Awareness of the benefits of folic acid and prevalence of the use of folic acid supplements to prevent neural tube defects among Thai women

Objective To determine the level of knowledge about the usefulness of periconceptional folic acid supplementation among pregnant women. Materials and methods An anonymous questionnaire was completed by selected subjects to assess folic acid awareness. The questionnaire was administered to pregnant women who were seeking antenatal care at King Chulalongkorn Memorial Hospital May to December 2005. The questions covered their knowledge and use of folic acid supplements, pregnancy intention, and demographic and socioeconomic characteristics. Results Out of 401 women surveyed, 76.1% of them reported that they had heard of folate. Of these, only 24.4% of the total subjects knew that folate was something important. Overall, 9.7% of the total women took folic acid during periconceptional period. The most common information sources on folate were the media. Logistic regression analysis showed that education of mother was the strongest predictor of having taken folic acid during the correct period. Conclusion Although some pregnant women are aware of the need to take folic acid, the actual impact of the present recommendations is almost negligible. Information to specifically inform patients about the need to take folic acid to prevent neural tube defects by medias and healthcare personnel seem to improve the final intake of folic acid during the protective period.     

Periconceptional folic acid/multivitamin supplementation and twin pregnancy

OBJECTIVE: Results of our previous randomized controlled trial suggested an increase of twin pregnancies that was associated with the use of a multivitamin that contained folic acid during the periconceptional period. These findings were confirmed by US and Swedish studies, but not in the Chinese population. The aim of this analysis is to evaluate this possible association in a population-based data set. STUDY DESIGN: The population-based large control data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities (1980-1996) was evaluated. Control pregnant women were differentiated according to pre- and postconceptional supplementation of folic acid (in general 6 mg), multivitamins that contained 0.1 to 1.0 mg folic acid, folic acid plus multivitamin, and the prevalence of twin pregnancies was compared with the prevalence of twin pregnancies in the women who did not received supplements as referent. RESULTS: Of 38,151 women, 395 women gave birth to twins. The prevalence of twin births was 0.78% in the unsupplemented group; the rate of twin pregnancies was 1.52% after the preconceptional supplementation (adjusted odds ratio, 1.80; 95% CI, 1.14-2.85). The proportions of twin pregnancies were 1.14%, 1.45%, and 2.00% after the postconceptional folic acid, multivitamin, and folic acid plus multivitamin supplementation, respectively. CONCLUSION: Our findings suggest that both pre- and postconceptional supplementation of a high dose of folic acid and multivitamins are associated with a slight increase of the incidence of twin pregnancies.     

Periconceptional folic acid supplementation among women attending antenatal clinic in Anhui, China: data from a population-based cohort study

Objectives

to examine the rate of periconceptional and optimal folic acid supplementation, and to characterise their patterns and determinants among antenatal women in central China.

Design

data from 4290 women in the Anhui Birth Defects and Child Development Cohort Study recruited between October 2008 and September 2009 were analysed.

Setting

seven Maternal and Child Health Centres of two cities (Hefei and Maanshan) in Anhui province of central China.

Participants

women initiating prenatal care were included and asked to complete a structured questionnaire regarding folic acid supplementation.

Findings

sixty-eight per cent (2905/4290) of pregnant women reported taking folic acid supplementation periconceptionally (i.e. at some point before or during early pregnancy), and 32.8% (1405/4290) and 65.2% (2797/4290) had taken it before or during early pregnancy, respectively. However, only 16.1% (690/4290) used it optimally (i.e. regularly from four weeks before pregnancy throughout four weeks after pregnancy). Use of periconceptional folic acid was significantly associated with educational level, household income, registered residence, age, gestational age at recruitment, and planning of pregnancy.

Conclusion

optimal folic acid supplementation was relatively low.

Implications for practice

further efforts are needed to inform the population and promote the use of folic acid supplementation.     

Preconceptional and prenatal predictors of folic acid intake in Hungarian pregnant women

Objective

The purpose of the study was to determine demographic, obstetric and pregnancy care related factors of folic acid intake during preconceptional and prenatal period of pregnancy.

