1
|
Quinn M, Halsey J, Sherliker P, Pan H, Chen Z, Bennett DA, Clarke R. Global heterogeneity in folic acid fortification policies and implications for prevention of neural tube defects and stroke: a systematic review. EClinicalMedicine 2024; 67:102366. [PMID: 38169713 PMCID: PMC10758734 DOI: 10.1016/j.eclinm.2023.102366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024] Open
Abstract
Background Folic acid (pteroylmonoglutamic acid) supplements are highly effective for prevention of neural tube defects (NTD) prompting implementation of mandatory or voluntary folic acid fortification for prevention of NTDs. We used plasma folate levels in population studies by country and year to compare effects of folic acid fortification types (mandatory or voluntary folic acid fortification policies) on plasma folate levels, NTD prevalence and stroke mortality rates. Methods We conducted systematic reviews of (i) implementation of folic acid fortification in 193 countries that were member states of the World Health Organization by country and year, and (ii) estimated population mean plasma folate levels by year and type of folic acid fortification. We identified relevant English language reports published between Jan 1, 1990 and July 31, 2023 using Google Scholar, Medline, Embase and Global Health. Eligibility criteria were observational or interventional studies with >1000 participants. Studies of pregnant women or children <15 years were excluded. Using an ecological study design, we examined the associations of folic acid fortification types with NTD prevalence (n = 108 studies) and stroke mortality rates (n = 3 countries). Findings Among 193 countries examined up to 31 July 2023, 69 implemented mandatory folic acid fortification, 47 had voluntary fortification, but 77 had no fortification (accounting for 32%, 53% and 15% of worldwide population, respectively). Mean plasma folate levels were 36, 21 and 17 nmol/L in populations with mandatory, voluntary and no fortification, respectively (and proportions with mean folate levels >25 nmol/L were 100%, 15% and 7%, respectively). Among 75 countries with NTD prevalence, mean (95% CI) prevalence per 10,000 population were 4.19 (4.11-4.28), 7.61 (7.47-7.75) and 9.66 (9.52-9.81) with mandatory, voluntary and no folic acid fortification, respectively. However, age-standardised trends in stroke mortality rates were unaltered by the introduction of folic acid fortification. Interpretation There is substantial heterogeneity in folic acid fortification policies worldwide where folic acid fortification are associated with 50-100% higher population mean plasma folate levels and 25-50% lower NTD prevalence compared with no fortification. Many thousand NTD pregnancies could be prevented yearly if all countries implemented mandatory folic acid fortification. Further trials of folic acid for stroke prevention are required in countries without effective folic acid fortification policies. Funding Medical Research Council (UK) and British Heart Foundation.
Collapse
Affiliation(s)
- Matthew Quinn
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jim Halsey
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Paul Sherliker
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Medical Research Council Population Health Research Unit of University of Oxford, United Kingdom
| | - Hongchao Pan
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Medical Research Council Population Health Research Unit of University of Oxford, United Kingdom
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Derrick A. Bennett
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Medical Research Council Population Health Research Unit of University of Oxford, United Kingdom
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
2
|
Martinez H, Benavides-Lara A, Arynchyna-Smith A, Ghotme KA, Arabi M, Arynchyn A. Global strategies for the prevention of neural tube defects through the improvement of folate status in women of reproductive age. Childs Nerv Syst 2023; 39:1719-1736. [PMID: 37103517 DOI: 10.1007/s00381-023-05913-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/28/2023] [Indexed: 04/28/2023]
Abstract
INTRODUCTION Neural tube defects represent a global public health problem, mainly in countries where effective prevention strategies are not yet in place. The global prevalence of neural tube defects is estimated at 18.6/10,000 (uncertainty interval: 15.3-23.0) live births, where ~ 75% of cases result in under-five mortality. Most of the mortality burden is in low- and middle-income countries. The main risk factor for this condition is insufficient folate levels in women of reproductive age. METHODS This paper reviews the extent of the problem, including the most recent global information on folate status in women of reproductive age and the most recent estimates of the prevalence of neural tube defects. Additionally, we provide an overview of the available interventions worldwide to reduce the risk of neural tube defects by improving folate status in the population, including dietary diversification, supplementation, education, and fortification. RESULTS Large-scale food fortification with folic acid is the most successful and effective intervention to reduce the prevalence of neural tube defects and associated infant mortality. This strategy requires the coordination of several sectors, including governments, the food industry, health services providers, the education sector, and entities that monitor the quality of the service processes. It also requires technical knowledge and political will. An international collaboration between governmental and non-governmental organizations is essential to succeed in saving thousands of children from a disabling but preventable condition. DISCUSSION We propose a logical model for building a national-level strategic plan for mandatory LSFF with folic acid and explain the actions needed for promoting sustainable system-level change.
Collapse
Affiliation(s)
- Homero Martinez
- Global Technical Services, Nutrition International, 180 Elgin St. suite 1000, ON, Ottawa, Canada.
- Hospital Infantil de México Federico Gómez, Mexico City, Mexico.
| | - Adriana Benavides-Lara
- Costa Rican Birth Defects Register Center (CREC), Costa Rican Institute of Research and Education in Nutrition and Health (INCIENSA), Cartago, Costa Rica
| | - Anastasia Arynchyna-Smith
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kemel A Ghotme
- Translational Neuroscience Research Lab, Faculty of Medicine, Universidad de La Sabana, Chia, Colombia
- Department of Neurosurgery, Fundación Santa Fe de Bogota, Bogota, Colombia
| | - Mandana Arabi
- Global Technical Services, Nutrition International, 180 Elgin St. suite 1000, ON, Ottawa, Canada
| | - Alexander Arynchyn
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
3
|
Abstract
This research evaluates the prevalence of inadequate folate status in early pregnancy, the pattern of prenatal folic acid (FA) supplementation and associated factors in Spanish pregnant women from the ECLIPSES study, which included 791 participants prior gestational week 12. A cross-sectional evaluation of erythrocyte folate levels was performed at recruitment and used to calculate the prevalence of folate deficiency (erythrocyte folate < 340 nmol/l) and insufficiency (erythrocyte folate < 906 nmol/l). Sociodemographic and lifestyle data as well as information on prenatal FA supplementation were recorded. Descriptive and multivariate statistical analyses were performed. The prevalence of folate deficiency and insufficiency were 9·6 % and 86·5 %, respectively. Most of women used prenatal FA supplements, but only 6·3 % did so as recommended. Supplementation with FA during the periconceptional period abolished folate deficiency and reduced folate insufficiency. Prenatal FA supplementation with ≥1000 µg/d in periconceptional time and pregnancy planning increased erythrocyte folate levels. The main risk factor for folate insufficiency in early pregnancy was getting prenatal FA supplementation out of the periconceptional time (OR 3·32, 95 % CI 1·02, 15·36), while for folate deficiency they were young age (OR 2·02, 95 % CI 1·05, 3·99), and smoking (OR 2·39, 95 % CI 1·30, 4·37). In addition, social and ethnic differences according to folate status were also identified. As conclusion, periconceptional FA use is crucial for achieving optimal folate levels in early pregnancy. Pregnancy planning should focus on young women, smokers, those with low consumption of folate-rich foods, low socio-economic status or from ethnic minorities.
Collapse
|
4
|
An evaluation of adherence to folic acid supplementation in pregnant women during early gestation for the prevention of neural tube defects. Public Health Nutr 2022; 25:3025-3035. [PMID: 35875925 PMCID: PMC9991708 DOI: 10.1017/s1368980022001574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Neural tube defects (NTD) are potentially preventable by periconceptual folic acid supplementation. Women with obesity are at higher risk of NTD, therefore, are recommended a higher dose of 5 mg folic acid to mitigate this risk. The aim of this study was to evaluate maternal practice of folic acid supplementation amongst the antenatal population in relation to maternal obesity status. DESIGN Prospective observational study. SETTING Women ≤18 weeks' gestation at their first antenatal appointment attending University Maternity Hospital Limerick (Ireland) were recruited. Maternal height and weight were measured. Obesity was defined at a threshold of ≥30·0 kg/m2 and ≥27·5 kg/m2 when adjusting for ethnicity. A two-part questionnaire captured maternal characteristics and assessed supplementation compliance, commencement and dosage. Fisher's exact test for independence analysed differences in variables. A P value of <0·05 was considered significant. PARTICIPANTS A total of 328 women participated over a duration of 6 weeks. RESULTS Mean gestational age was 12·4 ± 1·4 weeks and mean BMI 26·7 kg/m2 ± 5·2 kg/m2. 23·8 % (n 78) were classified as obese. 96·5 % (n 315) were taking folic acid and 95·7 % (n 314) supplemented daily. 30·2 % (n 99) commenced supplementation 12 weeks prior to conception. Overall, 57·9 % (n 190) of women met folic acid supplementation dose requirements. 89·1 % (n 55) of women with obesity did not. Women with obesity were less likely to meet the higher folic acid supplementation dose requirements (P =< 0·001). CONCLUSION Folic acid supplementation practices within this cohort were suboptimal to prevent their risk of NTD. This study showed inadequate compliance of folic acid supplementation, and inadequate dosage for women with obesity. Increased patient education and awareness are needed within the antenatal period of pregnancy to bring folic acid supplementation practices in line with best practice guidelines.
Collapse
|
5
|
A review of current knowledge about the importance of iodine among women of child-bearing age and healthcare professionals. J Nutr Sci 2022; 11:e56. [PMID: 35836700 PMCID: PMC9274385 DOI: 10.1017/jns.2022.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022] Open
Abstract
Iodine is required for thyroid hormone synthesis and fetal neurogenesis. Recent population studies in the United Kingdom (UK) have found iodine deficiency among schoolgirls, women of child-bearing age and pregnant women. This review explores knowledge and awareness of iodine among women of child-bearing age and healthcare professionals (HCPs) in the UK, set within a global context. We aimed to identify gaps in iodine knowledge in the current UK setting of iodine deficiency without iodine fortification and where iodine is not included in antenatal guidelines. The search terms ‘iodine knowledge’ and ‘iodine awareness’ were used to identify relevant papers. Iodine knowledge is poor among women of child-bearing age in the UK according to four studies using questionnaires and qualitative methods. They were unsure of dietary sources of iodine and were not consistently provided with relevant information from HCPs during clinical care. Midwives have been recognised as the main providers of dietary information during pregnancy and, although they recognised the importance of their role in providing nutrition advice, they did not feel equipped to do so and lacked confidence in addressing nutritional concerns. Globally, there was a similar lack of knowledge, however, this was somewhat improved by the inclusion of iodine in antenatal care guidelines. Midwives’ knowledge of iodine was poor, as was knowledge among women of child-bearing age. Improved HCP knowledge and effective communication of information to pregnant women and women planning to conceive may help to improve iodine status which is of particular concern in pregnancy.
Collapse
|
6
|
Martín-Rodríguez A, Bustamante-Sánchez Á, Martínez-Guardado I, Navarro-Jiménez E, Plata-SanJuan E, Tornero-Aguilera JF, Clemente-Suárez VJ. Infancy Dietary Patterns, Development, and Health: An Extensive Narrative Review. CHILDREN 2022; 9:children9071072. [PMID: 35884056 PMCID: PMC9319947 DOI: 10.3390/children9071072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/03/2022] [Accepted: 07/16/2022] [Indexed: 11/27/2022]
Abstract
Correct dietary patterns are important for a child’s health from birth to adulthood. Understanding a child’s health as a state of entire physical, mental, and social well-being is essential. However, reaching adulthood in a complete health proper state is determined by feeding and dietary habits during preconception, pregnancy, or children infancy. Different factors, such as the mother’s lifestyle, culture, or socioeconomic status, are crucial during all these phases. In this review, we aimed to assess the long-term associations between infancy dietary patterns and health and their influence on development and growth. To reach this objective, a consensus critical review was carried out using primary sources such as scientific articles, and secondary bibliographic indexes, databases, and web pages. PubMed, SciELO, and Google Scholar were the tools used to complete this research. We found that high-income countries promote high-calorie foods and, consequently, obesity problems among children are rising. However, undernutrition is a global health issue concerning children in low- and middle-income countries; thus, parental socioeconomic status in early life is essential to children’s health and development, showing that biological, social, and environmental influences are increased risk factors for chronic diseases. This narrative review is aimed to collect evidence for early nutritional intervention and future disease prevention.
Collapse
Affiliation(s)
| | - Álvaro Bustamante-Sánchez
- Faculty of Sports Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain; (A.M.-R.); (V.J.C.-S.)
- Correspondence: (Á.B.-S.); (J.F.T.-A.); Fax: +34-911-413-585 (J.F.T.-A.)
| | | | | | | | - José Francisco Tornero-Aguilera
- Faculty of Sports Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain; (A.M.-R.); (V.J.C.-S.)
