计学分析。结果: 53. 8%的被调查人员知道叶酸来源, 不同职称组没有统计学差异。增补叶酸最佳时间的知晓率为45 .8%, 正确补充剂量的知晓率约30 .0%, 且不同技术职称、不同工作单位的人员均显示出显著性差异(P<0. 01)。89. 7%的人认为有必要增补叶酸, 75 .1%的人愿意向育龄妇女推荐。结论: 对于育龄妇女实施增补叶酸的措施, 计划生育技术人员有积极的态度和行为, 但正确补充叶酸的知晓率较低, 影响干预措施的落实。需要进一步有针对性地加强计划生育技术人员有关增补叶酸知识的培训。     

Use of supplements containing folic acid among women of childbearing age--United States, 2007

Neural tube defects (NTDs) are serious birth defects of the brain (anencephaly) and spine (spina bifida) that affect approximately 3,000 pregnancies each year in the United States. In 1992, the U.S. Public Health Service recommended that all women of childbearing age in the United States capable of becoming pregnant consume 400 microg of folic acid daily to reduce their risk for having a pregnancy affected by NTDs. To assess awareness, knowledge, and behavior related to folic acid among women of childbearing age (aged 18-45 years), CDC analyzed the results of a national survey conducted annually by the Gallup Organization during the period 2003-2007. This report summarizes the results of that analysis, which indicated that, among all women of childbearing age, those aged 18-24 years had the least awareness regarding folic acid consumption (61%), the least knowledge regarding when folic acid should be taken (6%), and the lowest reported daily use of supplements containing folic acid (30%). Because women in this age group account for nearly one third of all births in the United States, promotion of folic acid consumption should be targeted to this population.     

Folic acid and the prevention of neural tube defects: A survey of awareness among Latina women of childbearing age residing in southeast Michigan

Periconceptional intake of folic acid is known to reduce the risk for neural tube defects (NTDs). To inform southeast Michigan Latina women of childbearing age about the benefits of food and supplemental sources of the micronutrient in the prevention of NTDs, Spanish-English bilingual health educators carried out 20 education events in supermarkets and community organizations serving Latina women. One hundred and sixty Latina women ages 19 to 50 years indicated their current folic acid awareness and stated their future intentions regarding folic acid. Of 160 women surveyed, 114 (71%) had heard of folic acid, 84 (74%) knew that folic acid prevents birth defects, 63 (55%) knew the critical time to take folic acid, and 76 (67%) identified at least one source of folic acid. After participating in the education events, 136 women (85%) reported planning to eat more folate and/or folic acid-rich foods. Although general folic acid awareness is fairly high, health promotion efforts must be coordinated at community locations serving Latina women to share folic acid's specific protective effects in the prevention of NTDs, the critical timing of intake, and its food and supplement sources.     

叶酸预防神经管畸形在相关人群中的知晓率及行为

目的 了解妇幼卫生人员、婚检妇女和孕妇对孕前和孕早期服用叶酸预防神经管畸形的知识掌握程度及相关行为。 方法 根据不同的对象自行设计知识和行为调查问卷,由妇幼卫生人员、婚检妇女和孕妇自己填写,将结果进行x2检验和方差分析。 结果 76.7%(155/202)的妇幼卫生人员知道服用叶酸可以减少神经管畸形的发生,26.7%(54/202)的知道叶酸应当从孕前开始服用,仅有5.9%(12/202)的人知道叶酸每天摄入的适当量是0.4 mg-1 mg,34.7%(70/202)的妇幼卫生人员推荐的剂量大于1 mg;194名婚检妇女仅4人(2.1%)知道叶酸可以预防胎儿畸形,4人在服用叶酸增补剂,2人知道要从孕前服用;31.9%(67/210)的孕妇知道叶酸与神经管畸形的关系,16.2%(34/210)知道应从孕前服用,14.3%(30/210)孕妇在服用叶酸增补剂,仅4人(1.9%)真正从孕前开始服用。 结论 妇女增补叶酸预防神经管畸形的知识还没有得到很好的普及,叶酸的服用率低。建议培训妇幼人员(特别是县乡级人员)正确指导妇女应用叶酸的知识和能力,加大婚前教育宣传力度,增加服用叶酸预防神经管畸形知识的知晓率。     

Folate status in women of childbearing age,by race/ethnicity--United States, 1999-2000