Study design

A questionnaire-based retrospective study was delivered at the Department of Obstetrics and Gynecology and Pregnancy Care Centre. The frequency of folic acid intake was measured before and during pregnancy in 349 pregnant women.

Results

Factors influencing preconceptional folic acid consumption were planning of pregnancy, previous infertility therapy, multivitamin intake before pregnancy, and folic acid intake during pregnancy. Probability of taking folic acid during pregnancy increased with age, and decreased with gestational age. Earlier detection of pregnancy corresponded to a higher chance of folic acid intake. Prenatal folic acid intake significantly related to the earlier intake of folic acid, and prenatal multivitamin medication.

Conclusion

It is important to target women who are less likely to take periconceptional folic acid as well as to increase awareness of women of childbearing age in general through an intensive campaign and improved education.     

The regional campaign for women on awareness of neural tube defects and folic acid in Narlidere,Izmir: a community-based intervention

Objectives To create an awareness among women and to update the knowledge of health personnel about neural tube defects (NTDs) and folate in order to reduce the incidence of NTD in Narlidere, ?zmir.

Methods In 2006, a regional campaign was organized in Narlidere, Izmir that aimed at informing women of child-bearing age on folic acid and prevention of NTD. Nearly 4400 women participated in the study. By means of questionnaires the level of knowledge before and after the intervention was evaluated.

Results Before the campaign was carried out, 18% of women had heard of folic acid. Their level of knowledge increased after the campaign (p < 0.0001). Post-intervention scores of high school and university graduates and women with high or middle income, as well as those having a friend or kin with spina bifida were found to have significantly improved.

Conclusions The pilot community-based training programme was very successful. Similar programmes, integrated within routine health care services, promoting the use of folic acid will be fostered in the whole country.     

Midwives' awareness and experiences regarding domestic violence among pregnant women in southern Sweden

Objective

to explore midwives' awareness of and clinical experience regarding domestic violence among pregnant women in southern Sweden.

Design

an inductive qualitative design, using focus groups interviews.

Setting

midwives with experience of working in antenatal care (ANC) units connected to two university hospitals in southern Sweden. Participants 16 midwives recruited by network sampling and purposive sampling, divided into four focus groups of three to five individuals.

Findings

five categories emerged: ‘Knowledge about ‘the different faces’ of violence’, perpetrator and survivor behaviour, and violence-related consequences. ‘Identified and visible vulnerable groups’, ‘at risk’ groups for exposure to domestic violence during pregnancy, e.g. immigrants and substance users. ‘Barriers towards asking the right questions’, the midwife herself could be an obstacle, lack of knowledge among midwives as to how to handle disclosure of violence, fear of the perpetrator and presence of the partner at visits to the midwife. ‘Handling the delicate situation’, e.g. the potential conflict between the midwife's professional obligation to protect the pregnant woman and the unborn baby who is exposed to domestic violence and the survivor's wish to avoid interference. ‘The crucial role of the midwife’, insufficient or non-existent support for the midwife, lack of guidelines and/or written plans of action in situations when domestic violence is disclosed. The above five categories were subsumed under the overarching category ‘Failing both mother and the unborn baby’ which highlights the vulnerability of the unborn baby and the need to provide protection for the unborn baby by means of adequate care to the pregnant woman.

Key conclusions and implication for practice

avoidance of questions concerning the experience of violence during pregnancy may be regarded as a failing not only to the pregnant woman but also to the unprotected and unborn baby. Nevertheless, certain hindrances must be overcome before the implementation of routine enquiry concerning violence during pregnancy. It is important to develop guidelines and a plan of action for all health-care personnel at antenatal clinics as well as to provide continuous education and professional support for midwives in southern Sweden.     

