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Abdi Aw-Nuur H, Abdullahi Diriye N, Aasheim V, Engen T, Mehrara L, Skirnisdottir Vik E. Somali immigrant women's knowledge of and experiences with folic acid supplement use before and during pregnancy: A qualitative study from Norway. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 39:100946. [PMID: 38211483 DOI: 10.1016/j.srhc.2024.100946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 12/21/2023] [Accepted: 01/03/2024] [Indexed: 01/13/2024]
Abstract
INTRODUCTION Health authorities in many countries recommend that women should take folic acid supplements before and during pregnancy to prevent having babies with neural tube defects. Somali immigrant women in Norway use less folic acid supplements than the recommended amount and subsequently, less than Norwegian-born women. OBJECTIVES To explore Somali immigrant women's knowledge of and experiences with using folic acid supplements before and during pregnancy. METHODS Data were collected through semi-structured individual interviews with ten Somali immigrant women in Norway. The participants were recruited and interviewed between September and November 2019. Graneheim and Lundmańs qualitative content analysis was used for data analysis. RESULTS Two main themes were developed through the process of analysing the data: 1) Attitudes to life and pregnancy affect how health care advice is met; 2) Understanding the benefits of folic acid is crucial. CONCLUSIONS The women in this study had varied knowledge about, and experiences with the use of folic acid supplements before and during pregnancy. The findings suggest that the healthcare system needs to adapt the information it provides on folic acid supplementation to target the needs of Somali immigrant women. In line with suggestions from the study participants, information needs to be given in a timely manner, by someone they trust, in their first language, include visual aids, and be offered to all women of childbearing age before their first pregnancy.
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Affiliation(s)
- Hana Abdi Aw-Nuur
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, PO.box 7030, N-5020 Bergen, Norway
| | - Nasra Abdullahi Diriye
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, PO.box 7030, N-5020 Bergen, Norway
| | - Vigdis Aasheim
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, PO.box 7030, N-5020 Bergen, Norway
| | - Tone Engen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, PO.box 7030, N-5020 Bergen, Norway
| | - Lydia Mehrara
- Faculty of Education, Arts, and Sports, Western Norway University of Applied Sciences, PO.box 6856 Sogndal, Norway
| | - Eline Skirnisdottir Vik
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, PO.box 7030, N-5020 Bergen, Norway.
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Saunders CM, Rehbinder EM, Carlsen KCL, Gudbrandsgard M, Carlsen KH, Haugen G, Hedlin G, Jonassen CM, Sjøborg KD, Landrø L, Nordlund B, Rudi K, O Skjerven H, Söderhäll C, Staff AC, Vettukattil R, Carlsen MH. Food and nutrient intake and adherence to dietary recommendations during pregnancy: a Nordic mother-child population-based cohort. Food Nutr Res 2019; 63:3676. [PMID: 31920469 PMCID: PMC6939665 DOI: 10.29219/fnr.v63.3676] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 12/21/2022] Open
Abstract
Background A woman's food intake during pregnancy has important implications not only for herself but also for the future health and well-being of her child. Suboptimal dietary quality has been consistently reported in many high-income countries, reflecting poor adherence to dietary guidelines. Objective This study aimed to explore the intake of food and nutrients in a cohort of pregnant women in Norway and their adherence to Nordic Nutrition Recommendations (NNR) and Norwegian food-based guidelines (NFG). Design We investigated the dietary intake in 1,674 pregnant women from the mother-child birth cohort, PreventADALL, recruited at approximately 18-week gestational age. Dietary intake was assessed by an electronic validated food frequency questionnaire (PrevFFQ) in the first half of pregnancy. Results Total fat intake was within the recommended intake (RI) range in most women; however, the contribution of saturated fatty acids to the total energy intake was above RI in the majority (85.2%) of women. Carbohydrate intake was below RI in 43.9% of the women, and 69.5% exceeded the RI of salt. Intakes of fiber, vegetables, and fish were high in a large part of the population. Many women had a high probability of inadequate intakes of the following key micronutrients during pregnancy: folate (54.4%), iron (49.6%), calcium (36.2%), vitamin D (28.7%), iodine (24.4%), and selenium (41.3%). A total of 22.8% women reported an alcohol intake of >1 g/day, and 4.4% reported an alcohol intake of >10 g/day. Women with higher educational levels showed a tendency towards healthier eating habits, except for higher intakes of alcohol and coffee, compared to women with lower educational level. Discussion Excessive saturated fat intake and limited intake of many important micronutrients during pregnancy were common, potentially increasing the risk for adverse pregnancy and birth outcomes. Conclusions This study highlights the need for improved nutritional guidance to pregnant women across all educational levels.
