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Low compliance with recommendations on folic acid use in relation to pregnancy: is there a need for fortification?

  • Vibeke K Knudsen (a1), Ivanka Orozova-Bekkevold (a1), Lone B Rasmussen (a2), Tina B Mikkelsen (a1), Kim F Michaelsen (a3) (a4) and Sjúrður F Olsen (a1) (a2)...
Abstract
AbstractObjective:

As a means to prevent neural tube defects (NTDs), women planning pregnancy in Denmark are recommended to take a dietary supplement of 400 μg folic acid daily during the periconceptional period. We examined compliance with this recommendation in a national survey.

Design:

Cohort study on pregnant women in Denmark.

Setting:

The Danish National Birth Cohort (DNBC).

Subjects:

From November 2000 to February 2002, 22 000 pregnant women were recruited for DNBC. Use of dietary supplements was recorded at enrolment. Compliance with the recommendation was related to an information campaign that took place during the second half of 2001, and to lifestyle factors provided in a telephone interview by the end of the first trimester of pregnancy.

Results:

An increase was seen in the proportion of women complying with the recommendation in the study period and this coincided with the information campaign events. However, even at the end of the period, only 22.3% of the women who had planned their pregnancy fully complied with the recommendation. No increase at all was seen in periconceptional folic acid use among women with unplanned pregnancies. Young age, low education and smoking were identified as factors that determined non-compliance.

Conclusions:

Alternative and more effective strategies are needed if the Danish population is to benefit fully from the knowledge that folic acid prevents NTDs. Future strategies should not only target vulnerable groups, such as the less educated and the young, but also women who get pregnant without planning this. The only possible way to reach the last group may be through fortification of foods with folic acid.

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Corresponding author
*Corresponding author: Email vik@ssi.dk
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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

2 AE Czeizel , I Dudas . Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation. New England Journal of Medicine 1992; 327: 1832–5.

3 RJ Berry , Z Li , JD Erickson , S Li , CA Moore , H Wang , Prevention of neural-tube defects with folic acid in China. China–US Collaborative Project for Neural Tube Defect Prevention. New England Journal of Medicine 1999; 341: 1485–90.

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5 JL Mills . Fortification of foods with folic acid – how much is enough? New England Journal of Medicine 2000; 342: 1442–5.

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8 R McDonnell , Z Johnson , A Doyle , G Sayers . Determinants of folic acid knowledge and use among antenatal women. Journal of Public Health Medicine 1999; 21: 145–9.

11 KM Van der Pal-de Bruin , HE De Walle , W Jeeninga , C de Rover , MC Cornel , LT de Jong-van den Berg , The Dutch 'Folic Acid Campaign' – have the goals been achieved? Paediatric and Perinatal Epidemiology 2000; 14: 111–7.

14 J Olsen , M Melbye , SF Olsen , TI Sorensen , P Aaby , AM Andersen , The Danish National Birth Cohort – its background, structure and aim. Scandinavian Journal of Public Health 2001; 29: 300–7.

15 ES Page . Continuous inspection schemes. Biometrica 1954; 41: 100–14.

17 K Braekke , AC Staff . Periconceptional use of folic acid supplements in Oslo. Acta Obstetrica et Gynecologica Scandinavica 2003; 82: 620–7.

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Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
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