Folic Acid Awareness and Utilization in Pregnant Women with Neural Tube Defect Risk Factors: A Prospective Cohort Study

Abstract

Our aim in our study was to evaluate folic acid use and awareness among pregnant women with NTD risk factors. The prospective cohort study encompassed singleton pregnant women in their first trimester at a tertiary hospital in Turkey. The study group consisted of 132 pregnant women with at least one NTD risk factor and equal number without any risk factors, forming the control group. Demographic data were collected via responses to a 10-question survey developed through a literature review. The survey explored participants' knowledge of folic acid and awareness of NTDs. It was conducted face to face and categorized by outcome. The high-risk group exhibited better folate awareness and use. Although there was a significant increase in pre-pregnancy folate use in the high-risk group, only 18.35% had used pre-pregnancy folate. The study showed that folate awareness was higher among participants with at least a university degree. In conclusion, despite recommendations for pre-conceptional folate use, the study reveals that awareness and use are low and emphasizes the need to increase social awareness, especially by targeting women with NTD risk factors.

Keywords

• folate
• folic acid
• awareness
• high-risk pregnancy
• neural tube defect

Nöral Tüp Defekti Risk Faktörleri Olan Gebe Kadınlarda Folik Asit Farkındalığı ve Kullanımı: Prospektif Bir Kohort Çalışması

Abstract

Bu çalışmayla NTD risk faktörü olan gebe kadınların folik asit kullanımı ve bilinç düzeyini değerlendirmeyi amaçladık. Üçüncü basamak bir hastanede prospektif kohort çalışması olarak tasarlanan bu çalışma, gebeliğin ilk trimesterindeki tekil gebeleri kapsıyordu. Çalışmaya risk grubunu oluşturan en az bir NTD açısından risk faktörü olan 132 gebe ve kontrol grubu olarak da risk faktörü olmayan benzer sayıda gebe kadın dahil edildi. Literatür taraması yoluyla geliştirilen 10 soruluk bir ankete verilen yanıtlara dayanan çalışmamızda beraberinde demografik veriler toplandı. Anket, katılımcıların folik asit hakkındaki bilgilerini ve NTD'lere ilişkin farkındalık düzeyini araştırdı; anketler yüz yüze gerçekleştirildi ve sonuca göre kategorize edildi. Risk grubunda olan gebelerde folat farkındalığı ve kullanımı daha yüksek bulundu. Riskli grupta gebelik öncesi folat kullanımı kontrol grubuna kıyasla yüksek bulunmasına rağmen, yalnızca %18,35'i gebelik öncesi folat kullanmıştı. Çalışma, en az üniversite diplomasına sahip katılımcılar arasında folat farkındalığının daha yüksek olduğunu gösterdi. Sonuç olarak prekonsepsiyonel folat kullanımına yönelik önerilere rağmen çalışma, farkındalık ve kullanımın düşük olduğunu ortaya koymakta ve özellikle NTD risk faktörleri olan kadınları hedef alarak toplumsal farkındalığın artırılması gerektiğini vurgulamaktadır.

