The increasing knowledge of the role of periconceptional folate in Victorian women of child-bearing age: follow-up of a randomised community intervention trial

OBJECTIVES: To determine the changes since 1996 in knowledge of folate for the prevention of neural tube defects (NTDs) among women of child-bearing age and measure the residual effect of an earlier consumer-directed information campaign. DESIGN: A community, randomised trial with three matched pairs of geographically distinct local government areas in Victoria. INTERVENTION: Printed information recommending folate intake to decrease the risk of NTDs was disseminated in 1997 to women of child-bearing age. MAIN OUTCOME MEASURE: The proportion of women aware of the association between folate and spina bifida was established in 1996, 1997 and 2000 (approximately 200 respondents per local government area in each survey). RESULTS: 12.5% (adjusted for population sampling fraction) of 1,196 women interviewed in 1996, prior to the intervention, were aware of folate and NTDs. Independent surveys after the intervention in 1997 and again in 2000 showed that this had increased to 17.4% (n=1204) and 30.2% (n=1227) respectively. The intervention had a significant impact on folate awareness (a 4% difference in 1997 and a residual 3.3% in 2000, ORadj=1.24, 95% CI 1.19-1.37, p=0.007). CONCLUSIONS AND IMPLICATIONS: There has been a continuing increased awareness of folate in women of child-bearing age since 1996. Within this setting, the provision of printed educational material in a brief intervention in 1997 has caused enduring increased awareness of the association between folate and NTDs. The need for ongoing health promotion action on folate remains.     

Continuing low uptake of periconceptional folate warrants increased food fortification

Objective To assess whether the Health Education Authority's recent promotion of periconceptional folic acid has been successful in increasing uptake sufficient to prevent neural tube defects.
Design A retrospective questionnaire, completed by 162 patients in the early pregnancy clinic in Doncaster Royal Infirmary, an average-sized UK district general hospital. The study ran in February and March 1999.
Methods and main outcome measures Data were collected on: supplementation and dietary intake of folic acid, both preconceptionally and after confirmation of pregnancy; awareness of the benefits of folic acid; source of information on folic acid; the reasons for not taking folic acid (if this was so); planned or unplanned pregnancy; previous pregnancies; previous neural tube defect in a pregnancy; smoking habit; and age.
Results Eighty-one per cent of women were aware of the benefits of folic acid, but only 27% took it preconceptionally. Sixty-eight per cent took it after confirmation of pregnancy. A quarter of patients made an attempt to increase dietary folate. Unplanned pregnancy was a significant bar to uptake, with significant differences in awareness and consumption. Number of pregnancies had no effect. Older women were more likely to take postconceptional folate, but awareness and preconceptional use were the same as younger women.
Conclusion Despite an extensive campaign commissioned by the Department of Health and run by the Health Education Authority, use of periconceptional folate will probably only prevent one-sixth of affected pregnancies. The adverse effects of fortification discussed in the body of this paper are small. It is now time for increased fortification of all cereal-grain products to be instituted in the UK in a similar manner to the United States.     

Consequences of surveying folate awareness

Objectives  To assess women's concerns when interviewed about the association between folate and neural tube defects (NTDs) and to determine how this is affected by time, being folate aware, having seen folate promotional material or being pregnant.
Design  As part of a community randomized trial outcomes evaluation, independent cross-sectional follow-up surveys were carried out in 1997 and 2000.
Setting and participants  Six local government areas in the state of Victoria, Australia; 2431 women aged between 15 and 44 years.
Main variables studied  Whether or not women knew of the association between folate and NTDs (i.e. were folate aware), whether or not women had been concerned by seeing folate/NTD information and if an interview about folate and NTDs had raised any concerns for them.
Results  In the 1997 survey, 36% of women said that the interview had raised concerns and this decreased to 26% in 2000. Women who were folate aware were significantly less likely to have raised concerns than women who were not folate aware (OR_adj= 0.38, 95% CI 0.24–0.60). In general, women who had seen promotional material were less likely to feel concern about the interview than those who had not, although this varied with whether or not the promotional material had raised concerns. These effects were greater in women who were pregnant.
Conclusions  Women had increased concerns having seen folate promotional material and after being interviewed about it. These results are consistent with the proposition that an initial emotional response to sensitive health information is part of an adaptive response appropriate to the process of health-related behaviour change.     