- Correspondence: (Á.B.-S.); (J.F.T.-A.); Fax: +34-911-413-585 (J.F.T.-A.)
| | - Vicente Javier Clemente-Suárez
- Faculty of Sports Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain; (A.M.-R.); (V.J.C.-S.)
- Grupo de Investigación en Cultura, Educación y Sociedad, Universidad de la Costa, Barranquilla 080002, Colombia
| |
Collapse
|
7
|
Systematic review of parental influences on Hispanic children's nutritional and physical health. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-022-01713-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
8
|
Welch V, Dewidar O, Tanjong Ghogomu E, Abdisalam S, Al Ameer A, Barbeau VI, Brand K, Kebedom K, Benkhalti M, Kristjansson E, Madani MT, Antequera Martín AM, Mathew CM, McGowan J, McLeod W, Park HA, Petkovic J, Riddle A, Tugwell P, Petticrew M, Trawin J, Wells GA. How effects on health equity are assessed in systematic reviews of interventions. Cochrane Database Syst Rev 2022; 1:MR000028. [PMID: 35040487 PMCID: PMC8764740 DOI: 10.1002/14651858.mr000028.pub3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Enhancing health equity is endorsed in the Sustainable Development Goals. The failure of systematic reviews to consider potential differences in effects across equity factors is cited by decision-makers as a limitation to their ability to inform policy and program decisions. OBJECTIVES: To explore what methods systematic reviewers use to consider health equity in systematic reviews of effectiveness. SEARCH METHODS We searched the following databases up to 26 February 2021: MEDLINE, PsycINFO, the Cochrane Methodology Register, CINAHL, Education Resources Information Center, Education Abstracts, Criminal Justice Abstracts, Hein Index to Foreign Legal Periodicals, PAIS International, Social Services Abstracts, Sociological Abstracts, Digital Dissertations and the Health Technology Assessment Database. We searched SCOPUS to identify articles that cited any of the included studies on 10 June 10 2021. We contacted authors and searched the reference lists of included studies to identify additional potentially relevant studies. SELECTION CRITERIA We included empirical studies of cohorts of systematic reviews that assessed methods for measuring effects on health inequalities. We define health inequalities as unfair and avoidable differences across socially stratifying factors that limit opportunities for health. We operationalised this by assessing studies which evaluated differences in health across any component of the PROGRESS-Plus acronym, which stands for Place of residence, Race/ethnicity/culture/language, Occupation, Gender or sex, Religion, Education, Socioeconomic status, Social capital. "Plus" stands for other factors associated with discrimination, exclusion, marginalisation or vulnerability such as personal characteristics (e.g. age, disability), relationships that limit opportunities for health (e.g. children in a household with parents who smoke) or environmental situations which provide limited control of opportunities for health (e.g. school food environment). DATA COLLECTION AND ANALYSIS Two review authors independently extracted data using a pre-tested form. Risk of bias was appraised for included studies according to the potential for bias in selection and detection of systematic reviews. MAIN RESULTS: In total, 48,814 studies were identified and the titles and abstracts were screened in duplicate. In this updated review, we identified an additional 124 methodological studies published in the 10 years since the first version of this review, which included 34 studies. Thus, 158 methodological studies met our criteria for inclusion. The methods used by these studies focused on evidence relevant to populations experiencing health inequity (108 out of 158 studies), assess subgroup analysis across PROGRESS-Plus (26 out of 158 studies), assess analysis of a gradient in effect across PROGRESS-Plus (2 out of 158 studies) or use a combination of subgroup analysis and focused approaches (20 out of 158 studies). The most common PROGRESS-Plus factors assessed were age (43 studies), socioeconomic status in 35 studies, low- and middle-income countries in 24 studies, gender or sex in 22 studies, race or ethnicity in 17 studies, and four studies assessed multiple factors across which health inequity may exist. Only 16 studies provided a definition of health inequity. Five methodological approaches to consider health equity in systematic reviews of effectiveness were identified: 1) descriptive assessment of reporting and analysis in systematic reviews (140 of 158 studies used a type of descriptive method); 2) descriptive assessment of reporting and analysis in original trials (50 studies); 3) analytic approaches which assessed differential effects across one or more PROGRESS-Plus factors (16 studies); 4) applicability assessment (25 studies) and 5) stakeholder engagement (28 studies), which is a new finding in this update and examines the appraisal of whether relevant stakeholders with lived experience of health inequity were included in the design of systematic reviews or design and delivery of interventions. Reporting for both approaches (analytic and applicability) lacked transparency and was insufficiently detailed to enable the assessment of credibility. AUTHORS' CONCLUSIONS There is a need for improvement in conceptual clarity about the definition of health equity, describing sufficient detail about analytic approaches (including subgroup analyses) and transparent reporting of judgments required for applicability assessments in order to consider health equity in systematic reviews of effectiveness.
Collapse
Affiliation(s)
- Vivian Welch
- Methods Centre, Bruyère Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Omar Dewidar
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | | | | | | | | | - Kevin Brand
- Telfer School of Management, University of Ottawa, Ottawa, Canada
| | | | | | | | | | | | | | - Jessie McGowan
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | | | | | | | - Alison Riddle
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Marmora, Canada
| | - Peter Tugwell
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Mark Petticrew
- Department of Social & Environmental Health Research, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - George A Wells
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| |
Collapse
|
9
|
Kamura S, Sasaki A, Ogawa K, Kato K, Sago H. Periconceptional folic acid intake and disturbing factors: A single-center study in Japan. Congenit Anom (Kyoto) 2022; 62:42-46. [PMID: 34750867 DOI: 10.1111/cga.12449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 10/07/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022]
Abstract
We investigated folic acid (FA) intake and disturbing factors in pregnant women who visited our center in 2017. Among 1531 pregnant women, 45.1% of women initiated FA supplementation before pregnancy. The risk of failure of supplementation was significantly lower among women of ≥35 (adjusted odds ratio [aOR] 0.43) and 30-34 years of age (aOR: 0.59) in comparison to women of <30 years of age, and among those conceived with timing/artificial insemination of husband (aOR 0.47) and in vitro fertilization/intracytoplasmic sperm injection (aOR 0.32) in comparison to those conceived naturally. The risk among those with 1 (aOR 1.44) or ≥2 previous deliveries (aOR 2.75) was significantly higher in comparison to nulliparous women. Young, multiparous women, and those with natural conception should be targeted to promote preconceptional FA intake.
Collapse
Affiliation(s)
- Shunsuke Kamura
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.,Department of Obstetrics and Gynecology, Kyushu University School of Medicine, Fukuoka, Japan
| | - Aiko Sasaki
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kohei Ogawa
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kiyoko Kato
- Department of Obstetrics and Gynecology, Kyushu University School of Medicine, Fukuoka, Japan
| | - Haruhiko Sago
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|
10
|
McDougall B, Kavanagh K, Stephenson J, Poston L, Flynn AC, White SL. Health behaviours in 131,182 UK women planning pregnancy. BMC Pregnancy Childbirth 2021; 21:530. [PMID: 34315424 PMCID: PMC8317296 DOI: 10.1186/s12884-021-04007-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 07/13/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND A woman's health at the time of conception lays the foundation for a healthy pregnancy and the lifelong health of her child. We investigated the health behaviours of UK women planning pregnancy. METHODS We analysed survey data from the 'Planning for Pregnancy' online tool (Tommy's, UK). We described all women planning pregnancy and compared the frequency of non-adherence to preconception recommendations in women who had already stopped contraception (active planners) and those who had not (non-active planners). RESULTS One hundred thirty-one thousand one hundred eighty-two women from across the UK were included, of whom 64.8% were actively planning pregnancy. Of the whole cohort, twenty percent were smokers and less than one third took folic acid supplements (31.5%). Forty two percent engaged in less than the recommended 150 min of weekly physical activity and only 53.3% consumed five portions of fruit or vegetables 4 days a week. Smokers were 1.87 times more likely to be active planners than non-smokers (95% CI 1.79-1.94), and women who took folic acid were 7 times more likely to be active planners (95% CI 6.97-7.59) compared to women who did not. Smoking, drug use and lack of folic acid supplementation were common in younger women and those who were underweight. CONCLUSIONS This unique survey of UK women has identified poor adherence to preconception recommendations in those planning pregnancies and supports the need for a greater public health focus on preconception health. This study provides a contemporary basis from which to inform preconception health advice and a benchmark to measure changes over time.
Collapse
Affiliation(s)
- Beth McDougall
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Kimberley Kavanagh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Judith Stephenson
- EGA Institute for Women's Health, University College London, 74 Huntley Street, WC1E 6AU, London, UK
| | - Lucilla Poston
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, London, UK
| | - Angela C Flynn
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, London, UK
- Department of Nutritional Sciences, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK
| | - Sara L White
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, London, UK.
| |
Collapse
|
11
|
Frayne J, Hauck Y, Nguyen T, Liira H, Morgan VA. Reproductive planning, vitamin knowledge and use, and lifestyle risks of women attending pregnancy care with a severe mental illness. Scand J Prim Health Care 2021; 39:60-66. [PMID: 33569975 PMCID: PMC7971324 DOI: 10.1080/02813432.2021.1882081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE Women with severe mental illnesses are a vulnerable population and little is known about their reproductive planning needs. The aim of our study was to describe rates of unintended pregnancies, postpartum contraception, identify use and knowledge of prenatal/pregnancy vitamins and identify modifiable lifestyle risks. DESIGN Mixed methods study incorporating a cross-sectional survey and prospective pregnancy data collection. SETTING A multidisciplinary antenatal clinic in Australia. METHOD Thirty-eight pregnant women with severe mental illnesses: schizophrenia, schizoaffective, bipolar and severe post-traumatic stress disorder. MAIN OUTCOME MEASURES Unintended pregnancy rates, immediate postpartum contraception, use of prenatal and pregnancy vitamins and knowledge sources, obesity, and use and cessation rates for smoking, and substances, and comorbid medical conditions. RESULTS Overall 42% of women had unintended pregnancy, with those with schizophrenia at most risk (56%). A long acting reversible contraception was inserted in 5 women (13%), with 45% having no immediate contraception prescribed prior to postnatal discharge. Women's main source of vitamin supplementation for pregnancy was from general practitioners. Prenatal folic acid use occurred in 37%, with rates differing for those with a diagnosis of bipolar disorder (52%) and schizophrenia (25%). Vitamin deficiencies occurred in pregnancy, with iron deficiency (ferritin <30 ng/mL) (n = 27, 73%) the most frequent. Overall 21% of women smoked cigarettes and 35% were obese. DISCUSSION Addressing gaps in use of effective contraception, proactive reproductive planning and lifestyle management may improve outcomes for women with mental illnesses and their babies.Key pointsWomen with severe mental illnesses have complex health needs that require targeted reproductive counselling. This study adds to what is known by highlighting that:•Women with schizophrenia appear more likely to have unintended pregnancy.•Prenatal counselling for women with severe mental disorders should include recognition and optimisation of management for the high rates of pre-existing medical comorbidities, obesity and elevated nicotine and substance use.•Many women with severe mental illness need increased doses (5 mg) of prenatal folic acid due to psychotropic medication risk and obesity, as well as treatment for high rates of iron and vitamin D deficiency in pregnancy.
Collapse
Affiliation(s)
- Jacqueline Frayne
- Medical School, Division of General practice, The University of Western Australia, Crawley, WA, Australia
- Department of Obstetrics, Women and Newborn Health Service, Subiaco, WA, Australia
- CONTACT Jacqueline Frayne Division of General Practice, Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, M706, Perth, WA, 6009, Australia
| | - Yvonne Hauck
- Department of Nursing and Midwifery Education and Research, Women and Newborn Health Service, Subiaco, WA, Australia
- Nursing, Midwifery and Paramedicine, Curtin University, Perth, WA, Australia
| | - Thinh Nguyen
- Medical School, Division of Psychiatry, The University of Western Australia, Crawley, WA, Australia
- Peel and Rockingham Kwinana Mental Health Services, Rockingham, WA, Australia
| | - Helena Liira
- Medical School, Division of General practice, The University of Western Australia, Crawley, WA, Australia
- General Practice, University of Helsinki, Helsinki, Finland
| | - Vera A. Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Crawley, WA, Australia
- Centre for Clinical Research in Neuropsychiatry, Medical School, Division of Psychiatry, The University of Western Australia, Crawley, WA, Australia
| |
Collapse
|
12
|
Bala R, Singh A, Singh V, Verma P, Budhwar S, Shukla OP, Singh GP, Singh K. Impact of socio-demographic variables on antenatal services in eastern Uttar Pradesh, India. Health Care Women Int 2020; 42:580-597. [PMID: 32701388 DOI: 10.1080/07399332.2020.1789643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We investigated the impact of socio-demographic variables on antenatal care (ANC) utilization and the low birth weight of a child. Data were collected from 300 pregnant females. Only 22.5% of females received full antenatal care (≥4 visits). Our results showed that female's age at marriage and education plays a significant role in improving ANC. We observed an overall decrease in the utilization of services provided during each antenatal visit. ANC visits from the first trimester decrease the risk of having a baby with low birth weight. Awareness programs and educating families about pregnancy care are recommended to improve ANC utilization.