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Affiliation(s)
- Carina Madelen Saunders
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Eva Maria Rehbinder
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Dermatology, Oslo University Hospital, Oslo, Norway
| | - Karin C Lødrup Carlsen
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Malén Gudbrandsgard
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Kai-Håkon Carlsen
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Guttorm Haugen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Gunilla Hedlin
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Christine Monceyron Jonassen
- Genetic Unit, Centre for Laboratory Medicine, Østfold Hospital Trust, Kalnes, Norway.,Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway
| | | | - Linn Landrø
- Department of Dermatology, Oslo University Hospital, Oslo, Norway
| | - Björn Nordlund
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Knut Rudi
- Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway
| | - Håvard O Skjerven
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Cilla Söderhäll
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Anne Cathrine Staff
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Riyas Vettukattil
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Monica Hauger Carlsen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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3
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Mohammed BS, Kawawa AR, Wemakor A. Prevalence and determinants of uptake of folic acid in peri‐conceptional period in a rural lower‐middle‐income country, Ghana. Basic Clin Pharmacol Toxicol 2019; 126:254-262. [DOI: 10.1111/bcpt.13331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/23/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Anthony Wemakor
- University for Development Studies School of Allied Health Sciences Tamale Ghana
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Mortensen JHS, Øyen N, Nilsen RM, Fomina T, Tretli S, Bjørge T. Paternal characteristics associated with maternal periconceptional use of folic acid supplementation. BMC Pregnancy Childbirth 2018; 18:188. [PMID: 29843620 PMCID: PMC5975548 DOI: 10.1186/s12884-018-1830-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 05/15/2018] [Indexed: 11/16/2022] Open
Abstract
Background Maternal predictors of folic acid (FA) supplementation use to reduce offspring risk of neural tube defects are well known, while paternal determinants for maternal FA use are less known. Such knowledge is important to increase women’s compliance to recommended periconceptional FA use. Methods In a nation-wide study of 683,785 births registered in the Medical Birth Registry of Norway during 1999–2010, the associations between paternal characteristics (age, education, occupation, country of origin) and maternal FA use were estimated by relative risks (RR) with 95% confidence intervals (CI), using log-binomial regression. Results Maternal FA use before and during pregnancy (adequate FA use) was found in 16% of the births. The association between paternal age and adequate FA use was inversely U-shaped; adjusted RRs for adequate FA use were 0.35 (95% CI 0.28–0.43) and 0.72 (95% CI 0.71–0.74) for paternal age < 20 and ≥ 40 years, respectively, comparing age 30–34 years. Compulsory education (1–9 years) among fathers was compared to tertiary education; the RR was 0.69 (95% CI 0.68–0.71) for adequate FA use. The lower risk of adequate FA use for paternal compulsory education was present in all categories of maternal education. Occupation classes other than “Higher professionals” were associated with decreased risk of adequate FA use, compared with the reference “Lower professionals”. RR for adequate FA use was 0.58 (95% CI 0.56–0.60) comparing fathers from “Low/middle-income countries” with fathers born in Norway. Conclusion Adequate FA use in the periconceptional period was lower when fathers were younger or older than 30–34 years, had shorter education, had manual or self-employed occupations, or originated from low/middle-income countries. Partners may contribute to increase women’s use of periconceptional FA supplementation.
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Affiliation(s)
- Jan Helge Seglem Mortensen
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, N-5018, Bergen, Norway. .,Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.
| | - Nina Øyen
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, N-5018, Bergen, Norway.,Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway
| | - Roy M Nilsen
- Department of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Tatiana Fomina
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, N-5018, Bergen, Norway
| | | | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, N-5018, Bergen, Norway.,Cancer Registry of Norway, Oslo, Norway
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Frank AS, Lupattelli A, Nordeng H. Risk factors for discontinuation of thyroid hormone replacement therapy in early pregnancy: a study from the Norwegian Mother and Child Cohort Study and the Medical Birth Registry of Norway. Acta Obstet Gynecol Scand 2018. [PMID: 29512826 DOI: 10.1111/aogs.13339] [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] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Approximately 3-5% of pregnant women have hypothyroidism. Despite the potential impact of untreated hypothyroidism on infant neurodevelopment, few studies have investigated the risk factors associated with discontinuation of thyroid hormone replacement therapy (THRT) in pregnancy. We aimed to identify such factors in a population of women using THRT prior to pregnancy. MATERIAL AND METHODS Data from the Norwegian Mother and Child Cohort Study were linked to records in the Medical Birth Registry of Norway. Pregnant women with hypothyroidism prior to pregnancy were categorized as discontinuers or continuers of THRT in pregnancy. The main analysis used generalized estimating equations based on multiply imputed data. RESULTS Of 86 848 enrolled pregnant women, 2720 (3.2%) had a medically confirmed thyroid disorder and/or reported use of thyroid therapy. More than half (n = 1587; 57.8%) used THRT prior to pregnancy; of these, 207 (13.0%) discontinued and 1380 (86.9%) continued THRT during early pregnancy. Having a non-medicated mental disorder [odds ratio (OR) 1.64, 95% CI 1.03-2.63] and non-compliance with recommended nutritional supplementation (OR 2.51, 95% CI 1.82-3.47) increased the odds of discontinuing THRT. Women medicated for somatic comorbidities (OR 0.56, 95% CI 0.33-0.98) had a 44% decreased odds of discontinuing THRT. CONCLUSIONS In Norway, around 13% of women with hypothyroidism discontinue THRT in early pregnancy. For discontinuers, non-medicated mental comorbidity and non-compliance with nutritional supplements presented increased risk, whereas having a medicated somatic disorder was protective. Health professionals advising women with hypothyroidism should be aware of risk factors associated with THRT discontinuation.