Social and ethnic differences in folic acid use preconception and during early pregnancy in the UK: effect on maternal folate status

Background:  The role of folate supplementation in preventing neural tube defects is well known; however, preconception supplement use continues to be low, especially amongst the socially disadvantaged. The present study explored periconception folic acid supplement use in a socially deprived, ethnically diverse population.
Methods:  Pregnant women ( n  = 402) in the first trimester of pregnancy were recruited in East London. Using a researcher led questionnaire, details were obtained regarding social class, ethnicity and folic acid use. Red cell folate levels were determined for 367 participants during the first trimester.
Results:  Although 76% of participants reported using folic acid supplements during the first trimester, only 12% started preconception and a further 17% started before neural tube closure. Mothers from higher social groups or with higher levels of education were more likely to use folic acid and started taking it earlier. Ethnic differences were also seen in preconception usage (Africans, 5%; West Indians, 8%; Asians, 12%; Caucasians, 19%; P  = 0.038). Participants who took folic acid supplements had significantly higher mean (SD) red cell folate concentrations than those who took none [936 (*\1.6) and 579 (*\1.6) nmol L⁻¹, respectively; P  < 0.001].
Conclusions:  Folic acid supplement use preconception and prior to neural tube closure continues to be low, exhibiting both social and ethnic disparities.     

Folate and the prevention of neural tube defects: evaluation of a health promotion project in Western Australia

The objectives of this study were: to inform health professionalsand women of childbearing age about the prevention of neuraltube defects by folate; to recommend that all women of childbearingage increase their intake of folate; and to evaluate the effectivenessof the strategies used to achieve these aims. The study tookplace in Western Australia. The Folate and Neural Tube DefectsPrevention Project is a health promotion project using writtenmaterial, presentations and unpaid media. Surveys were carriedout of general practitioners, child health nurses and womenof childbearing age before the project began and 12 months later.The main outcome measures were: knowledge of folate and preventionof neural tube defects and exposure to and effectiveness ofpromotional material. Knowledge of folate and the preventionof neural tube defects increased amongst general practitionersand child health nurses, and most displayed the promotionalmaterial and made changes in their practice to promote an increasedfolate intake for women planning a pregnancy. In women of childbearingage, the knowledge of folate, of spina bifida, and of the associationbetween the two, increased over the study period. Women whohad seen the promotional pamphlet were over seven times morelikely to know that increased folate helps prevent spina bifida.The Project has been effective in raising awareness amongsthealth professionals and women of the prevention of neural tubedefects by folate. Further evaluation is needed to determinethe extent to which folate intake has increased, and its effectivenessin reducing the birth prevalence of neutral tube defects.     

Effects of once-a-week or daily folic acid supplementation on red blood cell folate concentrations in women

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: Randomized 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. INTERVENTION: Women were randomized to receive a once-a-week 2800 microg folic acid supplement, a daily 400 microg 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. CONCLUSION: A once-a-week 2800 microg 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 microg 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 Zealand) provided the supplements.     

Understanding the intention to permanently follow a high folate diet among a sample of low-income pregnant women according to the Health Belief Model.

Despite folate fortification of the US food supply beginning January 1, 1998, evidence indicates that a substantial proportion of women of child-bearing age will continue to have folate intakes inadequate for the prevention of neural tube defects (NTDs). Therefore, health education remains an essential component of this public health campaign. The purpose of this study was to determine the applicability of the Health Belief Model (HBM) to understanding the intention to permanently follow a high folate diet among low-income pregnant women. A convenience sample of 251 low-income pregnant women participated in individual 15 min interviews assessing their folate attitudes and beliefs according to the model. Correlations consistent with the HBM were found between the perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy and cues to action constructs, and participants' intention to permanently follow a high folate diet (folate intention). In regression analyses, the perceived benefits construct was consistently the most predictive of folate intention. Participants were generally unfamiliar with and had many misperceptions concerning both folate and NTDs. The HBM may offer an effective foundation for development of tailored educational interventions promoting permanent consumption of a high folate diet among low-income women.     