妊娠期亚临床甲状腺功能减退孕妇叶酸利用能力与血清同型半胱氨酸、维生素B12的相关性分析

目的 探究妊娠期亚临床甲状腺功能减退(妊娠期亚甲减)孕妇叶酸(FA)利用能力与血清同型半胱氨酸(Hcy)、维生素B₁₂的相关性。方法 选取100例妊娠期亚甲减孕妇为研究组;另选同期100例甲状腺功能正常孕妇为对照组。检测两组孕妇FA、Hcy、维生素B₁₂以及甲状腺功能,并分析其相关性。结果 两组FA利用能力比较,差异具有统计学意义(P<0.05)。研究组血清Hcy水平高于对照组,维生素B₁₂水平低于对照组,差异具有统计学意义(P<0.05)。两组游离三碘甲状腺原氨酸(FT₃)、游离四碘甲状腺原氨酸(FT₄)水平比较,差异无统计学意义(P>0.05),研究组促甲状腺激素(TSH)水平高于对照组,差异具有统计学意义(P<0.05)。FA利用能力与Hcy呈负相关(r=-0.454),与维生素B₁₂呈正相关(r=0.219);Hcy与维生素B₁₂、FT₃、FT₄呈负相关(r=...     

Knowledge on periconceptional use of folic acid in women of British Columbia

OBJECTIVE: Our purpose was to evaluate the knowledge of folic acid and its use preconceptionally in women of British Columbia. METHODS: The study was conducted at British Columbia Women's Hospital in Vancouver, Canada, between April 15 and June 15, 1999. Pregnant women and women in the postpartum period were asked to complete a survey on folic acid. RESULTS: In total, 1,004 women completed the questionnaire during the study period. Seventy-one percent of the women knew that vitamins could help prevent birth defects. Of those, 76.3% identified folic acid as the one vitamin specifically associated with reduction of birth defects. It was identified that 49.4% of all women took vitamins prior to pregnancy. CONCLUSIONS: Women in the population studied were relatively well informed about the benefits of folic acid, but less than 50% of them took vitamins prior to conception.     

Randomized trial of a physician-based intervention to increase the use of folic acid supplements among 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 randomly 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%.     

Homocysteine,folic acid and B12 serum levels in pregnancy complicated with preeclampsia

Objective Elevated plasma homocysteine has been implicated in vascular changes compatible with atherosis and endothelial dysfunction similar to the vascular changes of the placenta in preeclampsia. Previous reports have indicated an increased incidence of hyperohomocysteinemia in preeclamptic patients. The aim of this study was to examine the association of homocysteine levels and preeclampsia in our patients. Study design Prospective study of 28 preeclamptic patients that were matched with 26 normal controls of the same gestational age. Results The preeclamptic group had an increased incidence of cesarean sections (75%), of growth retarded fetuses (50%), intrauterine deaths (7%) and placental abruptions (7%). Mean levels of homocysteine were significantly elevated in the preeclamptic than in control group (11.11 vs. 6.40 μmol/l, P < 0.001). There were no differences between the groups regarding the levels of folic acid (11.12 vs. 9.73 ng/ml, P = 0.55) and vitamin B12 (295.76 vs. 356.15 pg/ml, P = 0.43). Conclusion It is concluded that in our study homocysteine levels are significantly elevated in patients with preeclampsia compared with control group, while no vitamin deficiencies were observed.     

母体叶酸水平与子代生长发育状况相关性的研究进展

叶酸是一种重要的人体必需营养素。研究表明,孕期补充叶酸可以预防多种出生缺陷的发生,已有多个国家全面推行了叶酸强化政策。但有证据指出,过量补充叶酸不仅无法预防疾病,还会适得其反。目前研究聚焦在母体叶酸补充剂量与子代健康的相关性上,特别是孕期过量补充叶酸是否会对子代造成副作用。本文拟从叶酸的代谢、人群叶酸营养水平、临床常见的叶酸检测方法、应用以及母体叶酸摄入异常对后代生长发育的影响4个方面进行综述。     