Keywords

• folik asit
• folat
• farkındalık
• yüksek riskli gebelik
• nöral tüp defekti

References

1. 1. Ferrazzi E, Tiso G, Di Martino D. Folic acid versus 5- methyl tetrahydrofolate supplementation in pregnancy. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2020;253:312–319. https://doi.org/10.1016/j.ejogrb.2020.06.012
2. 2. Ondičová M, Irwin RE, Thursby SJ, Hilman L, Caffrey A, Cassidy T, et al. Folic acid intervention during pregnancy alters DNA methylation, affecting neural target genes through two distinct mechanisms. Clinical Epigenetics. 2022;16;14(1):63. https://doi.org/10.1186/s13148-022-01282-y
3. 3. AlDuraibi S, Al-Mutawa J. Knowledge and awareness of folic acid usage in Saudi pregnant women in Riyadh city from 2019-2020. Journal of Family Medicine and Primary Care. 2020;9(10):5158. http://doi.org/10.4103/jfmpc.jfmpc_638_20
4. 4. Barchitta M, Maugeri A, Magnano San Lio R, Favara G, La Mastra C, La Rosa MC, et al. Dietary folate intake and folic acid supplements among pregnant women from Southern Italy: evidence from the “Mamma & Bambino” Cohort. International Journal of Environmental Research and Public Health. 2020;17(2):638. https://doi.org/10.3390/ijerph17020638
5. 5.Cui M, Lu XL, Lyu YY, Wang F, Xie XL, Cheng XY, et al. Knowledge and intake of folic acid to prevent neural tube defects among pregnant women in urban China: a cross-sectional study. BMC pregnancy and childbirth. 2021;21(1):432. https://doi.org/10.1186/s12884-021-03893-4
6. 6. World Health Organization. Guideline: Daily iron and folic acid supplementation in pregnant women. World Health Organization, 2012. Available at: https://www.ncbi.nlm.nih.gov/books/NBK132263
7. 7. Houk VN, Oakley GP, Erickson JD, Mulinare J, James LM. Recommendations iterate use of folic acid to reduce the number of cases of spina bifida and other neural tube defects. MMWR recommendations and reports. 1992;41(RR-14):1–7.
8. 8. Centers for Disease Control and Prevention (CDC). Spina bifida and anencephaly before and after folic acid mandate—United States, 1995-1996 and 1999-2000. MMWR Morbidity and mortality weekly report. 2004;53(17):362–365.

9. 9. “TURKEY NUTRITION GUIDE (TÜBER) 2022” Ministry of Health, General directorate of public health, Ministry of Health Publication No:1031, Ankara 2022
10. 10. Myerson R, Crawford S, Wherry LR. Medicaid expansion increased preconception health counseling, folic acid intake and postpartum contraception. health affairs. 2020;39(11):1883–1890. https://doi.org/10.1377/hlthaff.2020.00106
11. 11. Gebremichael TG, Welesamuel TG. Adherence to iron-folic acid supplement and associated factors among antenatal care attending pregnant mothers in governmental health institutions of Adwa town, Tigray, Ethiopia: cross-sectional study. Gebremedhin S, itera. PLOS ONE. 2020;15(1):e0227090. https://doi.org/10.1371/journal.pone.0227090
12. 12. Practice Bulletin No. 187: Neural tube defects. Obstetrics & Gynecology. 2017;130(6):e279–290. https://doi.org/10.1097/aog.0000000000002412
13. 13. Avagliano L, Massa V, George TM, Qureshy S, Bulfamante GP, Finnell RH. Overview on neural tube defects: from development to physical characteristics. Birth Defects Research. 2018;111(19). https://doi.org/10.1002%2Fbdr2.1380
14. 14. Demir O, Sal H, Ozalp M, Topbas M. Investigation of the change in the incidence of neural tube defects in the eastern Black Sea region of Turkey by years and its relationship with folic acid use: a case-control study. Medical Bulletin of Haseki. 2022;60(4):303–309. https://doi.org/10.4274/haseki.galenos.2022.8245
15. 15. Yamamoto S, Wada Y. Awareness, use and information sources of folic acid supplementation to prevent neural tube defects in pregnant Japanese women. Public Health Nutrition. 2017;21(04):732–739. https://doi.org/10.1017/s1368980017003172
16. 16. Alblowi SA, Alomayri MH. Assessment of knowledge, awareness and behavior of folic acid use among females during the childbearing period in Tabuk City, 2017. The Egyptian Journal of Hospital Medicine. 2018;70(7):1242–1247. https://doi.org/10.4103%2Fjfmpc.jfmpc_638_20
17. 17. Karaçil Ermumcu MŞ, Mengi Çelik Ö, Acar Tek N. An Evaluation of awareness, knowledge and use of folic acid and dietary folate intake among non-pregnant women of childbearing age and pregnant women: a cross-sectional study from Turkey. Ecology of Food and Nutrition. 2020;1–15. https://doi.org/10.1080/03670244.2020.1807344
18. 18. Baykan Z, Öztürk A, Poyrazoğlu S, Gün İ. Awareness, knowledge and use of folic acid among women: a study from Turkey. Archives of Gynecology and Obstetrics. 2010;283(6):1249–1253. https://doi.org/10.1007/s00404-010-1547-5
19. 19. Hibbard ED, Smithells RW. Folio acid metabolism and human embryopathy. The Lancet. 1965;285(7398):1254. https://doi.org/10.1016/S0140-6736(65)91895-7