Prevention of neural tube defects: effect of an intervention aimed at implementing the official recommendations

OBJECTIVES: The periconceptional intake of 0.4 mg folic acid is recommended in many countries to prevent neural tube defects. This paper describes the poor implementation of corresponding guidelines in Germany, the effectiveness of an intervention-based on providing adequate information and the problems associated with the implementation. METHODS: Two cross sectional studies investigated knowledge, attitude, and behaviour of randomly sampled gynaecologists (n = 24/27), pharmacists (n = 21/21), and women in childbed (n = 131/118) before and after the information campaign. RESULTS: Before the intervention, 3.8% of the women implemented folic-acid-prophylaxis compared with 9.3% afterwards (p = n.s.). The awareness of the prophylaxis before pregnancy correlated with socio-economic status and rose from 28% (before) to 42% after intervention (p < 0.05). Before the intervention, 38% of the gynaecologists and 38% of the pharmacists recommended the prophylaxis compared with 74% (p < 0.05) and 43% (p = n.s.) afterwards. CONCLUSIONS: The effect of the intervention was small. To improve the situation, fortification of specially selected and labelled food should be considered. An accompanying nationwide information campaign should focus on women with lower socio-economic status.     

Prevention of neural tube defects: effect of an intervention aimed at implementing the official recommendations

Summary.¶Objectives: The periconceptional intake of 0.4 mg folic acid is recommended in many countries to prevent neural tube defects. This paper describes the poor implementation of corresponding guidelines in Germany, the effectiveness of an intervention-based on providing adequate information and the problems associated with the implementation.¶ Methods: Two cross sectional studies investigated knowledge, attitude, and behaviour of randomly sampled gynaecologists (n = 24/27), pharmacists (n = 21/21), and women in childbed (n = 131/118) before and after the information campaign.¶ Results: Before the intervention, 3.8% of the women implemented folic-acid-prophylaxis compared with 9.3% afterwards (p = n.s.). The awareness of the prophylaxis before pregnancy correlated with socio-economic status and rose from 28% (before) to 42% after intervention (p<0.05). Before the intervention, 38% of the gynaecologists and 38% of the pharmacists recommended the prophylaxis compared with 74% (p<0.05) and 43% (p = n.s.) afterwards.¶ Conclusions: The effect of the intervention was small. To improve the situation, fortification of specially selected and labelled food should be considered. An accompanying nation-wide information campaign should focus on women with lower socio-economic status.     

Do Thai women of child bearing age need pre-conceptional supplementation of dietary folate?

Recent studies in western countries have indicated that women with low serum folate before pregnancy have greater risk of giving birth to babies with neural tube defects, and preconceptional folate supplementation has been recommended to prevent such defects. To determine whether Thai women needed folate supplementation before pregnancy, we carried out a cross-sectional study from September 2001 to January 2002. The objectives were to determine serum folate levels among women of child-bearing age and their relationship to dietary folate intake. One hundred and sixty-five apparently healthy, volunteer women aged 15 - 45 years were recruited from the Family Planning Clinic, Mother and Child Hospital, Health Promotion Centre, Region I, Bangkok. Data on general characteristics, nutritional status and dietary folate intake were recorded while venous blood was drawn for serum folate analysis. Results showed that 65.5% of the study group had low dietary folate intake, that 18% had low serum folate, and that there was a significant correlation between dietary intake and serum level (r = 0.68, P<0.001). There were also significant correlations between serum level and body mass index, (r =0.13, P<0.001). However, there were no significant associations between serum level and age, educational level, occupation, family income, or duration vegetables were stored in the refrigerator before consumption. In conclusion, there is preliminary evidence that some pregnant Thai women may have sufficiently low serum folate levels to put their babies at risk. We recommend further study on a larger scale to confirm whether folate supplementation is needed for Thai women at child bearing age. In the interim, it may be wise for obstetricians to measure serum folate in pregnant women to determine whether folate supplementation is required.     