叶酸联合甲古胺对妊娠期高血压疾病患者高同型半胱氨酸血症的影响

目的　研究血浆总同型半胱氨酸 (tHcy)水平与妊娠期高血压疾病的关系及叶酸联合甲古胺对其的影响。方法　 2 0 0 1年 1月至 2 0 0 3年 6月广东省东莞市人民医院采用荧光偏振免疫分析法测定 16 2例妊娠期高血压疾病患者和 15 0例正常晚期妊娠妇女血浆tHcy水平 ,同时采用离子捕捉免疫分析法检测其血清叶酸水平和微粒子酶联免疫分析法检测其血清VitB1 2 水平 ,并对 36例合并高Hcy血症的患者采用叶酸联合甲古胺进行干预治疗 ,4周后再次测定其血浆tHcy水平、血清叶酸和VitB1 2 水平。结果　妊娠期高血压疾病患者血浆tHcy水平显著高于正常妊娠组 (P <0 0 1) ,血清叶酸和VitB1 2 水平显著低于正常妊娠组 (P <0 .0 5 ) ;36例合并高Hcy血症的患者治疗后血浆tHcy水平比治疗前显著下降 (P <0 0 1) ,而血清叶酸和VitB1 2 水平比治疗前则显著升高 (P <0 0 5 )。结论　高Hcy血症是妊娠期高血压疾病发病的重要因素之一 ,应用叶酸联合甲古胺治疗 ,可显著降低妊娠期高血压疾病合并高Hcy血症患者的血浆tHcy水平 ,减少高Hcy对血管的毒性作用 ,有助于改善妊娠期高血压疾病患者的疾病转归。     

Maternal-fetal attachment in pregnant women who use illicit drugs

OBJECTIVE: To explore cognitive, affective, and altruistic dimensions of maternal-fetal attachment in pregnant women who use illicit drugs. DESIGN: Content analysis with deductive and inductive coding methods was used to uncover common themes in each dimension of attachment. SETTING: A prenatal clinic of a tertiary medical center in the northeastern United States. PARTICIPANTS: Forty pregnant women. Inclusion criteria were the following: used illicit drugs after the last menstrual period, had felt fetal movement, and could read and speak English. Women in methadone treatment programs were excluded. RESULTS: Knowing the baby's characteristics and health through fetal movement, acknowledging the fetus as an individual with physical and emotional functions, and knowing the baby by relating the fetus to self and family members are the three major themes in cognitive attachment. Themes in affective attachment include mixing strong affection with guilt and viewing fetal movement as visual and tactile enjoyment but also discomfort. Common themes with conflicting feelings were salient in altruistic attachment, including feeling uncomfortable versus feeling worthwhile, viewing being pregnant as an incentive for lifestyle changes, battling with substance use and concern for fetal health, and alternating between uncertainty and hope in preparing for the baby's arrival. CONCLUSION: Maternal-fetal attachment is not a phenomenon that is present or absent, but a struggle manifested by guilt, concern, and uncertainty. Without proper treatment and counseling, many women struggle between illicit drug use and development of maternal-fetal attachment.     

妊娠并发疟疾补充铁剂、叶酸效果的临床观察

目的 :临床观察孕妇并发疟疾补充铁剂、叶酸的效果。方法 :将 158例孕妇并发疟疾者根据补充铁剂、叶酸前血红蛋白水平分为空白对照组、预防组 (两组血红蛋白皆≥ 90g L)和治疗组 (血红蛋白 <90g L)。预防组 4 2例 ,治疗组 50例 ,于孕 2 0～ 2 4周开始口服硫酸亚铁、叶酸 ;空白对照组 66例。 3组分别于服药前查血红蛋白与红细胞 ,观察期间每 4周复查 1次血红蛋白与红细胞直至分娩 ,并观察临床结局。结果 :预防组服药后血红蛋白与红细胞明显高于空白对照组 (P <0 .0 1) ;治疗组服药后血红蛋白与红细胞明显高于服药前及对照组 (P <0 .0 1)。结论 :合理的抗疟治疗及补充铁剂、叶酸可有效地改善孕妇并发疟疾的贫血 ,减少孕妇并发疟疾发作次数及异常妊娠结局的发生率