In September 1992, the U.S. Public Health Service (PHS) recommended that women of childbearing age (i.e., aged 15-44 years) who are capable of becoming pregnant should consume 400 microg of the B-vitamin folic acid to reduce the number of cases of spina bifida and anencephaly (neural tube defects [NTDs]). Since then, an ongoing national effort has encouraged women to consume dietary supplements containing folic acid. In 1998, the Food and Drug Administration (FDA) required the fortification of enriched cereal grain products with folic acid, and manufacturers have voluntarily added more folic acid to many ready-to-eat breakfast cereals (CDC, unpublished data, 2002). To assess temporal changes in serum and red blood cell (RBC) folate concentrations among childbearing-aged women, CDC compared folate concentrations for childbearing-aged women who participated during 1988-1994 and 1999-2000 in the National Health and Nutrition Examination Survey (NHANES). This report outlines the results of this comparison and describes serum and RBC folate levels by race/ethnicity. The results indicate that over the period studied, the median serum folate concentration for women aged 15-44 years increased approximately threefold, and the median RBC folate concentration increased approximately twofold. These findings indicate that the national health objective for 2010 to increase the median RBC folate level among women of childbearing age to 220 ng/mL RBC (objective 16.16b) has been met for Mexican-American and non-Hispanic white women but not for non-Hispanic black women. To reduce the number of pregnancies affected by NTDs further, all women of childbearing age capable of becoming pregnant should consume the PHS-recommended level of folic acid daily.     

Achieving a public health recommendation for preventing neural tube defects with folic acid.

OBJECTIVES: This study examined 3 approaches to achieving the public health recommendation that all women of child-bearing age ingest 0.40 mg of folic acid per day to reduce the occurrence of neural tube defects (NTDs). METHODS: A total of 1136 mothers of infants with major malformations from the Boston and Philadelphia areas, whose pregnancies began from 1993 to 1995, were interviewed within 6 months of delivery about vitamin supplementation, dietary intakes, and other factors. RESULTS: Seventy-one percent of the 1136 women in the study did not take folic acid--containing supplements daily before conception, but the proportion decreased over the years of the study. Women not taking supplements consumed an average of 0.25 mg of naturally occurring folates daily. On the basis of dietary intakes reported by women not taking folic acid supplements, a simulation of cereal grain fortification with folic acid at the level required by the US Food and Drug Administration showed that an average of only 0.13 mg of folic acid would be ingested daily. CONCLUSIONS: With consumption of folic acid only through dietary intake, sizeable portions of the childbearing population would receive less than the level of folic acid recommended for preventing NTDs. Even with food fortification, women of childbearing age should be advised to take folic acid--containing supplements on a daily basis.     

Trends in Folic Acid Awareness and Behavior in the United States: The Gallup Organization for the March of Dimes Foundation Surveys, 1995–2005

Objective: To summarize changes in folic acid awareness, knowledge, and behavior among women of childbearing age in the United States since the U.S. Public Health Service (USPHS) 1992 folic acid recommendation and later fortification. Methods: Random-digit dialed telephone surveys were conducted of approximately 2000 women (per survey year) aged 18–45 years from 1995–2005 in the United States. Results: The percentage of women reporting having heard or read about folic acid steadily increased from 52% in 1995 to 84% in 2005. Of all women surveyed in 2005, 19% knew folic acid prevented birth defects, an increase from 4% in 1995. The proportion of women who reported learning about folic acid from health care providers increased from 13% in 1995 to 26% in 2005. The proportion of all women who reported taking a vitamin supplement containing folic acid increased slightly from 28% in 1995 to 33% in 2005. Among women who were not pregnant at the time of the survey in 2005, 31% reported taking a vitamin containing folic acid daily compared with 25% in 1995. Conclusions: The percentage of women taking folic acid daily has increased modestly since 1995. Despite this increase, the data show that the majority of women of childbearing age still do not take a vitamin containing folic acid daily. Health care providers and maternal child health professionals must continue to promote preconceptional health among all women of childbearing age, and encourage them to take a vitamin containing folic acid daily.

     

Effectiveness of Folic Acid Supplementation Recommendations among Polish Female Students from the Podkarpackie Region

Adequate folic acid supplementation during the preconception period is an important element in the primary prevention of neural tube defects (NTDs). This study aims to study the effectiveness of folic acid supplementation recommendations among women of childbearing age, and to assess and characterise their awareness about this public health measure. The cross-sectional study included women (N = 1285) aged 22.27 ± 4.6 years old on average. Some of the results were obtained on a subgroup of women (N = 1127) aged 21.0 ± 2.1. This study was performed using a questionnaire. The analysis was performed with the use of a logistic regression model, chi-square test for independence and odds ratio (OR). According to the results, only 13.9% of women supplement folic acid, and 65.3% of them do so daily. A total of 91.1% of the respondents were not aware of its recommended dose and 43% did not know the role it plays in the human body. Among women who do not currently supplement folic acid (N = 1052), 52.4% declared doing so while planning their pregnancy. Women’s awareness about the role of folic acid in NTD prevention (OR = 4.58) and the information they got from physicians (OR = 1.68) are key factors that increased the odds of the women taking folic acid before pregnancy. There is therefore a need for more information and education campaigns to raise awareness about folic acid.     

