Counselling women about periconceptional use of folic acid: the role of the community pharmacist can be improved

Objective — To assess community pharmacists' attitudes towards, and practice behaviour, relating to the periconceptional use of folic acid to prevent neural tube defects Method — A postal questionnaire was sent to a random sample of 150 community pharmacists at the end of 1996. The questionnaire covered knowledge, attitude and behaviour regarding the use of folic acid by women of childbearing age Setting — Two regions in the Netherlands (Northern and Western Netherlands) Key findings — The response rate was 72 per cent. Pharmacists' attitudes towards promoting the use of folic acid by women who wish to have a child are positive. Most pharmacists reported distributing folic acid brochures in their pharmacy and many stated that they displayed posters to promote the use of folic acid. Nearly 30 per cent of pharmacists reported using an additional label on the packaging of oral contraceptives with the standard text: “If you stop using the pill because you wish to have a child, please ask your pharmacist for information about the use of folic acid before you become pregnant”. Perceived attitudes of local general practitioners seemed to influence the willingness of pharmacists to promote the use of folic acid. The results indicate a tendency for some pharmacists to be more reactive than proactive in their advice-giving on the use of folic acid Conclusion — Compared with the findings of a similar survey two years ago, it appears that more pharmacists are actively promoting the periconceptional use of folic acid. However, further improvements could still be achieved and pharmacists could become more proactive in their information and advice-giving     

Increasing awareness of and behaviour towards periconceptional folic acid consumption in The Netherlands from 1994 to 1995

Objective: In November 1993, Dutch health authorities advised that women planning a pregnancy should take folic acid in the periconceptional period to reduce the risk of fetal neural tube defects. In the autumn of 1995 a national campaign was organized to inform women and health care professionals in a systematic way. Methods: We assessed the awareness and behaviour of women at their first or second antenatal visit in two surveys in the spring of 1994 and the autumn of 1995, in order to evaluate the impact of non-systematic information during that period, and to collect baseline data to evaluate the effect of the national folic acid campaign. The two surveys were carried out in the north and the west of The Netherlands. Results: The proportion of women who had heard of folic acid increased from 28% to 78%. The proportion that used folic acid during any period in pregnancy increased from 7.8% to 26%. The proportion that took folic acid tablets during the whole of the recommended period increased from 0.8 to 4.4%. In the group of women who did not take folic acid, the proportion who did “not like to use anything during pregnancy” decreased, as did the proportion who did “not think it is useful”. Conclusion: In The Netherlands, non-systematic information about periconceptional folic acid use has already led to significant changes in awareness and behaviour before the start of the national folic acid campaign. Received: 21 November 1997 / Accepted in revised form: 3 March 1998     

Ten years after the Dutch public health campaign on folic acid: the continuing challenge

Background Folic acid use in the periconceptional period reduces the risk of neural tube defects (NTDs). However, applying this knowledge in daily practice is not an easy task. We report here the current level of folic acid use in the Netherlands and discuss the figures within the framework of a national governmental campaign held in 1995 promoting the use of folic acid and the professional interventions undertaken since then. Methods We carried out six studies in the northern Netherlands during 1995, 1996, 1998, 2000, 2003 and 2005, respectively. The same methodology in the same health professionals’ practices was followed in all studies. Pregnant women attending their first or second antenatal visit were asked to fill in a questionnaire aimed at assessing their awareness and use of folic acid. Results In 2005, most of the pregnant women used folic acid “at some time in their pregnancy”, and 51% used it for the entire advised period. Prior knowledge on the protective affect of folic acid and on the period of use was strongly related to the level of education. The use of folic acid in a previous pregnancy [odds ratio (OR) 3.9, 95% confidence interval (95% CI) 1.6–9.9], the use of an oral contraceptive (OR 2.1, 95% CI 1.1–4.1) and parity (OR 0.08, 95% CI 0.01–0.5) significantly predicted the current correct use. The most recent figures revealed that there is still a large gap between more highly and less educated women in terms of taking folic acid in the advised period: 63 versus 31%, respectively. Discussion The aim of the Dutch Ministry of Health is to have 70% of Dutch women wanting to become pregnant use folic acid supplements in the advised period by 2010. While this level has almost been reached among more highly educated women (63%), it will take a great deal more effort, money and creativity to achieve the necessary increase from the current level of 31% among women with a lower educational background.     