Collapse
Affiliation(s)
- Renu Bala
- Department of Molecular & Human Genetics, Banaras Hindu University, Varanasi, India
| | - Ajay Singh
- Institute of Environmental and Sustainable Development, Banaras Hindu University, Varanasi, India
| | - Vertika Singh
- Department of Molecular & Human Genetics, Banaras Hindu University, Varanasi, India
| | - Priyanka Verma
- Department of Molecular & Human Genetics, Banaras Hindu University, Varanasi, India
| | - Snehil Budhwar
- Department of Molecular & Human Genetics, Banaras Hindu University, Varanasi, India
| | - Om Prakash Shukla
- Department of Obstetrics & Gynaecology, Community Health Centre, Varanasi, India
| | | | - Kiran Singh
- Department of Molecular & Human Genetics, Banaras Hindu University, Varanasi, India
| |
Collapse
|
13
|
Sijpkens MK, van Voorst SF, Rosman AN, de Jong-Potjer LC, Denktaş S, Koch BCP, Bertens LCM, Steegers EAP. Change in Lifestyle Behaviors After Preconception Care: A Prospective Cohort Study. Am J Health Promot 2020; 35:116-120. [PMID: 32431156 PMCID: PMC7747029 DOI: 10.1177/0890117120927287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose: To evaluate the effects of preconception care (PCC) consultations by change in lifestyle behaviors. Setting and Intervention: Women in deprived neighborhoods of 14 Dutch municipalities were encouraged to visit a general practitioner or midwife for PCC. Sample: The study included women aged 18 to 41 years who had a PCC consultation. Design: In this community-based prospective cohort study, we assessed initiation of folic acid supplementation, cessation of smoking, alcohol consumption, and illicit drug use. Measures: Self-reported and biomarker data on behavioral changes were obtained at baseline and 3 months later. Analysis: The changes in prevalence were assessed with the McNemar test. Results: Of the 259 included participants, paired analyses were available in 177 participants for self-reported outcomes and in 82 for biomarker outcomes. Baseline self-reported prevalence of no folic acid use was 36%, smoking 12%, weekly alcohol use 22%, and binge drinking 17%. Significant changes in prevalence toward better lifestyle during follow-up were seen for folic acid use (both self-reported, P < .001; and biomarker-confirmed, P = .008) and for self-reported binge drinking (P = .007). Conclusion: Our study suggests that PCC contributes to initiation of folic acid supplementation and cessation of binge drinking in women who intend to become pregnant. Although based on a small sample, the study adds to the limited body of evidence regarding the benefits of PCC in improving periconception health.
Collapse
Affiliation(s)
- Meertien K Sijpkens
- Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynecology, 6993Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Sabine F van Voorst
- Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynecology, 6993Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ageeth N Rosman
- Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynecology, 6993Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Lieke C de Jong-Potjer
- Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynecology, 6993Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Semiha Denktaş
- Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynecology, 6993Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Psychology, Education and Child Studies, 6993Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Birgit C P Koch
- Department of Hospital Pharmacy, 6993Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Loes C M Bertens
- Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynecology, 6993Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Eric A P Steegers
- Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynecology, 6993Erasmus University Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
14
|
Lockyer S, Spiro A. Socio‐economic inequalities in childhood obesity: Can community level interventions help to reduce the gap? NUTR BULL 2019. [DOI: 10.1111/nbu.12410] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- S. Lockyer
- British Nutrition Foundation, London London UK
| | - A. Spiro
- British Nutrition Foundation, London London UK
| |
Collapse
|
15
|
Knowledge, attitude and practice level of women at the periconceptional period: a cross-sectional study in Shaanxi China. BMC Pregnancy Childbirth 2019; 19:326. [PMID: 31484502 PMCID: PMC6727354 DOI: 10.1186/s12884-019-2481-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 08/28/2019] [Indexed: 11/20/2022] Open
Abstract
Background Identifying and understanding the knowledge, attitude and practice (KAP) level of women at the periconceptional period has implications for formulating and measuring the adverse pregnancy outcomes for primary prevention. Methods A cross-sectional study among pregestational and pregnant women was conducted in Shaanxi during 2016–2017. Results Among 791 participants, the average score of periconceptional healthcare knowledge awareness was 6.32 ± 1.78, whereas 28.8% of women have failed. Women who planned to or had undergone premarital and pre-pregnancy examinations accounted for 50.2, and 62.5%, respectively. Less than half (42.0%) of the women started taking folic acid (FA) before pregnancy, and only 37.9% of them took FA regularly at the right time. Multivariate analysis showed that age was the main factor influencing the Attitude and Practice level of women at the periconceptional period, and demonstrated a positive effect on the awareness of right timing of folic acid supplementation, and high rates of premarital and pre-pregnancy examinations. Also, the knowledge pass rate was increased with education level. Fewer women who have birth experience were willing to take FA consistently at the right time compared to those women without birth. Conclusions The women at the periconceptional period in Shaanxi lacked the total KAP level of periconceptional healthcare, especially those who live in rural areas and have less education. Government agencies should reinforce more effective primary preventive measures and policies for the prevention of adverse pregnancy outcomes. Electronic supplementary material The online version of this article (10.1186/s12884-019-2481-6) contains supplementary material, which is available to authorized users.
Collapse
|
16
|
Camier A, Kadawathagedara M, Lioret S, Bois C, Cheminat M, Dufourg MN, Charles MA, de Lauzon-Guillain B. Social Inequalities in Prenatal Folic Acid Supplementation: Results from the ELFE Cohort. Nutrients 2019; 11:nu11051108. [PMID: 31109064 PMCID: PMC6566921 DOI: 10.3390/nu11051108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/10/2019] [Accepted: 05/15/2019] [Indexed: 11/16/2022] Open
Abstract
Most professional and international organizations recommend folic acid supplementation for women planning pregnancy. Various studies have shown high levels of non-compliance with this recommendation. This study aimed to identify sociodemographic characteristics related to this compliance. The analyses were based on 16,809 women from the French nationwide ELFE cohort (Etude Longitudinale Française depuis l’Enfance). Folic acid supplementation was assessed at delivery, and sociodemographic characteristics were collected at two months postpartum. The association between sociodemographic characteristics and compliance with recommendations on folic acid supplementation (no supplementation, periconceptional supplementation, and supplementation only after the periconceptional period) was examined using multivariate multinomial logistic regression. Only 26% of French women received folic acid supplementation during the periconceptional period, 10% of women received supplementation after the periconceptional period, and 64% received no supplementation. Young maternal age, low education level, low family income, multiparity, single parenthood, maternal unemployment, maternal overweight, and smoking during pregnancy were related to lower likelihood of folic acid supplementation during the periconceptional period compared to no supplementation. These associations were not explained by unplanned pregnancy. Immigrant and underweight women were more likely to receive folic acid supplementation after the periconceptional period. Our study confirms great social disparities in France regarding the compliance with the recommendations on folic acid supplementation.
Collapse
Affiliation(s)
- Aurore Camier
- INSERM, UMR1153 Center for Research in Epidemiology and StatisticS (CRESS), Research Team on Early Life Origins of Health (EAROH), 75004 Paris, France.
- Université de Paris, UMR1153 Center for Research in Epidemiology and StatisticS (CRESS), Research Team on Early Life Origins of Health (EAROH), 75004 Paris, France.
| | - Manik Kadawathagedara
- INSERM, UMR1153 Center for Research in Epidemiology and StatisticS (CRESS), Research Team on Early Life Origins of Health (EAROH), 75004 Paris, France.
- Université de Paris, UMR1153 Center for Research in Epidemiology and StatisticS (CRESS), Research Team on Early Life Origins of Health (EAROH), 75004 Paris, France.
| | - Sandrine Lioret
- INSERM, UMR1153 Center for Research in Epidemiology and StatisticS (CRESS), Research Team on Early Life Origins of Health (EAROH), 75004 Paris, France.
- Université de Paris, UMR1153 Center for Research in Epidemiology and StatisticS (CRESS), Research Team on Early Life Origins of Health (EAROH), 75004 Paris, France.
| | - Corinne Bois
- Unité Mixte Inserm-Ined-EFS Elfe, Ined, 75020 Paris, France.
| | - Marie Cheminat
- Unité Mixte Inserm-Ined-EFS Elfe, Ined, 75020 Paris, France.
| | | | - Marie Aline Charles
- INSERM, UMR1153 Center for Research in Epidemiology and StatisticS (CRESS), Research Team on Early Life Origins of Health (EAROH), 75004 Paris, France.
- Université de Paris, UMR1153 Center for Research in Epidemiology and StatisticS (CRESS), Research Team on Early Life Origins of Health (EAROH), 75004 Paris, France.
- Unité Mixte Inserm-Ined-EFS Elfe, Ined, 75020 Paris, France.
| | - Blandine de Lauzon-Guillain
- INSERM, UMR1153 Center for Research in Epidemiology and StatisticS (CRESS), Research Team on Early Life Origins of Health (EAROH), 75004 Paris, France.
- Université de Paris, UMR1153 Center for Research in Epidemiology and StatisticS (CRESS), Research Team on Early Life Origins of Health (EAROH), 75004 Paris, France.
- INRA, U1125 Center for Research in Epidemiology and StatisticS (CRESS), Research Team on Early Life Origins of Health (EAROH), 75004 Paris, France.
| |
Collapse
|
17
|
da Rosa EB, Silveira DB, Correia JD, Grapiglia CG, de Moraes SAG, Nunes MR, Zen TD, Oliveira CA, Correia EPE, Alcay CT, Lisboa ML, da Cunha AC, Zen PRG, Rosa RFM. Periconceptional folic acid supplementation in Southern Brazil: Why are not we doing it right? Am J Med Genet A 2018; 179:20-28. [PMID: 30569628 DOI: 10.1002/ajmg.a.60699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 09/28/2018] [Accepted: 10/29/2018] [Indexed: 11/06/2022]
Abstract
Several countries, as Brazil, have public policies for periconceptional folic acid supplementation (FAS) in order to prevent unfavorable outcomes. Our aim was to evaluate the FAS situation in a public reference hospital from Southern Brazil. This study included all mothers who had children born at the Hospital Materno Infantil Presidente Vargas, RS, Brazil, in a 1-year period. Data collection was conducted through interviews with application of a clinical protocol and analysis of the patients' records. FAS was defined as the use of folic acid in any period of the periconceptional period, irrespective of the duration and amount. We also classified those mothers who correctly followed the national recommendation proposed by the Health Ministry of Brazil. The sample consisted of 765 mothers evaluated soon after childbirth. Their ages ranged from 12 to 45 years (mean 25.2 years). The overall level of FAS was 51.5%, and the use according to the national recommendation occurred in only 1.6%. Factors associated with non-FAS consisted of lower maternal age (p = .009) and maternal schooling (p = .023), higher number of pregnancies (p = .003), fewer prenatal visits (p = .050) and later prenatal care onset (p = .037). Periconceptional FAS in our midst seems to be very far from the ideal goal. Susceptible groups appeared to be mothers who were younger, less educated, multiparous, and had inadequate prenatal care. We believe that efforts of education and awareness should be especially targeted for these groups. These recommendations should also be strengthened among those who prescribe the FAS.
Collapse
Affiliation(s)
- Ernani B da Rosa
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil
| | - Daniélle B Silveira
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil
| | - Jamile D Correia
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil
| | | | | | | | - Tatiana D Zen
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil.,Pharmacy, Faculdade de Ciências da Saúde, Centro Universitário Ritter dos Reis - UniRitter, Porto Alegre, Brazil
| | - Ceres A Oliveira
- Institute of Education and Research, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | - Cristiane T Alcay
- Nursing Service, Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre, Brazil
| | - Marli L Lisboa
- Nursing Service, Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre, Brazil.,Fetal Medicine, HMIPV, Porto Alegre, Brazil
| | | | - Paulo R G Zen
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil.,Clinical Genetics, UFCSPA and Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre, Brazil
| | - Rafael F M Rosa
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil.,Clinical Genetics, UFCSPA and Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre, Brazil
| |
Collapse
|
18
|
Thorslund K, Alfredsson E, Axberg U. Universal parental support for parents of adolescents: Who wants municipality-based parental support and in what form? Scand J Psychol 2018; 60:16-25. [PMID: 30412930 DOI: 10.1111/sjop.12498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 09/27/2018] [Indexed: 11/29/2022]
Abstract
Parenting a child through adolescence can be a challenge for many parents; adolescents go through notable developmental, physical, and psychological changes that affect the relationships around them. Most parents find parental support during these years important. These young people's relationships with their parents are important to their mental health, but although parental support is universally available to parents of younger children, it is still scarce for parents of adolescents. The aim of this study was to explore what factors are associated with interest in universal parental support through telephone interviews and questionnaires with 223 parents of 13- to 17-year-olds. Parents' interest in parental support was linked to their own anxious mood, their lower perceived parental capacity, their perception of the child as having psychiatric problems, the parents' perception of their adolescents' openness about things and their perception of the adolescent's overall difficulties in daily life due to psychiatric symptoms. The results show that lighter forms of support such as lectures or seminars were more appealing to parents with higher social status. Offering community-based individual counseling and leader-led parent training groups therefore has the potential to reach parents with difficulties more equally, while offering support only through lectures and seminars could increase the inequality between parents in different social situations.