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Affiliation(s)
- Anna S Frank
- Pharmacoepidemiology and Drug Safety Research Group, School of Pharmacy, University of Oslo, Oslo, Norway
| | - Angela Lupattelli
- Pharmacoepidemiology and Drug Safety Research Group, School of Pharmacy, University of Oslo, Oslo, Norway
| | - Hedvig Nordeng
- Pharmacoepidemiology and Drug Safety Research Group, School of Pharmacy, University of Oslo, Oslo, Norway.,Department of Child Health and Development, National Institute of Public Health, Oslo, Norway
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Wolf HT, Hegaard HK, Huusom LD, Pinborg AB. Multivitamin use and adverse birth outcomes in high-income countries: a systematic review and meta-analysis. Am J Obstet Gynecol 2017; 217:404.e1-404.e30. [PMID: 28377269 DOI: 10.1016/j.ajog.2017.03.029] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/10/2017] [Accepted: 03/23/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND In high-income countries, a healthy diet is widely accessible. However, a change toward a poor-quality diet with a low nutritional value in high-income countries has led to an inadequate vitamin intake during pregnancy. OBJECTIVE We conducted a systematic review and meta-analysis to evaluate the association between multivitamin use among women in high-income countries and the risk of adverse birth outcomes (preterm birth [primary outcome], low birthweight, small for gestational age, stillbirth, neonatal death, perinatal mortality, and congenital anomalies without further specification). STUDY DESIGN We searched electronic databases (MEDLINE, Embase, Cochrane, Scopus, and CINAHL) from inception to June 17, 2016, using synonyms of pregnancy, study/trial type, and multivitamins. Eligible studies were all studies in high-income countries investigating the association between multivitamin use (3 or more vitamins or minerals in tablets or capsules) and adverse birth outcomes. We evaluated randomized, controlled trials using the Cochrane Collaboration tool. Observational studies were evaluated using the Newcastle-Ottawa Scale. Meta-analyses were applied on raw data for outcomes with data for at least 2 studies and were conducted using RevMan (version 5.3). Outcomes were pooled using the random-effect model. The quality of evidence was assessed using the Grades of Research, Assessment, Development and Evaluation approach. RESULTS We identified 35 eligible studies including 98,926 women. None of the studies compared the use of folic acid and iron vs the use of multivitamins. The use of multivitamin did not change the risk of the primary outcome, preterm birth (relative risk, 0.84 [95% confidence interval, 0.69-1.03]). However, the risk of small for gestational age (relative risk, 0.77 [95% confidence interval, 0.63-0.93]), neural tube defects (relative risk, 0.67 [95% confidence interval, 0.52-0.87]), cardiovascular defects (relative risk, 0.83 [95% confidence interval, 0.70-0.98]), urine tract defects (relative risk, 0.60 [95% confidence interval, 0.46-0.78]), and limb deficiencies (relative risk, 0.68 [95% confidence interval, 0.52-0.89]) was decreased. Of the 35 identified studies, only 4 were randomized, controlled trials. The degree of clinical evidence according to the Grades of Research, Assessment, Development, and Evaluation system was low or very low for all outcomes except for recurrence of neural tube defects in which a moderate degree of clinical evidence was found. CONCLUSION Routine multivitamin use in high-income countries can be recommended but with caution because of the low quality of evidence. Randomized, controlled trials or well-performed, large prospective cohort studies are needed.
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7
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Kinnunen TI, Sletner L, Sommer C, Post MC, Jenum AK. Ethnic differences in folic acid supplement use in a population-based cohort of pregnant women in Norway. BMC Pregnancy Childbirth 2017; 17:143. [PMID: 28506268 PMCID: PMC5433134 DOI: 10.1186/s12884-017-1292-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 03/23/2017] [Indexed: 11/13/2022] Open
Abstract
Background Peri-conceptional use of folic acid supplements is recommended to prevent neural tube defects. Correct supplement use seems to be less common among ethnic minorities. We examined ethnic differences in folic acid supplement use before and during pregnancy and possible effect modification by education or planning of pregnancy. Methods The participants were 811 healthy pregnant women from a population-based cohort study in Oslo, Norway in 2008–2010. Ethnicity was categorized to five groups (European, Middle Eastern, South Asian, East Asian, African). Data on folic acid supplement use were obtained from hospital records and remaining data by a questionnaire. Logistic regression analyses were adjusted for age, parity, planning of pregnancy, education and Norwegian language skills. Results Before pregnancy, 30.1% of European women and 7.1 to 13.6% of women in the other ethnic groups used folic acid supplements (p < 0.001). The adjusted odds ratio (OR) for supplement use was 0.55 (95% confidence interval 0.31; 0.96) for South Asian and 0.42 (95% confidence interval 0.19; 0.94) for Middle Eastern women compared with European women. During pregnancy, supplement use was most common in European women (65.7%) and least common in Middle Eastern (29.4%) and African women (29.0%) (p < 0.001). Compared with European women, all other ethnic groups had lower adjusted odds (OR 0.30 to 0.50, p < 0.05 for all) for supplement use among women with high school or less education, but not among more educated women. Planning of pregnancy did not modify the association between ethnicity and supplement use. Conclusions Few women used folic acid supplements before pregnancy. Educational level modified the association between ethnicity and supplement use during pregnancy. Public health campaigns should focus on increasing awareness especially in ethnic minority groups with low educational level.