中国神经管缺陷高发地区育龄妇女叶酸增补的KAP现况调查

目的:了解我国中西部6省育龄妇女叶酸增补知识,行为和态度的基本情况,为进一步提高干预效果提供科学依据。方法:随机抽取全国神经管缺陷发生率较高的山西、新疆、内蒙、青海、甘肃和陕西6省的293个贫困县的33025名19～44岁育龄妇女作为调查对象,进行不记名自填式问卷调查。结果:43.47%的调查对象知晓叶酸的性质,33.79%知晓叶酸的防治知识,8.41%知晓每天正确服用叶酸的方法,愿意服用免费发放的叶酸的人数占82.60%。结论:我国中西部6省贫困县育龄妇女的叶酸增补知识和行为均有待于进一步提高,应开展有针对性的干预工作。     

Folate status in women of childbearing age--United States, 1999

In 1992, the U.S. Public Health Service (PHS) recommended that women of child-bearing age increase consumption of the vitamin folic acid to reduce spina bifida and anencephaly (neural tube defects [NTD]) cases (1). Since then, national efforts have been implemented to increase the use of dietary supplements containing folic acid (2). In 1996, the U.S. Food and Drug Administration (FDA) mandated that all enriched cereal grain products be fortified with folic acid (3). To assess levels of folic acid among childbearing-aged women, CDC compared serum and red blood cell (RBC) folate concentrations for childbearing-aged women who participated in the 1999 National Health and Nutrition Examination Survey (NHANES 1999) to childbearing-aged women who participated in the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994). The findings indicate substantial increases in serum and RBC folate concentrations among women of childbearing age.     

Folate intake and food-related behaviors in nonpregnant, low-income women of childbearing age

Information about folate intake among low-income women of childbearing age remains limited. This report presents results from a cross-sectional study of folate intake and food-related behaviors in a sample of low-income, nonpregnant women of childbearing age in California. One hundred fifty-seven nonpregnant, low-income (相似文献   

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.     

Folic acid campaign and evaluation--southwestern Virginia, 1997-1999

A needs assessment conducted in rural southwestern Virginia in 1996 indicated higher rates of birth defects in that region than in the entire state. In response to these findings, in January 1997 the regional perinatal council conducted a community folic acid information campaign designed to raise awareness about the 1992 Public Health Service recommendation that all women who are capable of becoming pregnant consume 400 microg (0.4 mg) of the B vitamin folic acid every day to decrease their risk for having a pregnancy affected with spina bifida or other neural tube defects (NTDs). This report describes the information campaign and the findings from precampaign and postcampaign surveys, which showed a significant increase in reported awareness and knowledge of the benefits of folic acid and reported knowledge about the sources of folic acid.     

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.     

增补叶酸预防神经管缺陷效果及其影响因素

育龄妇女增补叶酸是预防神经管缺陷（neural tube defects,NTDs）的重要措施之一。本文综述了叶酸现场干预试验、人群推广叶酸增补剂以及叶酸食品强化等叶酸增补方式预防NTDs的效果,分析了预防效果差异的原因及其影响因素。结果可为叶酸干预NTDs的策略与措施及其效果的科学评价提供参考依据。     

Assessing the Association between Natural Food Folate Intake and Blood Folate Concentrations: A Systematic Review and Bayesian Meta-Analysis of Trials and Observational Studies

Folate is found naturally in foods or as synthetic folic acid in dietary supplements and fortified foods. Adequate periconceptional folic acid intake can prevent neural tube defects. Folate intake impacts blood folate concentration; however, the dose-response between natural food folate and blood folate concentrations has not been well described. We estimated this association among healthy females. A systematic literature review identified studies (1 1992–3 2014) with both natural food folate intake alone and blood folate concentration among females aged 12–49 years. Bayesian methods were used to estimate regression model parameters describing the association between natural food folate intake and subsequent blood folate concentration. Seven controlled trials and 29 observational studies met the inclusion criteria. For the six studies using microbiologic assay (MA) included in the meta-analysis, we estimate that a 6% (95% Credible Interval (CrI): 4%, 9%) increase in red blood cell (RBC) folate concentration and a 7% (95% CrI: 1%, 12%) increase in serum/plasma folate concentration can occur for every 10% increase in natural food folate intake. Using modeled results, we estimate that a natural food folate intake of ≥450 μg dietary folate equivalents (DFE)/day could achieve the lower bound of an RBC folate concentration (~1050 nmol/L) associated with the lowest risk of a neural tube defect. Natural food folate intake affects blood folate concentration and adequate intakes could help women achieve a RBC folate concentration associated with a risk of 6 neural tube defects/10,000 live births.