疫情期间“互联网+药学服务”模式干预孕妇叶酸补充效果评价

目的探讨药师如何在新型冠状病毒肺炎(COVID-19)疫情期间通过“互联网+”模式提高孕妇叶酸补充依从性,以及确保新型冠状病毒肺炎(COVID-19)疫情期间孕妇围孕期用药安全、合理。方法医院药师采用“互联网+药学服务”模式干预,通过在线免费咨询、电话形式开展叶酸代谢基因检测个体化用药指导,以及微信群管理干预孕妇的叶酸补充。结果2020年2月1日至今(截至投稿时)共接受在线咨询38条,咨询内容主要为妇科用药、高血压、糖尿病等慢病用药,其中孕妇用药为9条;以电话形式开展叶酸代谢基因检测个体化用药指导85例,实施干预调整剂量35例。药师干预后,患者叶酸补充依从性得到很大提高,妊娠结局较好。结论疫情期间采用“互联网+药学服务”模式,可为药师参与围孕期妇女用药管理、提高孕妇叶酸补充的依从性提供切实可靠的路径。     

Enhanced Metabolism of Levonorgestrel During Phenobarbital Treatment and Resultant Pregnancy

Levonorgestrel implants (Norplant) are an alternative to oral contraceptives and medroxyprogesterone acetate intramuscular injections. An interaction may exist between levonorgestrel and agents that induce the hepatic microsomal enzyme system. A 21-year-old woman with a history of a seizure disorder, treated with phenobarbital, who received levonorgestrel implants became pregnant. After a normal delivery, she took oral contraceptives concomitantly with phenobarbital. Although she was educated about the importance of a backup method of contraception, the woman again became pregnant and delivered twins. A recent national survey of neurologists and obstetricians was conducted evaluating prescriber knowledge of interactions between oral contraceptives and anticonvulsants. Only 4% of neurologists and zero percent of obstetricians knew all the interactions between the six most commonly prescribed anticonvulsants and oral contraceptives. This case supports the importance of continued patient and prescriber education regarding the possibility of drug-drug interactions in women taking anticonvulsants and hormonal contraceptives.     

How many pregnant women in Christchurch are using folic acid supplements in early pregnancy?

AIMS: To determine the proportion of pregnant women in Christchurch using folic acid supplements in early pregnancy. To evaluate the level of current knowledge relating to folic acid amongst pregnant women. To determine the main sources from which this information was gained. METHODS: A short questionnaire was administered to 191 pregnant women in Christchurch during antenatal visits with their lead maternity carer. The survey contained questions relating to knowledge about folic acid and use together with sources of information regarding folic acid. Obstetric and demographic details were also collected. RESULTS: The response rate was 95.5%. Ninety-one per cent (174/191) of participants had heard of folic acid and, of these, 63% knew that folic acid reduces the risk of spina bifida. Of the 191 participants in the study, 118(62%) took folic acid supplements at some stage of their pregnancy, however, only 33(17%) had taken periconceptual folic acid supplements. Of the 44% of all women in the study with a planned pregnancy, only 35% had taken folic acid supplements periconceptually. Of those women with an unplanned pregnancy (55%), only 2.8% had taken a folic acid supplement periconceptually. The main sources of advice for women relating to folic acid were general practitioners (48%) or media advertising, either in the form of a magazine, or health pamphlet or television promotion (20%). CONCLUSIONS: The results of this study indicate that the level of knowledge amongst women of child-bearing age relating to folic acid is relatively high compared with other countries. Despite this high level of knowledge, only a small percentage of women are actually consuming a folic acid supplement during the recommended periconceptual period due in part to the high proportion of unplanned pregnancies. These results emphasize the need for an effective public health strategy to ensure that all women of child-bearing age have access to an adequate folic acid intake.     