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Affiliation(s)
- Tarja I Kinnunen
- Faculty of Social Sciences /Health Sciences, University of Tampere, Tampere, Finland
| | - Line Sletner
- Department of Child and Adolescents Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Christine Sommer
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Anne Karen Jenum
- Institute of Health and Society, Department of General Practice, Faculty of Medicine, University of Oslo, Oslo, Norway.
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Gildestad T, Øyen N, Klungsøyr K, Nilsen RM, Daltveit AK, Vollset SE. Maternal use of folic acid supplements and infant risk of neural tube defects in Norway 1999–2013. Scand J Public Health 2016; 44:619-26. [DOI: 10.1177/1403494816649494] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2016] [Indexed: 12/16/2022]
Abstract
Aims: Like most European countries, Norway has refrained from mandatory food fortification with folic acid to reduce the number of neural tube defects. We explored the role of folic acid and multivitamin supplements in the prevention of neural tube defects among newborn infants. Methods: We used data from the Medical Birth Registry of Norway, 1999–2013. A total of 528,220 women had 880,568 pregnancies resulting in 896,674 live- and stillborn infants, of whom 270 had neural tube defects. Relative risks were estimated with log-binomial regression. Results: From 1999 to 2013, intake of folic acid supplements increased from 4.8% to 27.4%. Vitamin supplement use was more frequent in older, married or cohabiting women and those with lower parity, as well as women who did not smoke during pregnancy. The overall adjusted relative risk of infant neural tube defects associated with maternal vitamin intake before pregnancy relative to no intake was 0.76 (95% confidence interval: 0.53–1.10). When we divided our study period in two (1999–2005 and 2006–2013), we found a significantly reduced risk of neural tube defects overall by vitamin use in the second time period, but not in the first: adjusted relative risk 0.54 (95% confidence interval: 0.31–0.91) and 1.02 (95% confidence interval: 0.63–1.65), respectively. Conclusions:Over the full study period, we found no statistically significant association between vitamin use and neural tube defects overall. However, vitamin use was associated with a significantly lower risk of neural tube defects in the second half of the study period, 2006–2013.
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Affiliation(s)
- Trude Gildestad
- Department of Global Public Health and Primary Care, University of Bergen, Norway
- Department of Dermatology, Haukeland University Hospital, Norway
| | - Nina Øyen
- Department of Global Public Health and Primary Care, University of Bergen, Norway
- Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Norway
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Norway
- Medical Birth Registry of Norway, Norwegian Institute of Public Health, Norway
| | - Roy Miodini Nilsen
- Department of Global Public Health and Primary Care, University of Bergen, Norway
- Centre for Clinical Research, Haukeland University Hospital, Norway
| | - Anne Kjersti Daltveit
- Department of Global Public Health and Primary Care, University of Bergen, Norway
- Medical Birth Registry of Norway, Norwegian Institute of Public Health, Norway
| | - Stein Emil Vollset
- Department of Global Public Health and Primary Care, University of Bergen, Norway
- Centre for Disease Burden; Norwegian Institute of Public Health, Norway
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Navarrete-Muñoz EM, Valera-Gran D, García de la Hera M, Gimenez-Monzo D, Morales E, Julvez J, Riaño I, Tardón A, Ibarluzea J, Santa-Marina L, Murcia M, Rebagliato M, Vioque J. Use of high doses of folic acid supplements in pregnant women in Spain: an INMA cohort study. BMJ Open 2015; 5:e009202. [PMID: 26603248 PMCID: PMC4663411 DOI: 10.1136/bmjopen-2015-009202] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES We examined the use of low (<400 μg/day, including no use) and high folic acid supplement (FAS) dosages (≥1000 μg/day) among pregnant women in Spain, and explored factors associated with the use of these non-recommended dosages. DESIGN Population-based cohort study. SETTING Spain. PARTICIPANTS We analysed data from 2332 pregnant women of the INMA study, a prospective mother-child cohort study in Spain. MAIN OUTCOME MEASURES We assessed usual dietary folate and the use of FAS from preconception to the 3rd month (first period) and from the 4th to the 7th month (second period), using a validated food frequency questionnaire. We used multinomial logistic regression to estimate relative risk ratios (RRRs). RESULTS Over a half of the women used low dosages of FAS in the first and second period while 29% and 17% took high dosages of FAS, respectively. In the first period, tobacco smoking (RRR=1.63), alcohol intake (RRR=1.40), multiparous (RRR=1.44), unplanned pregnancy (RRR=4.20) and previous spontaneous abortion (RRR=0.58, lower use of high FAS dosages among those with previous abortions) were significantly associated with low FAS dosages. Alcohol consumption (RRR=1.42), unplanned pregnancy (RRR=2.66) and previous spontaneous abortion (RRR=0.68) were associated with high dosage use. In the second period, only tobacco smoking was significantly associated with high FAS dosage use (RRR=0.67). CONCLUSIONS A high proportion of pregnant women did not reach the recommended dosages of FAS in periconception and a considerable proportion also used FAS dosages ≥1000 μg/day. Action should be planned by the Health Care System and health professionals to improve the appropriate periconceptional use of FAS, taking into consideration the associated factors.