Collapse
Affiliation(s)
- Karin Thorslund
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Elin Alfredsson
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Ulf Axberg
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
19
|
Teixeira JA, Castro TG, Wall CR, Marchioni DM, Berry S, Morton SMB, Grant CC. Determinants of folic acid supplement use outside national recommendations for pregnant women: results from the Growing Up in New Zealand cohort study. Public Health Nutr 2018; 21:2183-2192. [PMID: 29708087 PMCID: PMC11106014 DOI: 10.1017/s1368980018000836] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 01/14/2018] [Accepted: 03/06/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate the sociodemographic and lifestyle factors associated with insufficient and excessive use of folic acid supplements (FAS) among pregnant women. DESIGN A pregnancy cohort to which multinomial logistic regression models were applied to identify factors associated with duration and dose of FAS use. SETTING The Growing Up in New Zealand child study, which enrolled pregnant women whose children were born in 2009-2010. SUBJECTS Pregnant women (n 6822) enrolled into a nationally generalizable cohort. RESULTS Ninety-two per cent of pregnant women were not taking FAS according to the national recommendation (4 weeks before until 12 weeks after conception), with 69 % taking insufficient FAS and 57 % extending FAS use past 13 weeks' gestation. The factors associated with extended use differed from those associated with insufficient use. Consistent with published literature, the relative risks of insufficient use were increased for younger women, those with less education, of non-European ethnicities, unemployed, who smoked cigarettes, whose pregnancy was unplanned or who had older children, or were living in more deprived households. In contrast, the relative risks of extended use were increased for women of higher socio-economic status or for whom this was their first pregnancy and decreased for women of Pacific v. European ethnicity. CONCLUSIONS In New Zealand, current use of FAS during pregnancy potentially exposes pregnant women and their unborn children to too little or too much folic acid. Further policy development is necessary to reduce current socio-economic inequities in the use of FAS.
Collapse
Affiliation(s)
- Juliana A Teixeira
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- The Centre for Longitudinal Research – He Ara ki Mua, School of Population Health (Building 730, Level 3), Tamaki Campus, University of Auckland, 261 Morrin Road, St Johns, Auckland 1072, New Zealand
| | - Teresa G Castro
- The Centre for Longitudinal Research – He Ara ki Mua, School of Population Health (Building 730, Level 3), Tamaki Campus, University of Auckland, 261 Morrin Road, St Johns, Auckland 1072, New Zealand
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Clare R Wall
- The Centre for Longitudinal Research – He Ara ki Mua, School of Population Health (Building 730, Level 3), Tamaki Campus, University of Auckland, 261 Morrin Road, St Johns, Auckland 1072, New Zealand
- Discipline of Nutrition and Dietetics, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - Dirce Maria Marchioni
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Sarah Berry
- The Centre for Longitudinal Research – He Ara ki Mua, School of Population Health (Building 730, Level 3), Tamaki Campus, University of Auckland, 261 Morrin Road, St Johns, Auckland 1072, New Zealand
| | - Susan MB Morton
- The Centre for Longitudinal Research – He Ara ki Mua, School of Population Health (Building 730, Level 3), Tamaki Campus, University of Auckland, 261 Morrin Road, St Johns, Auckland 1072, New Zealand
| | - Cameron C Grant
- The Centre for Longitudinal Research – He Ara ki Mua, School of Population Health (Building 730, Level 3), Tamaki Campus, University of Auckland, 261 Morrin Road, St Johns, Auckland 1072, New Zealand
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
- Starship Children’s Hospital, Auckland District Health Board, Auckland, New Zealand
| |
Collapse
|
20
|
Thomson K, Hillier-Brown F, Todd A, McNamara C, Huijts T, Bambra C. The effects of public health policies on health inequalities in high-income countries: an umbrella review. BMC Public Health 2018; 18:869. [PMID: 30005611 PMCID: PMC6044092 DOI: 10.1186/s12889-018-5677-1] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 06/06/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Socio-economic inequalities are associated with unequal exposure to social, economic and environmental risk factors, which in turn contribute to health inequalities. Understanding the impact of specific public health policy interventions will help to establish causality in terms of the effects on health inequalities. METHODS Systematic review methodology was used to identify systematic reviews from high-income countries that describe the health equity effects of upstream public health interventions. Twenty databases were searched from their start date until May 2017. The quality of the included articles was determined using the Assessment of Multiple Systematic Reviews tool (AMSTAR). RESULTS Twenty-nine systematic reviews were identified reporting 150 unique relevant primary studies. The reviews summarised evidence of all types of primary and secondary prevention policies (fiscal, regulation, education, preventative treatment and screening) across seven public health domains (tobacco, alcohol, food and nutrition, reproductive health services, the control of infectious diseases, the environment and workplace regulations). There were no systematic reviews of interventions targeting mental health. Results were mixed across the public health domains; some policy interventions were shown to reduce health inequalities (e.g. food subsidy programmes, immunisations), others have no effect and some interventions appear to increase inequalities (e.g. 20 mph and low emission zones). The quality of the included reviews (and their primary studies) were generally poor and clear gaps in the evidence base have been highlighted. CONCLUSIONS The review does tentatively suggest interventions that policy makers might use to reduce health inequalities, although whether the programmes are transferable between high-income countries remains unclear. TRIAL REGISTRATION PROSPERO registration number: CRD42016025283.
Collapse
Affiliation(s)
- Katie Thomson
- Institute of Health and Society, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
- Fuse – UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Frances Hillier-Brown
- Fuse – UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- School of Applied Social Sciences, Durham University, 32 Old Elvet, Durham, DH1 3HN UK
| | - Adam Todd
- Institute of Health and Society, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
- Fuse – UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle upon Tyne, NE1 7RU UK
| | - Courtney McNamara
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Building 9, Level 5, 7491 Dragvoll, Trondheim, Norway
| | - Tim Huijts
- Research Centre for Education and the Labour Market, Maastricht University, Tongersestraat 53, 6211 LM Maastricht, The Netherlands
| | - Clare Bambra
- Institute of Health and Society, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
- Fuse – UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| |
Collapse
|
21
|
Singh K, Drouin K, Newmark LP, Lee J, Faxvaag A, Rozenblum R, Pabo EA, Landman A, Klinger E, Bates DW. Many Mobile Health Apps Target High-Need, High-Cost Populations, But Gaps Remain. Health Aff (Millwood) 2018; 35:2310-2318. [PMID: 27920321 DOI: 10.1377/hlthaff.2016.0578] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
With rising smartphone ownership, mobile health applications (mHealth apps) have the potential to support high-need, high-cost populations in managing their health. While the number of available mHealth apps has grown substantially, no clear strategy has emerged on how providers should evaluate and recommend such apps to patients. Key stakeholders, including medical professional societies, insurers, and policy makers, have largely avoided formally recommending apps, which forces patients to obtain recommendations from other sources. To help stakeholders overcome barriers to reviewing and recommending apps, we evaluated 137 patient-facing mHealth apps-those intended for use by patients to manage their health-that were highly rated by consumers and recommended by experts and that targeted high-need, high-cost populations. We found that there is a wide variety of apps in the marketplace but that few apps address the needs of the patients who could benefit the most. We also found that consumers' ratings were poor indications of apps' clinical utility or usability and that most apps did not respond appropriately when a user entered potentially dangerous health information. Going forward, data privacy and security will continue to be major concerns in the dissemination of mHealth apps.
Collapse
Affiliation(s)
- Karandeep Singh
- Karandeep Singh is an assistant professor of learning health sciences and of medicine at the University of Michigan Medical School, in Ann Arbor
| | - Kaitlin Drouin
- Kaitlin Drouin is a project manager in the Department of Medicine at Brigham and Women's Hospital, in Boston, Massachusetts
| | - Lisa P Newmark
- Lisa P. Newmark is a project manager in the Information Systems Department at Partners HealthCare, in Wellesley, Massachusetts
| | - JaeHo Lee
- JaeHo Lee is an associate professor of biomedical informatics at the Asan Medical Center, in Seoul, Republic of Korea
| | - Arild Faxvaag
- Arild Faxvaag is a visiting scientist in the Division of General Internal Medicine at Brigham and Women's Hospital
| | - Ronen Rozenblum
- Ronen Rozenblum is a research associate in the Division of General Internal Medicine at Brigham and Women's Hospital
| | - Erika A Pabo
- Erika A. Pabo is an instructor in medicine at Brigham and Women's Hospital
| | - Adam Landman
- Adam Landman is chief information officer at Brigham and Women's Hospital
| | - Elissa Klinger
- Elissa Klinger is a project manager in the Division of General Internal Medicine at Brigham and Women's Hospital
| | - David W Bates
- David W. Bates is chief of the Division of General Internal Medicine at Brigham and Women's Hospital
| |
Collapse
|
22
|
Dorling H, Ollerhead L, Kidgell C. The NIHR public health research programme: intervention approaches to tackle health inequalities. J Public Health (Oxf) 2017; 39:856-862. [PMID: 27915256 PMCID: PMC5896582 DOI: 10.1093/pubmed/fdw128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The National Institute for Health Research (NIHR) Public Health Research (PHR) Programme evaluates interventions intended to improve the health of the public and reduce inequalities in health in the UK. The aim of the research was to establish how projects funded by the PHR Programme between 2009 and 2014 addressed health inequalities. Methods A health inequalities intervention framework developed by Bambra et al. was used to map PHR funded studies to a typology. The framework is based on interventions that are characterized by their level of action and their approach to tackling inequalities. Results A total of 57 primary research projects funded by the PHR Programme were categorized using the framework; 16 PHR research projects were classified as strengthening individuals, 24 strengthening communities, 15 improving living and school/work conditions and 2 promoting healthy macro policies. Eighteen were classified as targeted interventions whereas 39 were universal. Conclusions Mapping the interventions being evaluated by the PHR Programme to a typology differentiated health inequality interventions and illustrates how they are expected to have an impact. Emerging findings will contribute to the evidence base for addressing health inequalities to inform research and future commissioning of public health services.