泸州地区育龄妇女叶酸增补依从性及其影响因素

目的调查泸州地区育龄妇女叶酸增补依从性及其影响因素,为制定增补叶酸干预措施提供科学依据。方法于2020年6月至12月期间,采用方便抽样法选取四川省泸州市江阳区、纳溪区及泸县等7个县区共计38个乡镇或社区卫服务中心招募携带1岁及以内儿童接种疫苗的儿童母亲作为调查对象进行《育龄妇女叶酸知晓及叶酸服用情况》问卷调查,采用描述性分析方法对结果进行分析,并采用单、多因素分析方法对叶酸增补依从性影响因素进行分析。结果709名育龄妇女年龄20~47岁,平均年龄(32.09±6.51)岁。有307名(43.30%)进行孕前优生健康检查。84.76%调查对象曾服用过叶酸,32.02%正确知晓叶酸增补目的,而孕前3个月至孕早期3个月规范服用叶酸者仅占19.46%。多因素Logistic回归分析结果显示,大专及以上文化程度(OR=2.158)、家庭月收入>3000元(OR=2.502)、机关事业单位职工(OR=3.543)、企业工作人员(OR=2.776)、生育2次(OR=1.793)和≥3次(OR=2.504)、孕前有进行优生健康检查(OR=4.586)、叶酸知识知晓(OR=8.499)的泸州地区育龄妇女对叶酸规范服用率更高。结论泸州地区育龄妇女的叶酸知晓和孕前叶酸规范服用率均较低,应针对重点人群增强叶酸预防神经管缺陷的认知,加强叶酸增补健康知识的宣传教育,从而提高孕前叶酸增补依从性。     

Strategies to increase folate/folic acid intake in women: an overview

Summary   Supplementation with folic acid reduces the risk of neural tube defects (NTDs) and may also be associated with other health benefits in relation to cancer and vascular disease. There is strong support around the world for public health policies that encourage increased folic acid intake by women of childbearing age, especially daily intake of supplemental folic acid, to reduce the incidence of NTDs. Campaigns promoting the use of folic acid supplements are useful but many women remain unaware and many pregnancies are unplanned. They have therefore had a limited impact in the primary target group, namely women around the time of conception and in the early weeks of pregnancy. Studies suggest that only about 30% of women aged 18–45 years use folic acid periconceptionally, and among younger, less educated and poorer women, use is even less. It is estimated that the majority of women who take folic acid don't start until they know they are pregnant, and so miss the critical window (first 12 weeks) for the prevention of NTDs. It is therefore important that routes other than supplementation are considered. A European Union-funded programme of work, 'Folate: from food to functionality and optimal health' (FolateFuncHealth, QLRT1-1999-00576 & QLRT-2001-2740), has contributed to this work and the findings were presented at a conference in Warsaw in 2004.     

Use of vitamins containing folic acid among women of childbearing age--United States, 2004

Neural tube defects (NTDs) are serious birth defects of the spine (spina bifida) and brain (anencephaly), affecting approximately 3,000 pregnancies each year in the United States. Periconceptional consumption of the B vitamin folic acid reduces the occurrence of NTDs by 50%-70%. To prevent these defects, the U.S. Public Health Service (1992) and Institute of Medicine (1998) issued separate recommendations that all women capable of becoming pregnant consume 400 micro g of folic acid daily, and the Food and Drug Administration mandated fortification of cereal grain products with folic acid to increase women's daily intake. Fortification of the U.S. food supply with folic acid has resulted in a 26% reduction in NTDs. However, even with fortification, not all women receive adequate levels of folic acid from their diets. Therefore, increasing the use of vitamins containing folic acid remains an important component of NTD prevention. To monitor the use of vitamins containing folic acid among women of childbearing age, the Gallup Organization has conducted a series of surveys for the March of Dimes Birth Defects Foundation since 1995. This report presents results from the 2004 survey, which indicated that although no substantial increase in the proportion of women who use vitamins containing folic acid daily occurred during 1995-2003, a substantial increase was observed in 2004, with 40% of women aged 18-45 years reporting daily consumption of a vitamin containing folic acid. This report also presents information about women's dieting behaviors. Regardless of dieting status, public health programs should stress the importance of women in their childbearing years consuming 400 micro g of folic acid daily through supplements, fortified foods, and a diet containing folate-rich foods.     