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Affiliation(s)
- Eva María Navarrete-Muñoz
- Departamento Salud Pública, Universidad Miguel Hernández, San Juan de Alicante, Spain CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Desirée Valera-Gran
- Departamento Salud Pública, Universidad Miguel Hernández, San Juan de Alicante, Spain
| | - Manoli García de la Hera
- Departamento Salud Pública, Universidad Miguel Hernández, San Juan de Alicante, Spain CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Daniel Gimenez-Monzo
- Departamento Salud Pública, Universidad Miguel Hernández, San Juan de Alicante, Spain
| | - Eva Morales
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - Jordi Julvez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - Isolina Riaño
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain Servicio de Pediatria, Hospital San Agustin-Aviles, Asturias, Spain
| | - Adonina Tardón
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain Universidad de Oviedo, Asturias, Spain
| | - Jesus Ibarluzea
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain Subdirección de Salud Pública y Adicciones de Gipuzkoa, San Sebastian, Spain Instituto de Investigación Sanitaria BIODONOSTIA, San Sebastián, Spain
| | - Loreto Santa-Marina
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain Subdirección de Salud Pública y Adicciones de Gipuzkoa, San Sebastian, Spain Instituto de Investigación Sanitaria BIODONOSTIA, San Sebastián, Spain
| | - Mario Murcia
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO/CSISP), Public Health, Valencia, Spain
| | - Marisa Rebagliato
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain Departamento de Medicina, Universitat Jaume I, Castellón de la Olana, Spain
| | - Jesus Vioque
- Departamento Salud Pública, Universidad Miguel Hernández, San Juan de Alicante, Spain CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
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10
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Lilungulu A, Matovelo D, Kihunrwa A, Gumodoka B. Spectrum of maternal and perinatal outcomes among parturient women with preceding short inter-pregnancy interval at Bugando Medical Centre, Tanzania. Matern Health Neonatol Perinatol 2015; 1:1. [PMID: 27057319 PMCID: PMC4772750 DOI: 10.1186/s40748-014-0002-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 10/24/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Traditionally women with a short inter-pregnancy interval will not have sufficient time to recover and get ready for the subsequent pregnancy. This includes socio-economic, cultural, psychological and physical body preparedness. The present study aimed at comparing the maternal and perinatal outcomes among parturient women with preceding short and normal inter-pregnancy interval attending at Bugando Medical Centre (BMC). This was a prospective cohort study. It was done from November 2012 to April 2013. Multiple matching design approach was used to adjust for age variable during selection of participants. Chi-square test and Relative Risk (RR) were calculated to test for strength of association between variables. RESULTS Four hundred and fifty (450) women were recruited in this study in which 150 had a SIPI and 300 had a NIPI. The premature rupture of membrane (PROM) was higher [RR = 13.6; 95% CI 7.2 - 25.6] among SIPI women than in NIPI women [RR = 0.57; 95% CI 0.49-0.7]. Women with a SIPI were found to have a significantly higher risk for anemia (RR = 3.4) compared to those with a NIPI (RR = 0.08). SIPI women had a higher risk for failure of trial of vaginal birth after caesarean section (VBAC) (RR = 14.7; 95% CI 6.4 - 33.6) compared to NIPI (RR = 0.72; 95% CI 0.65-0.8). The risk of postpartum hemorrhage (PPH) was higher among SIPI women (RR = 5.8) compared to women of NIPI (RR = 0.83). Women with SIPI had higher risk for small for gestation age (SGA) babies (RR = 7.7; 95% CI 3.8-15.7), low birth weight (RR = 6.7; 95% CI 3.6-12.3), preterm delivery (RR = 9.78; 95% CI 4.9-19.5) and low Apgar score (RR = 6.9; 95% CI 0.7-0.8) compared to women in NIPI. CONCLUSION Higher risk for PROM, anemia, failure of trial of VBAC, PPH and preeclampsia were observed among women with SIPI. Babies born of mothers with a SIPI were significantly at higher risk for SGA, low birth weight, low Apgar score, preterm deliveries compared to women in NIPI. Birth spacing, creating more awareness of complications, on risks associated with SIPI and provision of folate supplements should be advocated.