Collapse
Affiliation(s)
- H Dorling
- Wessex Institute, University of Southampton, Southampton, UK
| | - L Ollerhead
- NIHR Evaluation Trials and Studies Coordinating Centre (NETSCC), University of Southampton, Southampton , UK
| | - C Kidgell
- NIHR Evaluation Trials and Studies Coordinating Centre (NETSCC), University of Southampton, Southampton , UK
| |
Collapse
|
23
|
Mosdøl A, Lidal IB, Straumann GH, Vist GE. Targeted mass media interventions promoting healthy behaviours to reduce risk of non-communicable diseases in adult, ethnic minorities. Cochrane Database Syst Rev 2017; 2:CD011683. [PMID: 28211056 PMCID: PMC6464363 DOI: 10.1002/14651858.cd011683.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Physical activity, a balanced diet, avoidance of tobacco exposure, and limited alcohol consumption may reduce morbidity and mortality from non-communicable diseases (NCDs). Mass media interventions are commonly used to encourage healthier behaviours in population groups. It is unclear whether targeted mass media interventions for ethnic minority groups are more or less effective in changing behaviours than those developed for the general population. OBJECTIVES To determine the effects of mass media interventions targeting adult ethnic minorities with messages about physical activity, dietary patterns, tobacco use or alcohol consumption to reduce the risk of NCDs. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, ERIC, SweMed+, and ISI Web of Science until August 2016. We also searched for grey literature in OpenGrey, Grey Literature Report, Eldis, and two relevant websites until October 2016. The searches were not restricted by language. SELECTION CRITERIA We searched for individual and cluster-randomised controlled trials, controlled before-and-after studies (CBA) and interrupted time series studies (ITS). Relevant interventions promoted healthier behaviours related to physical activity, dietary patterns, tobacco use or alcohol consumption; were disseminated via mass media channels; and targeted ethnic minority groups. The population of interest comprised adults (≥ 18 years) from ethnic minority groups in the focal countries. Primary outcomes included indicators of behavioural change, self-reported behavioural change and knowledge and attitudes towards change. Secondary outcomes were the use of health promotion services and costs related to the project. DATA COLLECTION AND ANALYSIS Two authors independently reviewed the references to identify studies for inclusion. We extracted data and assessed the risk of bias in all included studies. We did not pool the results due to heterogeneity in comparisons made, outcomes, and study designs. We describe the results narratively and present them in 'Summary of findings' tables. We judged the quality of the evidence using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology. MAIN RESULTS Six studies met the inclusion criteria, including three RCTs, two cluster-RCTs and one ITS. All were conducted in the USA and comprised targeted mass media interventions for people of African descent (four studies), Spanish-language dominant Latino immigrants (one study), and Chinese immigrants (one study). The two latter studies offered the intervention in the participants' first language (Spanish, Cantonese, or Mandarin). Three interventions targeted towards women only, one pregnant women specifically. We judged all studies as being at unclear risk of bias in at least one domain and three studies as being at high risk of bias in at least one domain.We categorised the findings into three comparisons. The first comparison examined mass media interventions targeted at ethnic minorities versus an equivalent mass media intervention intended for the general population. The one study in this category (255 participants of African decent) found little or no difference in effect on self-reported behavioural change for smoking and only small differences in attitudes to change between participants who were given a culturally specific smoking cessation booklet versus a booklet intended for the general population. We are uncertain about the effect estimates, as assessed by the GRADE methodology (very low quality evidence of effect). No study provided data for indicators of behavioural change or adverse effects.The second comparison assessed targeted mass media interventions versus no intervention. One study (154 participants of African decent) reported effects for our primary outcomes. Participants in the intervention group had access to 12 one-hour live programmes on cable TV and received print material over three months regarding nutrition and physical activity to improve health and weight control. Change in body mass index (BMI) was comparable between groups 12 months after the baseline (low quality evidence). Scores on a food habits (fat behaviours) and total leisure activity scores changed favourably for the intervention group (very low quality evidence). Two other studies exposed entire populations in geographical areas to radio advertisements targeted towards African American communities. Authors presented effects on two of our secondary outcomes, use of health promotion services and project costs. The campaign message was to call smoking quit lines. The outcome was the number of calls received. After one year, one study reported 18 calls per estimated 10,000 targeted smokers from the intervention communities (estimated target population 310,500 persons), compared to 0.2 calls per estimated 10,000 targeted smokers from the control communities (estimated target population 331,400 persons) (moderate quality evidence). The ITS study also reported an increase in the number of calls from the target population during campaigns (low quality evidence). The proportion of African American callers increased in both studies (low to very low quality evidence). No study provided data on knowledge and attitudes for change and adverse effects. Information on costs were sparse.The third comparison assessed targeted mass media interventions versus a mass media intervention plus personalised content. Findings are based on three studies (1361 participants). Participants in these comparison groups received personal feedback. Two of the studies recorded weight changes over time. Neither found significant differences between the groups (low quality evidence). Evidence on behavioural changes, and knowledge and attitudes typically found some effects in favour of receiving personalised content or no significant differences between groups (very low quality evidence). No study provided data on adverse effects. Information on costs were sparse. AUTHORS' CONCLUSIONS The available evidence is inadequate for understanding whether mass media interventions targeted toward ethnic minority populations are more effective in changing health behaviours than mass media interventions intended for the population at large. When compared to no intervention, a targeted mass media intervention may increase the number of calls to smoking quit line, but the effect on health behaviours is unclear. These studies could not distinguish the impact of different components, for instance the effect of hearing a message regarding behavioural change, the cultural adaptation to the ethnic minority group, or increase reach to the target group through more appropriate mass media channels. New studies should explore targeted interventions for ethnic minorities with a first language other than the dominant language in their resident country, as well as directly compare targeted versus general population mass media interventions.
Collapse
Affiliation(s)
- Annhild Mosdøl
- Norwegian Institute of Public HealthKnowledge Centre for the Health ServicesPO BOX 4404 NydalenOsloNorway
| | - Ingeborg B Lidal
- Norwegian Institute of Public HealthKnowledge Centre for the Health ServicesPO BOX 4404 NydalenOsloNorway
- Sunnaas Rehabilitation HospitalTRS National Resource Centre for Rare DisordersNesoddtangenNorway1450
| | - Gyri H Straumann
- Norwegian Institute of Public HealthKnowledge Centre for the Health ServicesPO BOX 4404 NydalenOsloNorway
| | - Gunn E Vist
- Norwegian Knowledge Centre for the Health ServicesPrevention, Health Promotion and Organisation UnitPO Box 7004St Olavs PlassOsloNorway0130
| | | |
Collapse
|
24
|
McStay CL, Prescott SL, Bower C, Palmer DJ. Maternal Folic Acid Supplementation during Pregnancy and Childhood Allergic Disease Outcomes: A Question of Timing? Nutrients 2017; 9:nu9020123. [PMID: 28208798 PMCID: PMC5331554 DOI: 10.3390/nu9020123] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 02/03/2017] [Indexed: 12/17/2022] Open
Abstract
Since the early 1990s, maternal folic acid supplementation has been recommended prior to and during the first trimester of pregnancy, to reduce the risk of infant neural tube defects. In addition, many countries have also implemented the folic acid fortification of staple foods, in order to promote sufficient intakes amongst women of a childbearing age, based on concerns surrounding variable dietary and supplementation practices. As many women continue to take folic acid supplements beyond the recommended first trimester, there has been an overall increase in folate intakes, particularly in countries with mandatory fortification. This has raised questions on the consequences for the developing fetus, given that folic acid, a methyl donor, has the potential to epigenetically modify gene expression. In animal studies, folic acid has been shown to promote an allergic phenotype in the offspring, through changes in DNA methylation. Human population studies have also described associations between folate status in pregnancy and the risk of subsequent childhood allergic disease. In this review, we address the question of whether ongoing maternal folic acid supplementation after neural tube closure, could be contributing to the rise in early life allergic diseases.
Collapse
Affiliation(s)
- Catrina L McStay
- Department of Health Western Australia, Perth 6004, Western Australia, Australia.
| | - Susan L Prescott
- School of Paediatrics and Child Health, The University of Western Australia, Subiaco 6008, Western Australia, Australia.
- Telethon Kids Institute, The University of Western Australia, Subiaco 6008, Western Australia, Australia.
- Members of the in-FLAME International Inflammation Network, Perth 6000, Western Australia, Australia.
| | - Carol Bower
- Telethon Kids Institute, The University of Western Australia, Subiaco 6008, Western Australia, Australia.
| | - Debra J Palmer
- School of Paediatrics and Child Health, The University of Western Australia, Subiaco 6008, Western Australia, Australia.
- Telethon Kids Institute, The University of Western Australia, Subiaco 6008, Western Australia, Australia.
- Members of the in-FLAME International Inflammation Network, Perth 6000, Western Australia, Australia.
| |
Collapse
|
25
|
Cawley S, Mullaney L, Kennedy R, Farren M, McCartney D, Turner MJ. Duration of periconceptional folic acid supplementation in women booking for antenatal care. Public Health Nutr 2017; 20:371-379. [PMID: 27702424 PMCID: PMC10261302 DOI: 10.1017/s1368980016002585] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 07/19/2016] [Accepted: 08/18/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To provide accurate estimates of the commencement time, duration and dosage of folic acid (FA) supplementation taken by Irish women in the periconceptional period. The study also aimed to establish the factors associated with optimal FA supplementation practices. DESIGN Cross-sectional observational study. Women's clinical and sociodemographic details were computerised. Maternal weight and height were measured before calculating BMI. Detailed FA supplementation questionnaires were completed under the supervision of a trained researcher. SETTING A large university maternity hospital, Republic of Ireland, January 2014-April 2016. SUBJECTS Women (n 856) recruited at their convenience in the first trimester. RESULTS While almost all of the women (97 %) were taking FA at enrolment, only one in four women took FA for at least 12 weeks preconceptionally (n 208). Among the 44 % of women who were supplementing with FA preconceptionally, 44 % (162/370) reported taking FA for less than the 12 weeks required to achieve optimal red-blood-cell folate levels for prevention of neural tube defects. On multivariate analysis, only planned pregnancy and nulliparity were associated with taking FA for at least 12 weeks preconceptionally. Among women who only took FA postconceptionally, almost two-thirds commenced it after day 28 of their pregnancy when the neural tube had already closed. CONCLUSIONS As the timing of FA was suboptimal both before and after conception, we recommend that current national FA guidelines need to be reviewed.
Collapse
Affiliation(s)
- Shona Cawley
- School of Biological Sciences, Dublin Institute of Technology, Dublin, Republic of Ireland
| | - Laura Mullaney
- School of Biological Sciences, Dublin Institute of Technology, Dublin, Republic of Ireland
| | - Rachel Kennedy
- School of Biological Sciences, Dublin Institute of Technology, Dublin, Republic of Ireland
| | - Maria Farren
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Republic of Ireland
| | - Daniel McCartney
- School of Biological Sciences, Dublin Institute of Technology, Dublin, Republic of Ireland
| | - Michael J Turner
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Republic of Ireland
| |
Collapse
|
26
|
Chung VCH, Wong SYS, Wang HHX, Wong MCS, Wei X, Wang J, Liu S, Ho RST, Yu ELM, Griffiths SM. Use of Traditional and Complementary Medicine as Self-Care Strategies in Community Health Centers: Cross-Sectional Study in Urban Pearl River Delta Region of China. Medicine (Baltimore) 2016; 95:e3761. [PMID: 27281074 PMCID: PMC4907652 DOI: 10.1097/md.0000000000003761] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 04/22/2016] [Accepted: 04/02/2016] [Indexed: 01/10/2023] Open
Abstract
In China, Community Health Centers (CHCs) are major providers of primary care services, but their potential in empowering patients' self-management capacity has not been assessed. This study aims to describe self-care practice patterns amongst CHC attendees in urban China.In this cross-sectional quantitative study, 3360 CHC patients from 6 cities within the Pearl Delta Region were sampled using multistage cluster sampling.Thirty-seven per cent had used with over-the-counter Chinese herbal medicines (OTC CHMs) in the past year and majority of respondents found OTC CHMs effective. OTC CHMs were more popular amongst those who needed to pay out of pocket for CHC services. Less than 10% used vitamins and minerals, and those with a lower socioeconomic background have a higher propensity to consume. Although doubts on their usefulness are expressed, their use by the vulnerable population may reflect barriers to access to conventional health care, cultural affinity, or a defense against negative consequences of illnesses. About 25% performed physical exercise, but the prevalence is lower amongst women and older people. Taiji seems to be an alternative for these populations with promising effectiveness, but overall only 6% of CHC attendees participated.These results suggest that CHCs should start initiatives in fostering appropriate use of OTC CHM, vitamins, and minerals. Engaging community pharmacists in guiding safe and effective use of OTC CHM amongst the uninsured is essential given their low accessibility to CHC services. Prescription of Taiji instead of physical exercises to women and older people could be more culturally appropriate, and the possibility of including this as part of the CHC services worth further exploration.
Collapse
Affiliation(s)
- Vincent C H Chung
- From the JC School of Public Health and Primary Care (VCHC, SYSW, MCSW, XW, SL, RSTH, ELMY, SMG); Hong Kong Institute of Integrative Medicine (VCHC, SYSW), The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR; School of Public Health (HHXW), Sun Yat-Sen University; School of Public Health (JW), Guangzhou Medical University, Guangzhou, Guangdong Province, China; and Institute of Global Health Innovation (SMG), Imperial College London, London, UK
| | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
El-Shabrawi MH, Kamal NM, Elhusseini MA, Hussein L, Abdallah EAA, Ali YZA, Azab AA, Salama MA, Kassab M, Krawinkel M. Folic Acid Intake and Neural Tube Defects: Two Egyptian Centers Experience. Medicine (Baltimore) 2015; 94:e1395. [PMID: 26376380 PMCID: PMC4635794 DOI: 10.1097/md.0000000000001395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Neural tube defects (NTDs) are a group of congenital malformations with worldwide distribution and complex etiopathogenesis. Folic acid plays a pivotal role in their prevention. We aimed to identify the protective effect of folic acid intake against NTDs and its dependence on different socioeconomic and environmental factors in a cohort of mothers in Egypt. A cross-sectional study was carried over a period of 12 months on mothers who gave birth to babies with NTDs (group 1) and a control group with healthy offsprings (group 2). Both groups completed 2 questionnaires: food frequency questionnaire targeting the daily folate intake, and socioeconomic status and medical history questionnaire. Both groups of mothers received folate <800 μg/day, recommended for pregnant women. A strong association was detected between NTDs and urban residency with medium educated mothers, with negative consanguinity, who had folate intake < 400 μg daily, and who had their food long cooked. Each of these factors separately had a limited impact to cause NTDs, but when present together they did augment each other. Interestingly enough is the role of fava bean, cauliflower, spinach, and mango in predisposing of NTDs in the presence of the above-mentioned factors. The protective effect of folic acid intake against NTDs may depend on the synergism of different socioeconomic and environmental factors (which differ from country to another). In Egypt, females especially the medium-educated who live in urban areas should be well-informed with the value of folate intake in the periconceptional period.