Evaluation of patient opinions in a pharmacy‐level intervention study

Objective To explore patients' satisfaction with their community pharmacy's services and to evaluate the effects of an intervention programme in which a trained technician organised patient education activities in the pharmacy. Method We surveyed patients visiting the participating pharmacies at three stages: at the start of the intervention period (0 months, T0), at the end (after 12 months, T1), and 12 months after the intervention had been completed (24 months from baseline, T2). At each stage, 500 questionnaires were distributed by each pharmacy. Setting 28 Dutch community pharmacies: 14 intervention and 14 controls. Key findings The response rates were 54%, 44% and 43% at T0, T1 and T2, respectively. Baseline data showed that patients reported satisfaction with helpfulness, waiting time, ease of asking questions, answers to questions, and patient leaflets provided. Around two thirds (59.5%) of the patients said they would ask a pharmacy employee questions if they were concerned about side effects of their medication. Asking questions was not reported to be difficult for most patients (88.9%). The reasons most often given for experiencing difficulties with asking questions were related to lack of privacy (16.9% of all patients), waiting time of other patients (8.8%) and busy pharmacy employees (6.7%). The most frequently reported reason for being less satisfied with the answers to questions was receiving too little information (7.5%). Our analyses showed a significant improvement only on the outcome variable “helpfulness” experienced by patients between 0 (T0) and 12 months (T1), and this was found to be sustained one year later (T2). Conclusion The overall findings on patient satisfaction showed that almost two‐thirds of the respondents saw the pharmacy as a source of information about medication. Community pharmacies clearly have an important role in providing such information. Lack of privacy was the most common reason for patients reporting difficulties in asking questions about medicines and this needs pharmacists' attention. Our analysis showed that the intervention had an effect on “helpfulness” experienced by patients, which slightly increased in the intervention period (T0‐T1 differences) and appeared to have remained at the higher level one year later (T2).     

东莞地区育龄期女性增补叶酸知信行情况的横断面研究

目的了解东莞地区育龄期女性关于叶酸增补的知识、信念与行为情况,为制定孕期保健的健康教育和健康促进政策提供参考依据。方法采取随机抽样的方法,对2015年7月-2016年3月东莞市第三人民医院就诊的1445名育龄期女性进行叶酸增补知信行情况的问卷调查。结果95.54%育龄期女性听说过叶酸,70.59%育龄期女性知道叶酸是一种维生素,88.47%育龄期女性知道叶酸可以预防神经管缺陷,86.35%育龄期女性知道叶酸的正确服用频率,45.26%育龄期女性知道叶酸的正确服用剂量,78.37%育龄期女性知道叶酸的最佳增补时间,32.35%育龄期女性能正确增补叶酸。在"叶酸可以预防出生缺陷"知晓率方面年龄、学历、职业、收入的差异有统计学意义(P<0.05),在"正确增补叶酸率"方面学历、职业、收入的差异有统计学意义(P<0.05)。结论东莞地区育龄期女性对增补叶酸知识掌握程度较好,但能正确增补叶酸的育龄期女性不足,知识、信念与行为存在脱节,知信行理论在健康教育工作中收获甚微,应加强健康促进工作,为育龄期女性提供良好的环境和政策支持,以预防神经管缺陷的发生,提高出生人口质量。     

The combined oral contraceptive pill containing drospirenone and ethinyl estradiol plus levomefolate calcium

Introduction: Neural tube defects are the second most common congenital anomaly in the United States, although their incidence may be decreased by periconception folic acid supplementation. A new oral contraceptive containing drospirenone and ethinyl estradiol plus levomefolate calcium was formulated to decrease the risk of neural tube defects in pregnancies conceived while taking or shortly after discontinuing this pill.

Areas covered: Because of its novelty, very few studies have been performed to evaluate the efficacy, side effects and safety related to contraception, premenstrual dysphoric disorder and acne; therefore, literature evaluating similar contraceptives without levomefolate is reviewed. Additionally, we review studies evaluating the addition of levomefolate calcium to oral contraceptives containing 3 mg drospirenone and either 20 or 30 μg ethinyl estradiol. To date, no study has been performed to evaluate the effect this new oral contraceptive has on reducing the incidence of neural tube defects.

Expert opinion: This new pill has similar contraceptive efficacy, side effect, safety and benefits profile to other drospirenone-containing contraceptives. While also approved to prevent neural tube defects, no studies validate this claim and physician time is better spent counseling women, regardless of contraceptive choice, on the importance of folic acid supplementation during the child-bearing years.     