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Affiliation(s)
- Athanase Lilungulu
- />Department of Obstetrics & Gynecology, Catholic University of Health & Allied sciences, P.O. BOX 1464, Mwanza, Tanzania
| | - Dismas Matovelo
- />Department of Obstetrics & Gynecology, Catholic University of Health & Allied sciences, P.O. BOX 1464, Mwanza, Tanzania
| | - Albert Kihunrwa
- />Department of Obstetrics & Gynecology, Catholic University of Health & Allied sciences, P.O. BOX 1464, Mwanza, Tanzania
- />Department of Obstetrics & Gynecology, Bugando Medical Centre, P.O. BOX 1370, Mwanza, Tanzania
| | - Balthazar Gumodoka
- />Department of Obstetrics & Gynecology, Catholic University of Health & Allied sciences, P.O. BOX 1464, Mwanza, Tanzania
- />Department of Obstetrics & Gynecology, Bugando Medical Centre, P.O. BOX 1370, Mwanza, Tanzania
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Disparities in Access to Prenatal Care Services for African Immigrant Women in Spain. J Immigr Minor Health 2014; 17:1355-63. [PMID: 25138137 DOI: 10.1007/s10903-014-0086-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This retrospective cohort study compares the utilization of prenatal care between African immigrant and native Spanish women. For 2007-2010, we identified 231 pregnant African immigrant women. The native-born population sample was obtained by simple random sampling in a 1:3 ratio. The Kessner Index (KI) and our Own Index (OI) were applied to rate prenatal care adequacy in three categories (adequate, intermediate, and inadequate). Odds ratios (ORs) were estimated using non-conditional logistic regression. Prenatal care was adequate according to the indexes (KI or OI) in 21.3 and 25.8% of North Africans and in 22.5 and 30.4% of sub-Saharan Africans. The ORs of inadequacy when adjusted for maternal age, social risk factors, and previous reproductive outcomes were 30.32 and 35.47 (KI or OI) in North and 64.43 and 67.93 in sub- Saharan Africans. These results suggest significant differences in obtaining adequate prenatal care between immigrant and native Spanish women.
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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
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Cueto HT, Riis AH, Hatch EE, Wise LA, Rothman KJ, Mikkelsen EM. Predictors of preconceptional folic acid or multivitamin supplement use: a cross-sectional study of Danish pregnancy planners. Clin Epidemiol 2012; 4:259-65. [PMID: 23071405 PMCID: PMC3470456 DOI: 10.2147/clep.s35463] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Compliance with the Danish preconceptional folic acid (FA) recommendation – a daily supplement of 400 μg – is reported to be poor. Uncertainty remains, however, about the prevalence of compliers and health-related predictors of compliance in the preconceptional period. Methods We used self-reported baseline data from 5383 women, aged 18–40 years, enrolled in an Internet-based prospective cohort study of Danish pregnancy planners during 2007–2011. We estimated the prevalence proportions of FA or multivitamin (MV) use in relation to selected sociodemographic, lifestyle, reproductive, and medical characteristics. Multivariate binomial regression was used to obtain prevalence proportion differences with 95% confidence intervals for each level of study predictors, adjusted for all other predictors. Results Overall, 7.7% of women used FA supplements, 20.4% used MV supplements, 34.0% used both, 1.5% used other single vitamins or minerals, and 36.4% did not use any dietary supplements. The prevalence of FA or MV supplement use was higher among older women, women with higher education and income, and women with healthy lifestyle factors such as being a nonsmoker, nondrinker, physically active, maintaining a normal body mass index and having regular pap smears. Greater intercourse frequency and a history of spontaneous abortion were also positively associated with FA or MV supplement use. We found no clear association between use of FA or MV supplements and a diagnosis of hypertension, diabetes, thyroid disease, pelvic inflammatory disease, or chlamydia. Conclusion A large proportion of pregnancy planners do not use FA or MV supplements. Pregnancy planners with generally risky lifestyle behaviors are less likely to comply with the FA recommendation.
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Affiliation(s)
- Heidi T Cueto
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Wien TN, Pike E, Wisløff T, Staff A, Smeland S, Klemp M. Cancer risk with folic acid supplements: a systematic review and meta-analysis. BMJ Open 2012; 2:e000653. [PMID: 22240654 PMCID: PMC3278486 DOI: 10.1136/bmjopen-2011-000653] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective To explore if there is an increased cancer risk associated with folic acid supplements given orally. Design Systematic review and meta-analysis of controlled studies of folic acid supplementation in humans reporting cancer incidence and/or cancer mortality. Studies on folic acid fortification of foods were not included. Data sources Cochrane Library, Medline, Embase and Centre of Reviews and Dissemination, clinical trial registries and hand-searching of key journals. Results From 4104 potential references, 19 studies contributed data to our meta-analyses, including 12 randomised controlled trials (RCTs). Meta-analysis of the 10 RCTs reporting overall cancer incidence (N=38 233) gave an RR of developing cancer in patients randomised to folic acid supplements of 1.07 (95% CI 1.00 to 1.14) compared to controls. Overall cancer incidence was not reported in the seven observational studies. Meta-analyses of six RCTs reporting prostate cancer incidence showed an RR of prostate cancer of 1.24 (95% CI 1.03 to 1.49) for the men receiving folic acid compared to controls. No significant difference in cancer incidence was shown between groups receiving folic acid and placebo/control group, for any other cancer type. Total cancer mortality was reported in six RCTs, and a meta-analysis of these did not show any significant difference in cancer mortality in folic acid supplemented groups compared to controls (RR 1.09, 95% CI 0.90 to 1.30). None of the observational studies addressed mortality. Conclusions A meta-analysis of 10 RCTs showed a borderline significant increase in frequency of overall cancer in the folic acid group compared to controls. Overall cancer incidence was not reported in the seven observational studies. Prostate cancer was the only cancer type found to be increased after folic acid supplementation (meta-analyses of six RCTs). Prospective studies of cancer development in populations where food is fortified with folic acid could indicate whether fortification similar to supplementation moderately increases prostate cancer risk.