Knowledge and use of folic acid among women of reproductive age--Michigan, 1998

Neural tube defects (NTDs), which include spina bifida and anencephaly, are serious malformations that occur in the developing fetus during the first 17-30 days after conception. Consumption of supplements containing folic acid can reduce NTDs 50%-70%. In the United States, approximately 4000 pregnancies are affected by NTDs each year, including approximately 140 infants in Michigan. In 1992, the U.S. Public Health Service recommended that all women of childbearing age consume at least 400 microg of folic acid daily. In 1998, the Institute of Medicine reaffirmed that recommendation and added that women capable of becoming pregnant take 400 microg of synthetic folic acid daily from fortified foods and/or supplements and consume a balanced, healthy diet of folate-rich foods. This report summarizes findings from the 1998 Behavioral Risk Factor Surveillance System (BRFSS) about multivitamin use and folic acid knowledge among women of reproductive age in Michigan. The findings suggest that public health campaigns that promote the consumption of folic acid should target women who are young, unmarried, obese, smoke, eat few fruits and vegetables, and have a low level of education.     

Use of dietary supplements containing folic acid among women of childbearing age--United States, 2005

Neural tube defects (NTDs) are serious birth defects of the spine (spina bifida) and brain (anencephaly), affecting approximately 3,000 pregnancies each year in the United States. Daily periconceptional consumption of 400 mug of folic acid, as recommended by the Public Health Service (PHS) since 1992, reduces the occurrence of NTDs by 50%-70%. The Food and Drug Administration ordered mandatory fortification with folic acid of U.S. cereal grain products, beginning in 1998. However, despite a 26% reduction in NTDs, not all women of childbearing age receive adequate levels of folic acid from their diets. Therefore, increasing the number of women who take dietary supplements containing 400 mug of folic acid daily remains an important component of NTD prevention. This report summarizes results from the 2005 March of Dimes Gallup survey, which determined a decrease in the proportion of childbearing-aged women who reported taking folic acid in dietary supplements daily, from 40% in 2004 to 33% in 2005, returning to a level consistent with that reported during 1995-2003. These results emphasize the need for innovative programs to increase folic acid consumption to further reduce NTDs.     

Increased awareness, knowledge and utilization of preconceptional folic acid in Israel following a national campaign

BACKGROUND: To decrease the risk of neural tube defects (NTDs), the Israeli Ministry of Health (MOH) issued guidelines in August 2000 recommending daily folic acid (FA) supplementation for women in their childbearing age, and concurrently launched a national FA campaign. Campaign effects were assessed by comparing the results of a survey done in 2002 with a baseline survey done in June 2000. METHODS: Both surveys were done within the network of the Public Health Services' Mother and Child Health Clinics (MCHC). Nursing staff conducted structured interviews of pregnant women and mothers of newborn infants. RESULTS: In the 2002 survey (n = 1661), awareness was 85%, correct knowledge was 77.7% and 30.5% utilized FA preconceptionally. Ratios of awareness, knowledge and utilization were highest among women with post-university education (93%, 84%, 46%), and awareness and utilization were significantly higher in the 25-29 year age bracket (90%, 35%). In the baseline 2000 survey (n = 1719), FA awareness had been 54.6%, knowledge of the benefits of FA was 17.6% and preconceptional utilization was reported by a mere 5.2%. CONCLUSIONS: A national periconceptional FA campaign in Israel resulted in significant increases in awareness and correct knowledge, and a sixfold increase in its intake.     

Prevalence of neural tube defects and folic acid knowledge and consumption--Puerto Rico, 1996-2006

Birth defects are one of the leading causes of infant mortality in both the mainland United States and Puerto Rico. Neural tube defects (NTDs) are serious birth defects of the spine and brain; two of the most common NTDs are spina bifida and anencephaly. In the United States, NTD prevalence is higher among Hispanic women than among non-Hispanic white or non-Hispanic black women. In Puerto Rico, where most residents are Hispanic, the prevalence of NTDs (8.68 per 10,000 live births) is higher than in the mainland United States (5.59). Consumption of folic acid before and during early pregnancy can prevent NTDs. To assess trends in NTD prevalence and prevalence of knowledge and consumption of folic acid supplements in Puerto Rico, data were analyzed from the Birth Defects Surveillance System (BDSS) for 1996-2005 and the Behavioral Risk Factor Surveillance System (BRFSS) for 1997-2006. This report describes the results of those analyses, which indicated that prevalence of folic acid knowledge and consumption among women of childbearing age increased from 1997 to 2003 but decreased from 2003 to 2006. During similar periods, NTD prevalence declined from 1996 to 2003 but did not change significantly from 2003 to 2005. To resume the decline in prevalence of NTDs, additional measures might be needed to increase folic acid supplement use among Puerto Rican women of childbearing age.     