Information sources used by women in Finland who use hormonal contraceptives

Objective The aim of this study was to examine information sources used by women who use hormonal contraceptives (HCs), and how information source affected women’s attitudes and perceptions in 2001 and 2007. Setting The questionnaires were distributed from university pharmacies in 12 large cities across Finland. Method The data were collected with two questionnaire surveys among women who used hormonal contraceptives in 2001 and 2007. In the 2001 survey the response rate was 53% (n = 264) and in the 2007 survey 55% (n = 436). Results The number of respondents who considered professional information sources the most important information sources was markedly bigger in 2007 than in 2001 (P = 0.005). The most common source of information concerning the benefits of hormonal contraceptives was a physician (2001: 43%, 2007: 53%). The most common source of information concerning the risks of hormonal contraceptives was friends and relatives (43%) in 2001 and physician in 2007 (35%). Only a few percent of the respondents considered a pharmacy the most important information source both the 2001 and 2007 surveys. Conclusion The importance of health care professionals as sources of information concerning hormonal contraceptives has increased. However, role of pharmacists as information source was surprisingly small. Women who use hormonal contraceptives need more information from professional sources to alleviate possible fears associated with use.     

妊娠妇女在不同孕期血清铁蛋白、叶酸和维生素B_(12)的检测及临床意义

目的检测妇女妊娠期血清铁蛋白、叶酸和维生素B12的含量,为预防和治疗妊娠贫血提供实验依据。方法用化学发光免疫分析方法检测妊娠妇女血清铁蛋白、叶酸和维生素B12的含量。结果血清铁蛋白、叶酸和维生素B12的含量随孕期增长而降低,早孕妇女与正常对照组比较,铁蛋白和叶酸明显低于对照组(P<0.05),维生素B12无统计学意义(P>0.05);中、晚孕期妇女血清铁蛋白、叶酸和维生素B12的含量与正常对照组比较,铁蛋白、叶酸和维生素B12均显著低于对照组(P<0.01)。结论测定妇女妊娠期血清铁蛋白、叶酸和维生素B12的含量,可以鉴别妇女妊娠期贫血的原因,预防和治疗孕妇贫血,并保障胎儿的正常生长发育。     

Awareness and use of folic acid, and blood folate concentrations among pregnant women in northern China--an area with a high prevalence of neural tube defects

BACKGROUND: The prevalence of neural tube defects (NTDs) in northern China remains high after 10 years since periconceptional supplementation with folic acid has been known to be effective in reducing the risk of NTDs. OBJECTIVE: The objectives of this study were to characterize folic acid awareness and use and to examine the association between folic acid supplementation with blood folate concentrations among early pregnant women in an area with a high prevalence of NTDs in northern China. SUBJECT AND METHOD: From December 2002 to February 2004, 693 early pregnant women were recruited and interviewed about folic acid awareness, knowledge and use. Four millilitres of venous blood was drawn and blood folate concentrations were measured. RESULTS: About 36% of women reported having ever heard of folic acid. Of these, 82.7% knew that folic acid can prevent NTDs, and 64.5% knew the best time to take it. Overall, 15% of women reported having ever taken folic acid. However, only 34.3% had begun to take it before the last menstrual period. Women with less education (21.1%), farmers (19.6%), rural dwellers (23.5%), and women who had a previous child (23.0%) were less likely to be aware of folic acid, and were less likely to take folic acid. Among women who had ever heard of folic acid, 37.5% took it during current pregnancy, compared with only 2.0% among those who had not. Women who were aware of folic acid were 25 times more likely to take it than women who were not. Overall, 44% of women had plasma folate deficiency, and 35% had red cell folate deficiency. Those who reported having ever taken folic acid had a lower rate of plasma folate deficiency (13.7%), compared with those who reported not taking folic acid (49.4%). The former group's mean plasma concentrations were twice as high as those of the latter group. CONCLUSION: The levels of folic acid awareness, knowledge and use among Chinese women living in a high NTD prevalence area during early pregnancy were very low and folate deficiency was quite prevalent. Campaigns aimed at increasing the awareness, knowledge, and periconceptional use of folic acid should target to less educated, parous women and women living in rural areas.     

The influence of oral contraceptives on the metabolism of methaqualone in man.