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Affiliation(s)
- Tale Norbye Wien
- Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | - Eva Pike
- Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | - Torbjørn Wisløff
- Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | - Annetine Staff
- Department of Obstetrics and Department of Gynaecology, Oslo University Hospital, Oslo, Norway
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sigbjørn Smeland
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Surgery and Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Marianne Klemp
- Norwegian Knowledge Centre for the Health Services, Oslo, Norway
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Kingston D, Heaman M, Chalmers B, Kaczorowski J, O’Brien B, Lee L, Dzakpasu S, O’Campo P. Comparison of Maternity Experiences of Canadian-Born and Recent and Non-Recent Immigrant Women: Findings From the Canadian Maternity Experiences Survey. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2011; 33:1105-1115. [DOI: 10.1016/s1701-2163(16)35078-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Staff A. [Neural tube defects can be prevented]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2011; 131:332. [PMID: 21339770 DOI: 10.4045/tidsskr.11.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Hoyo C, Murtha AP, Schildkraut JM, Forman MR, Calingaert B, Demark-Wahnefried W, Kurtzberg J, Jirtle RL, Murphy SK. Folic acid supplementation before and during pregnancy in the Newborn Epigenetics STudy (NEST). BMC Public Health 2011; 11:46. [PMID: 21255390 PMCID: PMC3038155 DOI: 10.1186/1471-2458-11-46] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 01/21/2011] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Folic acid (FA) added to foods during fortification is 70-85% bioavailable compared to 50% of folate occurring naturally in foods. Thus, if FA supplements also are taken during pregnancy, both mother and fetus can be exposed to FA exceeding the Institute of Medicine's recommended tolerable upper limit (TUL) of 1,000 micrograms per day (μg/d) for adult pregnant women. The primary objective is to estimate the proportion of women taking folic acid (FA) doses exceeding the TUL before and during pregnancy, and to identify correlates of high FA use. METHODS During 2005-2008, pre-pregnancy and pregnancy-related data on dietary supplementation were obtained by interviewing 539 pregnant women enrolled at two obstetrics-care facilities in Durham County, North Carolina. RESULTS Before pregnancy, 51% of women reported FA supplementation and 66% reported this supplementation during pregnancy. Before pregnancy, 11.9% (95% CI = 9.2%-14.6%) of women reported supplementation with FA doses above the TUL of 1,000 μg/day, and a similar proportion reported this intake prenatally. Before pregnancy, Caucasian women were more likely to take FA doses above the TUL (OR = 2.99; 95% = 1.28-7.00), compared to African American women, while women with chronic conditions were less likely to take FA doses above the TUL (OR = 0.48; 95%CI = 0.21-0.97). Compared to African American women, Caucasian women were also more likely to report FA intake in doses exceeding the TUL during pregnancy (OR = 5.09; 95%CI = 2.07-12.49). CONCLUSIONS Fifty-one percent of women reported some FA intake before and 66% during pregnancy, respectively, and more than one in ten women took FA supplements in doses that exceeded the TUL. Caucasian women were more likely to report high FA intake. A study is ongoing to identify possible genetic and non-genotoxic effects of these high doses.
