Folic Acid Supplementation to Prevent Serious Birth Defects Is Underused

Most women are not taking folic acid supplement prior to becoming pregnant, according to the results of a recent study conducted in the United Kingdom.

Overall, only about 1 in 3 women of childbearing age take folic acid regularly. Older women, those between 35 and 39 years, are most likely to take the supplement. But even among the older women, only 40% are taking the recommended supplement, the authors noted. Among teenagers, the youngest in the study, only 6% took the supplement.

Furthermore, the study findings indicated that the proportion of women taking folic acid supplements decreased from 35% in 1999-2001 to 31% in 2011-2012. 

Pertinent Points

- Two thirds of women are not
taking folic acid supplements prior to becoming pregnant, according to a UK study.

- Older reproductive-aged women are the most likely to use the supplement.

- Significant variations in use
of folic acid were noted among ethnic minorities.

The study, conducted by Queen Mary's Wolfson Institute of Preventive Medicine and published in the journal PLoS ONE, also revealed significant differences among ethnic minorities. While 35% of Caucasian women took the supplement, only 17% of Afro-Caribbean did so. Among the other ethnic cohorts, just 20% of South Asian women and 25% of East Asian women reported taking folic acid supplements.

Those most likely to take folic acid were women who previously had a pregnancy involving neural tube defects, but even among those women, only half took the supplement.

The study screened nearly half a million women attending antenatal screening between 1999 and 2012 in England and the Isle of Man.

Even after becoming pregnant, only about 62% of women take folic acid supplements, the authors reported.

Since the study is UK-based, the authors are using it to press governments for fortification of flour with folic acid. Other countries, including the United States, have mandatory folic acid fortification, the authors pointed out, noting that European Union countries do not have the same policy.

“Our results show that public health policy cannot rely on pre-pregnancy folic acid supplementation alone,” the authors wrote. “Improved education in communities with particularly low rates of pre-pregnancy folic acid supplementation may increase the rates, but for all women to benefit, countries that have not introduced folic acid fortification should do so to avert a preventable serious birth defect responsible for stillbirths, severe physical disability, and needless therapeutic abortions.”

References:

Bestwick JP, Huttly WJ, Morris JK, Wald NJ. Prevention of neural tube defects: a cross-sectional study of the uptake of folic acid supplementation in nearly half a million women. PLoS ONE. 2014;9(2):e89354. doi:10.1371/journal.pone.0089354