Collapse
Affiliation(s)
- Mortada H El-Shabrawi
- From the Professor of Pediatrics and Pediatric Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt (MHE-S); Associate Professor of Pediatrics and Pediatric Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt (NMK); Consultant Obstetrician and Gynecologist, Red Crescent Hospital, Ministry of Health and Population, Cairo, Egypt (MAE); Professor of Nutrition, Institute of Nutritional Sciences, University of Giessen, Giessen, Germany (MK); Professor of Nutrition, National Research Center, Cairo, Egypt (LH); Lecturer of Pediatrics and Neonatology, Faculty of Medicine, Cairo University, Cairo, Egypt (EAAA); Lecturer of Obstetrics and Gynecology, Faculty of Medicine, Fayoum University, Fayoum, Egypt (YZAA); Associate Professor of Pediatrics and Neonatology, Faculty of Medicine, Benha University, Egypt (AAA, MAS); Fellow in nutrition, Institute of Nutritional Sciences, University of Giessen, Giessen, Germany (MK); and Professor of Nutrition, Institute of Nutritional Sciences, University of Giessen, Giessen, Germany (MK)
| | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
McKeating A, Farren M, Cawley S, Daly N, McCartney D, Turner MJ. Maternal folic acid supplementation trends 2009-2013. Acta Obstet Gynecol Scand 2015; 94:727-733. [PMID: 25873187 DOI: 10.1111/aogs.12656] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 04/08/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We analyzed trends in folic acid supplementation among women booking for antenatal care between 2009 and 2013. DESIGN Prospective observational study. SETTING Large university teaching hospital. POPULATION We included all women who delivered an infant ≥500 g from 1 January 2009 to 31 December 2013. METHODS Body mass index was calculated using early pregnancy weight and height measured at first antenatal visits. Sociodemographic and clinical data were gathered prospectively. Multivariate logistic regression analyses were applied to determine the correlates of periconceptional folic acid supplementation. MAIN OUTCOME MEASURES Rates and correlates of folic acid supplementation. RESULTS Of 42 362 women, 99.2% (n = 42 042) were suitable for analysis. The mean age was 30.7 years and mean body mass index was 25.6 kg/m(2) , 40.7% (n = 17 054) were primigravidas and 70.6% (n = 29 741) were Irish-born. Overall, 43.9% (n = 18 473) took periconceptional (preconceptional and postconceptional) folic acid, 49.4% (n = 20 782) took postconceptional folic acid only, and 6.6% (n = 2787) took no folic acid. The women most likely to take folic acid were those who planned their pregnancy and were >30 years old, non-obese, Irish-born and employed professionally. The periconceptional folic acid rate decreased from 45.1% in 2009 to 43.1% in 2013 (p = 0.01). Over five years, periconceptional folic acid supplementation decreased among women who were multiparous (43.8-41.6%, p = 0.02), aged 30-39 years (58.9-55.0%, p < 0.001), Irish-born (50.1-47.1%, p < 0.001) and obese (38.6-36.9%, p = 0.02). CONCLUSION Overall, the rate of periconceptional folic acid supplementation decreased in the five years 2009-2013, particularly among women who were multiparous, aged 30-39 years, Irish-born and obese.
Collapse
Affiliation(s)
- Aoife McKeating
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Maria Farren
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Shona Cawley
- School of Biological Sciences, Dublin Institute of Technology, Dublin, Ireland
| | - Niamh Daly
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Daniel McCartney
- School of Biological Sciences, Dublin Institute of Technology, Dublin, Ireland
| | - Michael J Turner
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland
| |
Collapse
|
29
|
Shannon GD, Alberg C, Nacul L, Pashayan N. Preconception healthcare and congenital disorders: systematic review of the effectiveness of preconception care programs in the prevention of congenital disorders. Matern Child Health J 2015; 18:1354-79. [PMID: 24091886 DOI: 10.1007/s10995-013-1370-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Congenital disorders are a leading cause of global burden of disease; the birth prevalence remains constant at 6%. Initiating preconception care before pregnancy may be an effective strategy to reduce congenital disorders and improve the health of reproductive-age women. Our objectives are: (1) To identify components of preconception interventions, (2) to assess the effectiveness of preconception interventions in reducing the burden of congenital disorders, and (3) to prioritize these interventions. Medline and Science Direct search terms included: preconception, pre-pregnancy, childbearing, reproduction, care, intervention, primary care, healthcare, model, program, prevention, trial, efficacy, effectiveness, congenital disorders OR abnormalities. Inclusion criteria were: (1) English, (2) human subjects, (3) women of childbearing age, (4) 1980-current data, (5) all countries, (6) experimental studies, (7) systematic reviews or meta-analysis, (8) program reports/evaluations. Data was collected and abstracted by two independent reviewers. To prioritize preconception interventions likely to have the largest impact at a population level, a ranked scoring system was created incorporating the following: (1) quality of evidence supporting the intervention, (2) effect size of the intervention, and (3) global burden of the specific congenital disease. Preconception interventions include risk screening, education, motivational counseling, disease optimization and specialist referral. The most effective interventions, based on the strength of evidence, size of impact of intervention, and disease burden are: folic acid fortification/supplementation, diabetic control, smoking and alcohol interventions, HIV management, thrombophillia screening, obesity prevention and epilepsy management. Although multiple conditions require preconception attention, only nine interventions have evidence to support their effect on congenital disorders through a randomised control trial, systematic review or meta-analysis. There is a need for more high-level research in evaluating certain preconception interventions. These findings have significant implications on planning and implementation of preconception care.
Collapse
Affiliation(s)
- Geordan D Shannon
- Department of Public Health and Primary Care, Institute of Public Health, University Forvie Site, University of Cambridge, Robinson Way, Cambridge, CB2 2SR, UK,
| | | | | | | |
Collapse
|
30
|
Cawley S, Mullaney L, McKeating A, Farren M, McCartney D, Turner MJ. An analysis of folic acid supplementation in women presenting for antenatal care. J Public Health (Oxf) 2015; 38:122-9. [DOI: 10.1093/pubmed/fdv019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
31
|
Backholer K, Beauchamp A, Ball K, Turrell G, Martin J, Woods J, Peeters A. A framework for evaluating the impact of obesity prevention strategies on socioeconomic inequalities in weight. Am J Public Health 2014; 104:e43-50. [PMID: 25121810 PMCID: PMC4167106 DOI: 10.2105/ajph.2014.302066] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2014] [Indexed: 11/04/2022]
Abstract
We developed a theoretical framework to organize obesity prevention interventions by their likely impact on the socioeconomic gradient of weight. The degree to which an intervention involves individual agency versus structural change influences socioeconomic inequalities in weight. Agentic interventions, such as standalone social marketing, increase socioeconomic inequalities. Structural interventions, such as food procurement policies and restrictions on unhealthy foods in schools, show equal or greater benefit for lower socioeconomic groups. Many obesity prevention interventions belong to the agento-structural types of interventions, and account for the environment in which health behaviors occur, but they require a level of individual agency for behavioral change, including workplace design to encourage exercise and fiscal regulation of unhealthy foods or beverages. Obesity prevention interventions differ in their effectiveness across socioeconomic groups. Limiting further increases in socioeconomic inequalities in obesity requires implementation of structural interventions. Further empirical evaluation, especially of agento-structural type interventions, remains crucial.
Collapse
Affiliation(s)
- Kathryn Backholer
- Kathryn Backholer, Anna Peeters, and Alison Beauchamp are with the Obesity and Population Health Unit, Baker IDI Heart and Diabetes Institute, Melbourne, Australia. Kylie Ball is with the Centre for Physical Activity and Nutrition Research, Deakin University, Melbourne, Australia. Gavin Turrell is with the School of Public Health and Social Work/Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia. Jane Martin is with the Obesity Policy Coalition, Melbourne, Australia. Julie Woods is with the School of Exercise and Nutrition Science, Deakin University
| | | | | | | | | | | | | |
Collapse
|
32
|
Manniën J, de Jonge A, Cornel MC, Spelten E, Hutton EK. Factors associated with not using folic acid supplements preconceptionally. Public Health Nutr 2014; 17:2344-50. [PMID: 24107718 PMCID: PMC10282615 DOI: 10.1017/s1368980013002656] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 08/13/2013] [Accepted: 08/28/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Neural tube defects are among the most common birth defects worldwide. Folic acid intake from one month before to three months after conception reduces the likelihood of neural tube defects by at least 50%. Since 1995, several campaigns have been organised in the Netherlands which resulted in 51% of pregnant women using folic acid supplements during the entire recommended period in the northern part of the Netherlands in 2005. Our research question was to gain insight into the current prevalence and factors associated with inadequate pregnancy-related use of folic acid supplements. DESIGN Data from the DELIVER study were used, which is a population-based cohort study. SETTING Twenty midwifery practices across the Netherlands in 2009 and 2010. SUBJECTS In total 5975 pregnant women completed a questionnaire covering items on sociodemographic and lifestyle factors, including folic acid intake. RESULTS Of our study population, 55·5% (3318/5975) used folic acid supplements before conception. Several sociodemographic and lifestyle factors were associated with no preconception use of folic acid, of which non-Western ethnicity and not having a partner had the largest effect size. CONCLUSIONS In the Netherlands, the folic acid intake before conception is suboptimal and has not improved over recent years. Fortification of staple foods with folic acid should be reconsidered as it would provide a more effective means of ensuring an adequate intake, especially for those groups of women who are unlikely to plan their pregnancies or to receive or respond to health promotion messages.
Collapse
Affiliation(s)
- Judith Manniën
- 1Department of Midwifery Science,AVAG and the EMGO Institute for Health and Care Research,VU University Medical Center,Van der Boechorststraat 7 (MF-D4.44),1081 BT Amsterdam,The Netherlands
| | - Ank de Jonge
- 1Department of Midwifery Science,AVAG and the EMGO Institute for Health and Care Research,VU University Medical Center,Van der Boechorststraat 7 (MF-D4.44),1081 BT Amsterdam,The Netherlands
| | - Martina C Cornel
- 2Clinical Genetics and EMGO Institute for Health and Care Research,VU University Medical Center,Amsterdam,The Netherlands
| | - Evelien Spelten
- 1Department of Midwifery Science,AVAG and the EMGO Institute for Health and Care Research,VU University Medical Center,Van der Boechorststraat 7 (MF-D4.44),1081 BT Amsterdam,The Netherlands
| | - Eileen K Hutton
- 1Department of Midwifery Science,AVAG and the EMGO Institute for Health and Care Research,VU University Medical Center,Van der Boechorststraat 7 (MF-D4.44),1081 BT Amsterdam,The Netherlands
| |
Collapse
|
33
|
Abstract
INTRODUCTION There is increasingly a double burden of under-nutrition and obesity in women of reproductive age. Preconception underweight or overweight, short stature and micronutrient deficiencies all contribute to excess maternal and fetal complications during pregnancy. METHODS A systematic review and meta-analysis of the evidence was conducted to ascertain the possible impact of preconception care for adolescents, women and couples of reproductive age on maternal, newborn and child health (MNCH) outcomes. A comprehensive strategy was used to search electronic reference libraries, and both observational and clinical controlled trials were included. Cross-referencing and a separate search strategy for each preconception risk and intervention ensured wider study capture. RESULTS Maternal pre-pregnancy weight is a significant factor in the preconception period with underweight contributing to a 32% higher risk of preterm birth, and obesity more than doubling the risk for preeclampsia, gestational diabetes. Overweight women are more likely to undergo a Cesarean delivery, and their newborns have higher chances of being born with a neural tube or congenital heart defect. Among nutrition-specific interventions, preconception folic acid supplementation has the strongest evidence of effect, preventing 69% of recurrent neural tube defects. Multiple micronutrient supplementation shows promise to reduce the rates of congenital anomalies and risk of preeclampsia. Although over 40% of women worldwide are anemic in the preconception period, only one study has shown a risk for low birth weight. CONCLUSION All women, but especially those who become pregnant in adolescence or have closely-spaced pregnancies (inter-pregnancy interval less than six months), require nutritional assessment and appropriate intervention in the preconception period with an emphasis on optimizing maternal body mass index and micronutrient reserves. Increasing coverage of nutrition-specific and nutrition-sensitive strategies (such as food fortification; integration of nutrition initiatives with other maternal and child health interventions; and community based platforms) is necessary among adolescent girls and women of reproductive age. The effectiveness of interventions will need to be simultaneously monitored, and form the basis for the development of improved delivery strategies and new nutritional interventions.
Collapse
Affiliation(s)
- Sohni V Dean
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Zohra S Lassi
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Ayesha M Imam
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| |
Collapse
|
34
|
El-mani S, Charlton KE, Flood VM, Mullan J. Limited knowledge about folic acid and iodine nutrition in pregnant women reflected in supplementation practices. Nutr Diet 2014. [DOI: 10.1111/1747-0080.12132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Souad El-mani
- School of Medicine; Faculty of Science, Medicine and Health; University of Wollongong; Wollongong Australia
| | - Karen E. Charlton
- School of Medicine; Faculty of Science, Medicine and Health; University of Wollongong; Wollongong Australia
| | - Victoria M. Flood
- Faculty of Health Sciences; University of Sydney and St. Vincent's Hospital; Sydney New South Wales Australia
- Faculty of Social Sciences; University of Wollongong (Honorary position)
| | - Judy Mullan
- School of Medicine; Faculty of Science, Medicine and Health; University of Wollongong; Wollongong Australia
| |
Collapse
|
35
|
Elfrink MEC, Moll HA, Kiefte-de Jong JC, Jaddoe VWV, Hofman A, ten Cate JM, Veerkamp JSJ. Pre- and postnatal determinants of deciduous molar hypomineralisation in 6-year-old children. The generation R study. PLoS One 2014; 9:e91057. [PMID: 24988443 PMCID: PMC4079596 DOI: 10.1371/journal.pone.0091057] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 02/10/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Deciduous Molar Hypomineralisation (DMH) and Molar Incisor Hypomineralisation (MIH) are common developmental disturbances in pediatric dentistry. Their occurrence is related. The same determinants as suggested for MIH are expected for DMH, though somewhat earlier in life. Perinatal medical problems may influence the prevalence of DMH but this has not been studied sufficiently. OBJECTIVE This study aimed to identify possible determinants of DMH in a prospective cohort study among 6-year-old children. STUDY DESIGN This study was embedded in the Generation R Study, a population-based prospective cohort study from fetal life until young adulthood. The the data were used to identify the determinants of DMH. Clinical photographs of clean, moist teeth were taken with an intra-oral camera in 6690 children (mean age 6.2 years; 49.9% girls). Data on possible determinants that had occurred during pregnancy and/or the child's first year of life were on the basis of manual standardized measurements (like length and weight) and questionnaires. Multivariate analyse with backward and forward selection was performed. RESULTS A number of factors in the pre-, peri- and postnatal phase were found to be associated with DMH. After multivariate logistic regression analyses, Dutch ethnic background, low birth weight, maternal alcohol consumption during pregnancy, and fever episodes in the first year of the child's life were found to play a role in the development of DMH in 6-year-old children. CONCLUSION This study shows that Dutch ethnicity, low birth weight, alcohol consumption by the mother during pregnancy and any fever in the first year of the child's life are associated with DMH. Not only childhood factors but also prenatal lifestyle factors need to be taken into account when studying determinants for DMH.
Collapse
Affiliation(s)
- Marlies E. C. Elfrink
- Department of Cariology, Endodontology and Pedodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - Henriette A. Moll
- Department of Pediatrics, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jessica C. Kiefte-de Jong
- Department of Pediatrics, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
- The Generation R Study Group Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Vincent W. V. Jaddoe
- Department of Pediatrics, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
- The Generation R Study Group Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jacob M. ten Cate
- Department of Cariology, Endodontology and Pedodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - Jaap S. J. Veerkamp
- Department of Cariology, Endodontology and Pedodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
36
|
Beauchamp A, Backholer K, Magliano D, Peeters A. The effect of obesity prevention interventions according to socioeconomic position: a systematic review. Obes Rev 2014; 15:541-54. [PMID: 24629126 DOI: 10.1111/obr.12161] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 01/01/2014] [Accepted: 01/02/2014] [Indexed: 01/19/2023]
Abstract
Obesity prevention is a major public health priority. It is important that all groups benefit from measures to prevent obesity, but we know little about the differential effectiveness of such interventions within particular population subgroups. This review aimed to identify interventions for obesity prevention that evaluated a change in adiposity according to socioeconomic position (SEP) and to determine the effectiveness of these interventions across different socioeconomic groups. A systematic search of published and grey literature was conducted. Studies that described an obesity prevention intervention and reported anthropometric outcomes according to a measure of SEP were included. Evidence was synthesized using narrative analysis. A total of 14 studies were analysed, representing a range of study designs and settings. All studies were from developed countries, with eight conducted among children. Three studies were shown to have no effect on anthropometric outcomes and were not further analysed. Interventions shown to be ineffective in lower SEP participants were primarily based on information provision directed at individual behaviour change. Studies that were shown to be effective in lower SEP participants primarily included community-based strategies or policies aimed at structural changes to the environment. Interventions targeting individual-level behaviour change may be less successful in lower SEP populations. It is essential that our efforts to prevent obesity do not leave behind the most disadvantaged members of society.
Collapse
Affiliation(s)
- A Beauchamp
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Population Health Strategic Research Centre, Deakin University, Melbourne, Victoria, Australia
| | | | | | | |
Collapse
|
37
|
Evans SE, Mygind VL, Peddie MC, Miller JC, Houghton LA. Effect of increasing voluntary folic acid food fortification on dietary folate intakes and adequacy of reproductive-age women in New Zealand. Public Health Nutr 2014; 17:1447-53. [PMID: 23835153 PMCID: PMC10282421 DOI: 10.1017/s1368980013001717] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 05/10/2013] [Accepted: 05/29/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Mandatory folic acid fortification of breads in New Zealand was put on hold in 2009. At this time, bread manufacturers were requested to adopt greater voluntary fortification and agreed to add folic acid to approximately one-third of their bread range. We sought to evaluate the impact of increased voluntary fortification of bread and the proposed mandatory fortification programme on folate intake adequacy of reproductive-age women. DESIGN Cross-sectional study conducted in 2008. Dietary data were collected using 3 d weighed food records and usual folate intakes were generated by modifying the food composition table as follows: (i) voluntary fortification of bread as of 2008 (six breads); (ii) increased voluntary fortification of bread as of 2011 (thirty-four breads); and (iii) mandatory fortification of all breads. The prevalence of inadequate folate intake was calculated for all three scenarios using the Estimated Average Requirement (320 μg dietary folate equivalents/d) cut-point method. SETTING New Zealand. SUBJECTS Healthy non-pregnant women (n 125) aged 18-40 years. RESULTS Usual folate intake in 2008 was 362 μg dietary folate equivalents/d. Increased voluntary bread fortification led to a marginal increase in folate intakes (394 μg dietary folate equivalents/d) and a decline in inadequacy from 37 % to 29 %. Mandatory fortification resulted in an increase of 89 μg folic acid/d, which substantially shifted both the proportion of women with folic acid intakes above 100 μg/d and the distribution of overall folate intakes, producing a marked reduction in inadequacy to 5 %. CONCLUSIONS Increased voluntary bread fortification efforts are far inferior to mandatory fortification as a reliable public health intervention.
Collapse
Affiliation(s)
- Sophie E Evans
- Department of Human Nutrition, University of Otago, PO Box 56 Dunedin 9054, New Zealand
| | - Vanessa L Mygind
- Department of Human Nutrition, University of Otago, PO Box 56 Dunedin 9054, New Zealand
| | - Meredith C Peddie
- Department of Human Nutrition, University of Otago, PO Box 56 Dunedin 9054, New Zealand
| | - Jody C Miller
- Department of Human Nutrition, University of Otago, PO Box 56 Dunedin 9054, New Zealand
| | - Lisa A Houghton
- Department of Human Nutrition, University of Otago, PO Box 56 Dunedin 9054, New Zealand
| |
Collapse
|
38
|
Mental models of pregnancy may explain low adherence to folic acid supplementation guidelines: a cross-sectional international survey. Eur J Obstet Gynecol Reprod Biol 2014; 176:99-103. [PMID: 24630297 DOI: 10.1016/j.ejogrb.2014.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 01/22/2014] [Accepted: 02/05/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Mental models of pregnancy refer to women's perceptions of whether their pregnancies are susceptible to poor health outcomes. Mental models influence health behaviour during pregnancy. In the present study we examined whether mental models of pregnancy are linked to compliance with folic acid supplementation guidelines. STUDY DESIGN Cross-sectional survey implemented in four countries (France, Germany, Belgium, and Poland) of women planning a pregnancy (pregnancy planners, n=325) or within the first 18 weeks of pregnancy (currently pregnant, n=326). Logistic regression was used to examine the association between mental models of pregnancy (i.e. whether women felt susceptible to the health consequences of not taking folic acid supplements), maternal background, and use of folic acid supplements. RESULTS Most women (82.8%) had heard of folic acid but only 45.5% were taking folic acid supplements. Use of folic acid supplements did not differ between pregnancy planners and currently pregnant women. Women who believed that they had good general and obstetric health (e.g. no history of illness or miscarriage) and those living in adverse health environments (e.g. smoking, living in poverty) had mental models of being insusceptible to the health consequences of not taking folic acid supplements (p<0.001) and were the lowest users of folic acid supplements (p<0.01). Mediation analyses showed that perceived susceptibility was the common pathway through which the seemingly disparate predictors of folic acid supplementation (i.e. maternal background characteristics) operate. CONCLUSIONS Maternal background characteristics may shape women's mental models of pregnancy and its susceptibility to health complications. Mental models could therefore be the common factor explaining poor adherence to folic acid supplementation guidelines. Findings suggest that in the 'invulnerable mum' mental model, perceived susceptibility to health threats is reduced because the good health of the mother is believed to protect the pregnancy from threat, whereas in the 'invulnerable pregnancy' mental model, perceived susceptibility is reduced because pregnancy is viewed as naturally robust or immune to risk. The challenge for the practitioner wanting to increase adherence to periconceptional health advice is to elicit and correct patients' erroneous beliefs about pregnancy.
Collapse
|
39
|
Peake JN, Copp AJ, Shawe J. Knowledge and periconceptional use of folic acid for the prevention of neural tube defects in ethnic communities in the United Kingdom: systematic review and meta-analysis. ACTA ACUST UNITED AC 2014; 97:444-51. [PMID: 23873812 PMCID: PMC3798113 DOI: 10.1002/bdra.23154] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 04/08/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND: It is widely accepted that periconceptional supplementation with folic acid can prevent a significant proportion of neural tube defects (NTDs). The present study evaluated how folic acid knowledge and periconceptional use for NTD prevention varies by ethnicity in the United Kingdom (U.K.). METHODS: A literature search was conducted to identify studies that included assessment of folic acid knowledge or use in U.K. women of different ethnicities. Only research and referenced sources published after 1991, the year of the landmark Medical Research Council’s Vitamin Study, were included. A meta-analysis was performed of studies that assessed preconceptional folic acid use in Caucasians and non-Caucasians. RESULTS: Five studies met the inclusion criteria for assessment of knowledge and/or use of folic acid supplements in U.K. women including non-Caucasians. The available evidence indicates that South Asians specifically have less knowledge and lower periconceptional use of folic acid than Caucasians; one study found that West Indian and African women also had lower folic acid uptake. A synthesis of results from three of the studies, in a meta-analysis, shows that Caucasians are almost three times more likely to take folic acid before conception than non-Caucasians. CONCLUSION: From the limited evidence available, U.K. women of non-Caucasian ethnicity appear to have less knowledge and a lower uptake of folic acid supplementation than Caucasians during the periconceptional period. Implementing targeted, innovative education campaigns together with a mandatory fortification policy, including the fortification of ethnic minority foods, will be required for maximum prevention of folic acid–preventable NTDs across different ethnic groups. Birth Defects Research (Part A) 97:444–451, 2013. © 2013 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Jordana N Peake
- Institute for Women's Health, University College London, United Kingdom.
| | | | | |
Collapse
|
40
|
Affiliation(s)
- Laura Wyness
- Senior Research Fellow, Queen Margaret University, Edinburgh
| |
Collapse
|
41
|
Popa AD, Niţă O, Graur Arhire LI, Popescu RM, Botnariu GE, Mihalache L, Graur M. Nutritional knowledge as a determinant of vitamin and mineral supplementation during pregnancy. BMC Public Health 2013; 13:1105. [PMID: 24289203 PMCID: PMC3933411 DOI: 10.1186/1471-2458-13-1105] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Accepted: 11/26/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pregnancy is a critical period for both woman and baby from a nutritional perspective. Nutritional education is considered an important tool for promoting a healthy lifestyle, but has not been studied as a determinant for maternal use of supplements during pregnancy, especially in Romania, where evidence about pregnancy and nutrition is scarce. This study aimed to evaluate the relationship between nutritional knowledge and the use of folic acid, iron and multivitamin supplements during pregnancy and to assess the influence of socio-demographic factors and prenatal care. METHODS We conducted a cross-sectional study on a sample of 400 pregnant women admitted to the Cuza-Vodă Obstetrics and Gynaecology Clinical Hospital in Iaşi, Romania, during August-September 2010. We collected self-reported data regarding socio-demographic characteristics, number of prenatal check-ups and the use of folic acid, iron and multivitamin supplements during pregnancy. We assessed nutritional knowledge using a standardized questionnaire divided into three sections: general nutritional recommendations for pregnant women; the roles of nutrients; and sources of nutrients. We used logistic regression to analyse the associations between these factors. RESULTS The prevalence of the use of supplements during pregnancy was 48% for folic acid, 45.3% for iron and 68% for multivitamins. Above-average nutritional knowledge was independently associated with the use of folic acid (aOR, 4.7; 95% CI, 1.6-13.8), iron (aOR, 2.6; 95% CI, 1.2-5.7) and multivitamins (aOR, 2.8; 95% CI, 1.2-6.8). The use of folic acid was independently associated with a higher level of formal education (aOR, 5.2; 95% CI, 2.1-12.8) and an early start in prenatal care (aOR, 3.4; 95% CI, 1.0-11.1). Women with a higher education (aOR, 2.3; 95% CI, 1.1-4.9), more than 10 prenatal visits (aOR, 7.2; 95% CI, 3.4-15.0) and those who received advice on breastfeeding (aOR, 2.0; 95% CI, 1.1-3.5) were more likely to use iron during pregnancy. Similar results were found when analysing the contributing factors for the use of multivitamins: more than 12 years of schooling (aOR, 3.4; 95% CI, 1.4-7.9) and appropriate prenatal care (aOR, 9.4; 95% CI, 4.5-19.5). CONCLUSIONS Level of nutritional knowledge has a strong independent association with the use of supplements during pregnancy.
Collapse
Affiliation(s)
- Alina D Popa
- Nursing Department, University of Medicine and Pharmacy "Gr, T, Popa", Iaşi, România.
| | | | | | | | | | | | | |
Collapse
|
42
|
Tort J, Lelong N, Prunet C, Khoshnood B, Blondel B. Maternal and health care determinants of preconceptional use of folic acid supplementation in France: results from the 2010 National Perinatal Survey. BJOG 2013; 120:1661-7. [DOI: 10.1111/1471-0528.12414] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2013] [Indexed: 11/30/2022]
Affiliation(s)
- J Tort
- INSERM UMRS 953; Epidemiological Research Unit on Perinatal and Women's and Children's Health; Paris France
- UPMC University, Paris; France
| | - N Lelong
- INSERM UMRS 953; Epidemiological Research Unit on Perinatal and Women's and Children's Health; Paris France
- UPMC University, Paris; France
| | - C Prunet
- INSERM UMRS 953; Epidemiological Research Unit on Perinatal and Women's and Children's Health; Paris France
- UPMC University, Paris; France
| | - B Khoshnood
- INSERM UMRS 953; Epidemiological Research Unit on Perinatal and Women's and Children's Health; Paris France
- UPMC University, Paris; France
| | - B Blondel
- INSERM UMRS 953; Epidemiological Research Unit on Perinatal and Women's and Children's Health; Paris France
- UPMC University, Paris; France
| |
Collapse
|
43
|
Use of folic acid supplements and risk of cleft lip and palate in infants: a population-based cohort study. Br J Gen Pract 2012; 62:e466-72. [PMID: 22781994 DOI: 10.3399/bjgp12x652328] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Orofacial clefts occur when the lips or the roof of the mouth do not fuse properly during the early weeks of pregnancy. There is strong evidence that periconceptional use of folic acid can prevent neural tube defects but its effect on oral clefts has generated debate. AIM To identify factors associated with suboptimal periconceptional use of folic acid and its potential effect on oral clefts. DESIGN AND SETTING The population-based infant cohort of the national Growing Up in Ireland study, which consists of 11 134 9-month-old infants. METHOD Data collection comprised questionnaires conducted by interviewers with parents in parents' homes. Characteristics of mothers who did or did not take folic acid before and during pregnancy, as well as the effect of folic acid use on the prevalence of cleft lip and palate were recorded. RESULTS The prevalence of cleft lip and palate was 1.98 (95% confidence interval [CI] = 1.31 to 2.99) per 1000 9-month-olds. The odds ratio for cleft lip was 4.36-fold higher (95% CI = 1.55 to 12.30, P = 0.005) for infants of mothers who did not take folic acid during the first 3 months of pregnancy, when compared with those who did have a folate intake during the first trimester. Folic acid use was suboptimal in 36.3% (95% CI = 35.4 to 37.2) of the sample. CONCLUSION These findings support the hypothesis that taking folic acid may partially prevent cleft lip and palate. They are particularly relevant for GPs, because they are usually the first port of call for women before and during early pregnancy.
Collapse
|
44
|
Morse NL. Benefits of docosahexaenoic acid, folic acid, vitamin D and iodine on foetal and infant brain development and function following maternal supplementation during pregnancy and lactation. Nutrients 2012; 4:799-840. [PMID: 22852064 PMCID: PMC3407995 DOI: 10.3390/nu4070799] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 07/09/2012] [Accepted: 07/12/2012] [Indexed: 11/17/2022] Open
Abstract
UNLABELLED Scientific literature is increasingly reporting on dietary deficiencies in many populations of some nutrients critical for foetal and infant brain development and function. PURPOSE To highlight the potential benefits of maternal supplementation with docosahexaenoic acid (DHA) and other important complimentary nutrients, including vitamin D, folic acid and iodine during pregnancy and/or breast feeding for foetal and/or infant brain development and/or function. METHODS English language systematic reviews, meta-analyses, randomised controlled trials, cohort studies, cross-sectional and case-control studies were obtained through searches on MEDLINE and the Cochrane Register of Controlled Trials from January 2000 through to February 2012 and reference lists of retrieved articles. Reports were selected if they included benefits and harms of maternal supplementation of DHA, vitamin D, folic acid or iodine supplementation during pregnancy and/or lactation. RESULTS Maternal DHA intake during pregnancy and/or lactation can prolong high risk pregnancies, increase birth weight, head circumference and birth length, and can enhance visual acuity, hand and eye co-ordination, attention, problem solving and information processing. Vitamin D helps maintain pregnancy and promotes normal skeletal and brain development. Folic acid is necessary for normal foetal spine, brain and skull development. Iodine is essential for thyroid hormone production necessary for normal brain and nervous system development during gestation that impacts childhood function. CONCLUSION Maternal supplementation within recommended safe intakes in populations with dietary deficiencies may prevent many brain and central nervous system malfunctions and even enhance brain development and function in their offspring.
Collapse
Affiliation(s)
- Nancy L Morse
- Efamol Ltd., 14 Mole Business Park, Leatherhead KT22 7BA, UK.
| |
Collapse
|
45
|
Colapinto CK, O’Connor DL, Dubois L, Tremblay MS. Folic acid supplement use is the most significant predictor of folate concentrations in Canadian women of childbearing age. Appl Physiol Nutr Metab 2012; 37:284-92. [DOI: 10.1139/h11-161] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Cynthia K. Colapinto
- Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute (CHEO-RI), 401 Smyth Road, Room 242, Ottawa, ON K1H 8L1, Canada
- Institute of Population Health, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Deborah L. O’Connor
- Department of Clinical Dietetics; Physiology and Experimental Medicine Program, The Hospital for Sick Children, Room 8511C, 555 University Avenue, Toronto, ON M5G 1X8, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, ON M5S 3E2, Canada
| | - Lise Dubois
- Department of Epidemiology and Community Medicine, Faculty of Medicine, Institute of Population Health, University of Ottawa, 1 Stewart Street, Office 303, Ottawa, ON K1N 6N5, Canada
| | - Mark S. Tremblay
- Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute (CHEO-RI), 401 Smyth Road, Room 211, Ottawa, ON K1H 8L1, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, ON K1H 8L1, Canada
| |
Collapse
|
46
|
Lian H, Ma D, Zhou SF, Li X. Knowledge and use of folic acid for birth defect prevention among women of childbearing age in Shanghai, China: a prospective cross-sectional study. Med Sci Monit 2012; 17:PH87-92. [PMID: 22129911 PMCID: PMC3628124 DOI: 10.12659/msm.882111] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to assess the knowledge, attitude, and practice of folic acid intake for prevention of birth defects in Chinese women of child-bearing age. Material/Methods In this prospective cross-sectional study, a total of 1,338 women aged 20–45 years were randomly selected for interview. Data on folic acid knowledge and information on folic acid intake in the subjects were collected. Age, education, contraception, and status of family planning were used as the independent variables in multivariate logistic regression. Results 55.6% of the subjects took contraception at all times, and 33.9% had pregnancy planning in the next six months. 49.7% of the interviewed women knew the benefits of folic acid and 34.6% realized the correct time of folic acid intake; and 14.9% of these women actually took folic acid daily. Planning to be pregnant in the next six months was associated with knowledge of folic acid benefits, correct time of folic acid intake and actual intake. A higher education level was correlated with the knowledge of folic acid benefits and correct time of folic acid intake, but was not linked to actual intake of folic acid. Conclusions The knowledge and use of folic acid were at low to moderate levels in women at childbearing age in Shanghai, China, and general knowledge of folic acid benefits and correct time of folic acid intake should be conveyed to these women.
Collapse
Affiliation(s)
- Huan Lian
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | | | | | | |
Collapse
|
47
|
Zetstra-van der Woude PA, de Walle HE, de Jong-van den Berg LT. Periconceptional folic acid use: Still room to improve. ACTA ACUST UNITED AC 2012; 94:96-101. [DOI: 10.1002/bdra.22882] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 10/14/2011] [Accepted: 10/29/2011] [Indexed: 01/03/2023]
|
48
|
Emmett JK, Lawrence M, Riley M. Estimating the impact of mandatory folic acid fortification on the folic acid intake of Australian women of childbearing age. Aust N Z J Public Health 2011; 35:442-50. [PMID: 21973251 DOI: 10.1111/j.1753-6405.2011.00759.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The primary aim of this study was to estimate the impact of mandatory folic acid (FA) fortification of bread-making flour on the FA intake of Australian women of childbearing age (16-44 years). The secondary objective was to investigate the relationship between estimated FA intake and socio-economic status (SES) and age. METHOD Dietary modelling was used to estimate FA intake under four mandatory fortification scenarios--no supplement use, supplement use unrelated to FA intake, supplement use only among the highest consumers of bread, and increased supplement use. Data were obtained from the 1995 National Nutrition Survey for food intake patterns, the 2007 Victorian Population Health Survey for FA supplement use, and a marketplace survey. RESULTS It is estimated that the National Health and Medical Research Council (NHMRC) recommendation for an additional 400 μg/day [DOSAGE ERROR CORRECTED] FA will be achieved by a minimum of 3.9, 25.4, 21.7 and 30% of the target population under scenarios 1-4, respectively. The FA upper level of intake is exceeded by a maximum of 0.1, 1.7, 6.1 and 4.1% of the target population for scenarios 1-4, respectively. Conclusions : Mandatory FA fortification is not sufficient for the NHMRC recommendations for minimum and maximum intakes to be met by all of the target population under a number of plausible behaviour scenarios. IMPLICATIONS Targeted nutrition education campaigns are needed for SES and age sub-groups and research of this nature should be extended to other population groups. Monitoring and evaluation of this policy will be important to ensure appropriate FA intake.
Collapse
Affiliation(s)
- Jessica K Emmett
- WHO Collaborating Centre for Obesity Prevention, Deakin University, Victoria CSIRO Food and Nutritional Sciences, Victoria.
| | | | | |
Collapse
|
49
|
Mallard SR, Gray AR, Houghton LA. Delaying mandatory folic acid fortification policy perpetuates health inequalities: results from a retrospective study of postpartum New Zealand women. Hum Reprod 2011; 27:273-82. [DOI: 10.1093/humrep/der387] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
|
50
|
Delissaint D, McKyer ELJ. A systematic review of factors utilized in preconception health behavior research. HEALTH EDUCATION & BEHAVIOR 2011; 38:603-16. [PMID: 21511954 DOI: 10.1177/1090198110389709] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This systematic review critically synthesizes the literature focusing on factors related to preconception health behaviors (PCHBs) among childbearing age women in the United States, developed countries, and developing countries. Ovid Medline and CINAHL databases were searched for peer-reviewed articles published between 1998 and 2008 relating to PCHB. Six major categories of factors were identified: frequency of alcohol intake prior and during pregnancy, glycemic control/diabetes management, physical activity before and during pregnancy, pregnancy planning behavior, cystic fibrosis carrier screening, and other risk factors. A critical finding of this review is that knowledge, awareness, and beliefs of preconception care do not lead to preconception health practice. Younger preconceptional women and women with children were less likely to engage in PCHB. However, women with advanced postgraduate education were more likely to practice preconception care. There is an urgent need to educate young preconceptional women regarding the importance and benefits of practicing preconception care.
Collapse
Affiliation(s)
- Dieula Delissaint
- Texas A&M University Child & Adolescent Health Research Lab, College Station, TX, USA.
| | | |
Collapse
|