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Affiliation(s)
- Cathrine Hoyo
- Department of Community and Family Medicine and Program of Cancer Detection, Prevention and Control, Duke University, PO Box 104006, Durham, NC 27710, USA
| | - Amy P Murtha
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Duke University, 4022 Hospital South, Durham, NC 27710, USA
| | - Joellen M Schildkraut
- Department of Community and Family Medicine and Program of Cancer Detection, Prevention and Control, Duke University, PO Box 104006, Durham, NC 27710, USA
| | - Michele R Forman
- Department of Epidemiology, MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1340, Houston, TX 77030-4009, USA
| | - Brian Calingaert
- Department of Community and Family Medicine and Program of Cancer Detection, Prevention and Control, Duke University, PO Box 104006, Durham, NC 27710, USA
| | - Wendy Demark-Wahnefried
- Department of Behavioral Science, MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1340, Houston, TX 77030-4009, USA
| | - Joanne Kurtzberg
- Department of Pathology and Carolinas Cord Blood Banking Project, Duke University, 1430 N. Pavilion Bldg, Durham, NC 27705, USA
| | - Randy L Jirtle
- Department of Radiation Oncology, 139 Env Safety Bldg., Durham, NC 27710, USA
| | - Susan K Murphy
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Department of Pathology Duke University, 226 B Wing LSRC Research Drive Durham, NC 27708, USA
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Haugen M, Brantsaeter AL, Alexander J, Meltzer HM. Dietary supplements contribute substantially to the total nutrient intake in pregnant Norwegian women. ANNALS OF NUTRITION AND METABOLISM 2008; 52:272-80. [PMID: 18645244 DOI: 10.1159/000146274] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Accepted: 03/26/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND Use of dietary supplements during pregnancy may give an important contribution to nutrient intake, and for nutrients like folate and vitamin D supplements are recommended. Our objective was to study use and contribution of dietary supplement to nutrient intake among women participating in the Norwegian Mother and Child Cohort Study (MoBa). METHODS This study is based on 40,108 women participating in MoBa which is conducted by the Norwegian Institute of Public Health. The women had filled inversion 2 of the food frequency questionnaire in MoBa between February 2002 and February 2005. RESULTS 81% reported use of one or more dietary supplements. The most commonly used category was cod liver oil/fish oil supplements (59%) followed by singular folic acid supplements (36%) and multivitamin/multimineral supplements (31%). The nutrient contribution of the dietary supplements varied from 65% for folate and vitamin D to 1% for potassium among supplement users. The dietary intake of vitamin D, folate, iodine and iron did not reach the Nordic Recommendations for pregnant women. CONCLUSIONS Use of supplements improved the intake of folate, iron and vitamin D, but not sufficiently to reach the recommended amounts.
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Affiliation(s)
- Margaretha Haugen
- Department of Food Safety and Nutrition, Division of Environmental Medicine, Norwegian Institute of Public Health, Oslo, Norway.
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Chivu CM, Tulchinsky TH, Soares-Weiser K, Braunstein R, Brezis M. A systematic review of interventions to increase awareness, knowledge, and folic acid consumption before and during pregnancy. Am J Health Promot 2008; 22:237-45. [PMID: 18421888 DOI: 10.4278/06051566r2.1] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We conducted a systematic review of studies designed to increase awareness of knowledge about, and consumption of folic acid before and during pregnancy. DATA SOURCES Studies were identified from Cochrane Library, Medline, and the references of primary studies and reviews. STUDY INCLUSION AND EXCLUSION CRITERIA Studies included randomized controlled trials, quasi-experimental interrupted time series studies, follow-up studies, case-control studies, and before-and-after studies, all of which were conducted between 1992 and 2005 on women ages 15 to 49 years and/or health professionals, evaluating awareness and/or knowledge and/or consumption of folic acid both before and after intervention. Studies were excluded if data were not presented both before and after intervention or were other outcomes than those mentioned here. DATA EXTRACTION Data were extracted in relation to characteristics of studies, participants, interventions, and outcomes. DATA SYNTHESIS Because of heterogeneity, we performed a narrative synthesis describing the direction and the size of effects. RESULTS On average, women's awareness increased from 60% to 72%, knowledge from 21% to 45%, and consumption from 14% to 23%. CONCLUSIONS Interventions had a positive effect on folic acid intakes before and during pregnancy, although the average usage reached less than 25%.
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Affiliation(s)
- Corina Mihaela Chivu
- Department of Research and Evaluation of Health Care System, National Institute for Research and Development in Health, Bucharest, Romania.
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Use of folic acid supplements, particularly by low-income and young women: a series of systematic reviews to inform public health policy in the UK. Public Health Nutr 2008; 11:807-21. [PMID: 18457601 DOI: 10.1017/s1368980008002346] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To provide a basis for making recommendations on the potential to improve use of folic acid supplements in the UK, particularly among low-income and young women. DESIGN Systematic reviews of relevant research from 1989 to May 2006 in Europe, the USA, Canada, Australia and New Zealand. RESULTS Twenty-six systematic reviews and/or meta-analyses were identified from the wider public health literature, and eighteen studies on the effectiveness of preconception interventions were included. Ninety studies were identified which were directly relevant to folic acid supplement intake. There were factors that are particularly associated with lower rates of use of folic acid supplements. One of the most important of these is the link with unintended pregnancy, followed by age, socio-economic and ethnic group. Integrated campaigns can increase the use of folic acid supplements to some extent. Research trials indicated that: (i) printed resources and the mass media used in isolation are not effective in the longer term; and (ii) health-care-based initiatives can be effective and are more likely to be successful if they include making supplements easily available. CONCLUSIONS Campaigns and interventions have the potential to exacerbate socio-economic inequalities in folic acid use. One way of addressing this is to include elements that specifically target vulnerable women. To achieve and maintain an effect, they need to be based on good health promotion practice and to be sustained over a long period. However, even high-quality campaigns that increase use result in under half of women in the target group taking supplements.
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Braekke K, Ueland PM, Harsem NK, Karlsen A, Blomhoff R, Staff AC. Homocysteine, cysteine, and related metabolites in maternal and fetal plasma in preeclampsia. