Skip to main content
    • Aa
    • Aa
  • Access
  • Cited by 27
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Obara, Taku Nishigori, Hidekazu Nishigori, Toshie Metoki, Hirohito Ishikuro, Mami Tatsuta, Nozomi Mizuno, Satoshi Sakurai, Kasumi Nishijima, Ichiko Murai, Yuriko Fujiwara, Ikuma Arima, Takahiro Nakai, Kunihiko Mano, Nariyasu Yaegashi, Nobuo and Kuriyama, Shinichi 2016. Prevalence and determinants of inadequate use of folic acid supplementation in Japanese pregnant women: the Japan Environment and Children’s Study (JECS). The Journal of Maternal-Fetal & Neonatal Medicine, p. 1.

    Rautiainen, Susanne Manson, JoAnn E. Lichtenstein, Alice H. and Sesso, Howard D. 2016. Dietary supplements and disease prevention — a global overview. Nature Reviews Endocrinology, Vol. 12, Issue. 7, p. 407.

    Navarrete-Muñoz, Eva María Valera-Gran, Desirée García de la Hera, Manoli Gimenez-Monzo, Daniel Morales, Eva Julvez, Jordi Riaño, Isolina Tardón, Adonina Ibarluzea, Jesus Santa-Marina, Loreto Murcia, Mario Rebagliato, Marisa and Vioque, Jesus 2015. Use of high doses of folic acid supplements in pregnant women in Spain: an INMA cohort study. BMJ Open, Vol. 5, Issue. 11, p. e009202.

    Backhausen, Mette G. Ekstrand, Maria Tydén, Tanja Magnussen, Britta Kjeldberg Shawe, Jill Stern, Jenny and Hegaard, Hanne K. 2014. Pregnancy planning and lifestyle prior to conception and during early pregnancy among Danish women. The European Journal of Contraception & Reproductive Health Care, Vol. 19, Issue. 1, p. 57.

    Kondo, Atsuo Fukuda, Hiromi Matsuo, Takuya Shinozaki, Keiko and Okai, Ikuyo 2014. C677T mutation in methylenetetrahydrofolate reductase gene and neural tube defects: Should Japanese women undergo gene screening before pregnancy?. Congenital Anomalies, Vol. 54, Issue. 1, p. 30.

    Oliver, E. M. Grimshaw, K. E. C. Schoemaker, A. A. Keil, T. McBride, D. Sprikkelman, A. B. Ragnarsdottir, H. S. Trendelenburg, V. Emmanouil, E. Reche, M. Fiocchi, A. Fiandor, A. Stanczyk-Przyluska, A. Wilczynski, J. Busacca, M. Sigurdardottir, S. T. Dubakiene, R. Rudzeviciene, O. Vlaxos, G. D. Beyer, K. and Roberts, G. 2014. Dietary Habits and Supplement Use in Relation to National Pregnancy Recommendations: Data from the EuroPrevall Birth Cohort. Maternal and Child Health Journal, Vol. 18, Issue. 10, p. 2408.

    Scaglione, Francesco and Panzavolta, Giscardo 2014. Folate, folic acid and 5-methyltetrahydrofolate are not the same thing. Xenobiotica, Vol. 44, Issue. 5, p. 480.

    Andersen, Jon Trærup Petersen, Morten Jimenez-Solem, Espen Rasmussen, Jeppe Nørgaard Andersen, Nadia Lyhne Afzal, Shoaib Broedbaek, Kasper Hjelvang, Brian Rafn Torp-Pedersen, Christian and Poulsen, Henrik Enghusen 2013. Trimethoprim Use prior to Pregnancy and the Risk of Congenital Malformation: A Register-Based Nationwide Cohort Study. Obstetrics and Gynecology International, Vol. 2013, p. 1.