1 Oral contraceptives were shown to suppress the mid-cycle increase in methaqualone metabolism observed in premenopausal women not receiving oral contraceptive therapy. No women were identified in whom this suppression was not observed. 2 Combined oestrogen-progestogen contraceptives produced the effect in all nine women studied. The effect was also observed in one woman who was receiving progestogen-only contraceptives. 3 The effect of the combined contraceptives was observed within one month of the commencement of the contraceptive therapy. 4 The results emphasise the need to monitor the effect of the menstrual cycle in women not receiving oral contraceptive therapy when the effects of such therapy is studied. 5 These effects are more likely to be the consequence of an inhibition of hormonal control of hepatic metabolic activity by the synthetic steroids than they are to simple inhibition of hepatic metabolism.     

Patterns of regular drug use in Spanish childbearing women: changes elicited by pregnancy

Objective: To determine drug use in Spanish women before pregnancy and from conception to the awareness of pregnancy (early period of pregnancy, EPP), as well as to analyse attitudinal changes when pregnancy was planned or known. Methods: Trained gynaecologists used a structured questionnaire to collect demographic and obstetric characteristics, histories of regular drug taking before pregnancy, attitudes towards drug taking during pregnancy and current drug use in the EPP. Women were interviewed at their first antenatal visit during the first trimester. Results: Two hundred and seventy-two women were included (mean age 29.3 years and 66.3 days of gestation). Before pregnancy, 24% regularly took drugs, 70% of them more than twice a week; a significantly higher frequency was found in those receiving public antenatal care and in those who had had less education. In 39% of women, awareness of pregnancy did not change their attitudes towards regular drug use. Among those who decided to suppress their regular drug intake, 58% did so when their pregnancy was confirmed and 42% when they planned it. In women who planned their pregnancy, 30.1% stopped when they tried to become pregnant. However, 62% of all women took drugs during the EPP. In private antenatal care significantly more drugs were taken per patient. By the 168 women 278 compounds were consumed during the EPP: 40% were analgesics (mainly paracetamol and acetylsalicylic acid) and 25% were digestive and metabolic drugs (mainly antacids and laxatives). Drugs were often used more than twice a week, particularly in women receiving public antenatal care and in those who had had less education. Conclusion: Drug taking is common in Spanish women of childbearing age, and many of those in our study did not decide to stop during the EPP. Few women avoid drugs when planning a pregnancy. Therefore, gynaecologists must advise against drug taking in patients who wish to become pregnant and suggest that unnecessary drug use be avoided when the pregnancy is already diagnosed. Received: 17 February 1998 / Accepted in revised form: 20 May 1998     

The combined oral contraceptive pill containing drospirenone and ethinyl estradiol plus levomefolate calcium

INTRODUCTION: Neural tube defects are the second most common congenital anomaly in the United States, although their incidence may be decreased by periconception folic acid supplementation. A new oral contraceptive containing drospirenone and ethinyl estradiol plus levomefolate calcium was formulated to decrease the risk of neural tube defects in pregnancies conceived while taking or shortly after discontinuing this pill. AREAS COVERED: Because of its novelty, very few studies have been performed to evaluate the efficacy, side effects and safety related to contraception, premenstrual dysphoric disorder and acne; therefore, literature evaluating similar contraceptives without levomefolate is reviewed. Additionally, we review studies evaluating the addition of levomefolate calcium to oral contraceptives containing 3 mg drospirenone and either 20 or 30 μg ethinyl estradiol. To date, no study has been performed to evaluate the effect this new oral contraceptive has on reducing the incidence of neural tube defects. EXPERT OPINION: This new pill has similar contraceptive efficacy, side effect, safety and benefits profile to other drospirenone-containing contraceptives. While also approved to prevent neural tube defects, no studies validate this claim and physician time is better spent counseling women, regardless of contraceptive choice, on the importance of folic acid supplementation during the child-bearing years.     

叶酸在妊娠期的应用研究进展

叶酸是参与人体代谢的重要的微量营养素之一,对妊娠妇女及胎儿、新生儿健康有非常重要的意义。本文重在研究叶酸在妊娠期的作用及其机制,从而从妊娠期妇女及胎儿叶酸缺乏症的预防及叶酸补充角度对叶酸在妊娠期的重要作用做出概述。