云南省农村育龄妇女增补叶酸影响因素调查

目的:探讨云南省农村育龄妇女围孕期及妊娠期增补叶酸的现状及影响因素。方法:采用整群随机抽样法抽取泸西县符合条件的共2538位农村孕产妇进行问卷调查。应用单因素分析和多因素非条件logistic逐步回归法寻找围孕期及妊娠期增补叶酸的影响因素。结果:51.7%的调查对象在围孕期或妊娠期补充过叶酸。多因素分析显示影响农村育龄妇女增补叶酸的因素有妻子的受教育年限(OR=0.53)、家庭去年的总收入(OR=2.222)、孕前健康检查状况(OR=3.397)、家中有无优生宣传资料(OR=1.957)、优生知识是否及格(OR=2.380)、是否知道叶酸的作用(OR=88.015)。结论:健康教育应当成为云南广大农村增补叶酸服务的先导,孕前保健服务应当是叶酸推广和其他生殖保健技术服务的结合。在叶酸的推广中,计划生育宣传员发挥着重要作用。     

岳阳市育龄女性增补叶酸预防神经管缺陷的效果分析

目的分析岳阳市育龄女性增补叶酸预防神经管缺陷的效果,为以后的临床工作提供参考依据。方法选取2017年4月1日-2018年3月31日在岳阳市助产机构住院流产及分娩的64 276例育龄女性作为研究对象,根据治疗方式分为观察组(54 086例,规律服用叶酸)和对照组(10 190例,未规律服用叶酸)。比较两组神经管畸形发生率。结果观察组和对照组出生缺陷、围生儿出生缺陷、神经管畸形发生率比较差异均有统计学意义(均P<0. 05)。结论岳阳市增补叶酸预防神经管畸形发生的效果显著,但仍有提升空间,在未来工作中可通过优化健康宣教、干预出生缺陷发生的相关因素而降低神经管畸形发生率。     

Implementation and outcomes of recommended folic acid supplementation in Mexican-American women with prior neural tube defect-affected pregnancies

BACKGROUND: Upon discovering an NTD incidence rate of 27/10,000 in a Texas border county, the Texas Department of Health initiated folic acid intervention for prevention of recurrent NTDs in this predominantly Mexican-American population. This paper describes compliance of this population with USPHS folic acid recommendations and the impact of supplementation on pregnancy outcomes. METHODS: Based upon information from active surveillance, field teams personally contacted women having NTD-affected pregnancies to enroll them in FA intervention. Enrollees were provided FA at home visits at 3-month intervals throughout the project. RESULTS: Of 405 women identified with NTD-affected pregnancies, 299 (73.8%) enrolled in the intervention. One hundred ninety-three pregnancies occurred among 138 women. FA supplementation of 0.4 mg/day or more occurred during the last month preconception in 161 (83.4%) of the 193 pregnancies. No NTDs were detected in the 130 livebirths to women who received supplementation nor were NTDs detected in the 23 supplemented women who experienced pregnancy loss. CONCLUSIONS: Supplementation was successful in preventing recurrent NTDs in Mexican-American women.     

Awareness and Intake of Folic Acid for the Prevention of Neural Tube Defects Among Lebanese Women of Childbearing Age

Since the early 1990s, international recommendations have promoted folic acid supplementation during the periconception period as an effective way of preventing neural tube defects (NTDs). However, the adoption of this recommendation remains insufficient. To assess the awareness and actual intake of folic acid among married Lebanese women aged 18–45 years, a cross-sectional study was conducted among 600 women selected from all five administrative districts in Lebanon, using a multistage cluster sampling procedure. An anonymous questionnaire was completed which covered measures of knowledge and use of folate supplements, as well as demographic, socioeconomic and obstetrical factors. Sixty percent of surveyed women (60%; n = 360) had heard about folic acid. Doctors were the most frequent source of information (61.1%) but only 24.7% of women have been told of the correct period during which folic acid supplementation was useful. Overall, only 6.2% had taken folic acid tablets during the adequate period. Younger age, higher education level and stability/sufficiency of income appeared to be significant predictors of awareness among Lebanese women. Actual folic acid intake was significantly associated with younger age, higher number of pregnancies, planning the last pregnancy and having had that last one after 1990. In Lebanon, the level of folic acid awareness and adequate intake remain relatively low. Several approaches should be used to promote folic acid intake including awareness campaigns, and routine counseling by primary health care physicians on folic acid during preconception visits.