A Survey of Preconceptional Folic Acid Use in a Group of Canadian Women

BACKGROUND: Randomized controlled trials have demonstrated that periconceptional folic acid supplementation has a dramatic effect in reducing neural tube defects, one of the most serious congenital anomalies. Unfortunately, supplementation tends to be suboptimal in disadvantaged populations. OBJECTIVE: The primary objective was to determine patient factors associated with a lack of use of periconceptional folic acid among Canadian women in a multi-ethnic, urban setting. Our secondary objective was to assess patient knowledge about folic acid tablet supplementation and its link to reduced birth defects. METHODS: We undertook a cross-sectional study to survey postpartum Toronto women on their use and knowledge of periconceptional folic acid. RESULTS: Of the 383 women surveyed, only 28% took folic acid or a multivitamin containing folic acid during the periconceptional period. Multivariate analysis revealed that the use of periconceptional folic acid was more common among women of Jewish descent (adjusted relative risk [RR] 0.3; 95% confidence interval [CI], 0.04-0.9) and those who had 1 or no children (adjusted RR 0.6; 95% CI, 0.4-0.8). Not taking folic acid was associated with unplanned pregnancy (adjusted RR 1.5; 95% CI, 1.4-1.6) and a lack of knowledge about when folic acid should be taken (adjusted RR 1.8; 95% CI, 1.6-1.8). CONCLUSION: Ethnic background is an independent predictor of periconceptional folic acid use.