    Blumfield, Michelle L Hure, Alexis J Macdonald-Wicks, Lesley Smith, Roger and Collins, Clare E 2013. A systematic review and meta-analysis of micronutrient intakes during pregnancy in developed countries. Nutrition Reviews, Vol. 71, Issue. 2, p. 118.

    Kondo, Atsuo Morota, Nobuhito Ihara, Satoshi Saisu, Takeshi Inoue, Katsumi Shimokawa, Shoko Fujimaki, Hiroya Matsuo, Keisuke Shimosuka, Yoichi and Watanabe, Tomoyuki 2013. Risk factors for the occurrence of spina bifida (a case-control study) and the prevalence rate of spina bifida in Japan. Birth Defects Research Part A: Clinical and Molecular Teratology, Vol. 97, Issue. 9, p. 610.

    Rabiu, Taopheeq Bamidele and Adeleye, Amos Olufemi 2013. Prevention of myelomeningocele: African perspectives. Child's Nervous System, Vol. 29, Issue. 9, p. 1533.

    Tort, J Lelong, N Prunet, C Khoshnood, B and Blondel, B 2013. Maternal and health care determinants of preconceptional use of folic acid supplementation in France: results from the 2010 National Perinatal Survey. BJOG: An International Journal of Obstetrics & Gynaecology, Vol. 120, Issue. 13, p. 1661.

    2013. Nutrition and Development.

    Rofail, D. Colligs, A. Abetz, L. Lindemann, M. and Maguire, L. 2012. Factors contributing to the success of folic acid public health campaigns. Journal of Public Health, Vol. 34, Issue. 1, p. 90.

    Vandevijvere, S Amsalkhir, S Van Oyen, H and Moreno-Reyes, R 2012. Determinants of folate status in pregnant women: results from a national cross-sectional survey in Belgium. European Journal of Clinical Nutrition, Vol. 66, Issue. 10, p. 1172.

    Hall, Richard Whit 2011. Translational Neuroscience.

    Sheehy, Tony and Sharma, Sangita 2011. Use of FAO food balance sheets to estimate the potential ability of novel folate-enriched eggs to increase the folate supply in European Union countries. Public Health Nutrition, Vol. 14, Issue. 03, p. 551.

    Rowlands, Ingrid Graves, Nick de Jersey, Susan McIntyre, H. David and Callaway, Leonie 2010. Obesity in pregnancy: outcomes and economics. Seminars in Fetal and Neonatal Medicine, Vol. 15, Issue. 2, p. 94.

    Morales-Suarez Varela, M. M. Nohr, E. A. Llopis-Gonzalez, A. Andersen, A.-M. N. and Olsen, J. 2009. Socio-occupational status and congenital anomalies. The European Journal of Public Health, Vol. 19, Issue. 2, p. 161.

    Chivu, Corina Mihaela Tulchinsky, Theodore H. Soares-Weiser, Karla Braunstein, Rony and Brezis, Mayer 2008. A Systematic Review of Interventions to Increase Awareness, Knowledge, and Folic Acid Consumption Before and During Pregnancy. American Journal of Health Promotion, Vol. 22, Issue. 4, p. 237.


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)
  • DOI:
  • Published online: 01 January 2007

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.


Cohort study on pregnant women in Denmark.


The Danish National Birth Cohort (DNBC).


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.


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.


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.

    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

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

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Low compliance with recommendations on folic acid use in relation to pregnancy: is there a need for fortification?
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Low compliance with recommendations on folic acid use in relation to pregnancy: is there a need for fortification?
      Available formats
Corresponding author
*Corresponding author: Email
Linked references
Hide All

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.

2AE 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.

3RJ 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.

4LD Botto , CA Moore , MJ Khoury , JD Erickson . Neural-tube defects. New England Journal of Medicine 1999; 341: 1509–19.

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

6NJ Wald , MR Law , JK Morris , DS Wald . Quantifying the effect of folic acid. Lancet 2001; 358: 2069–73.

8R 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.

11KM 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.

14J 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.

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

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

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *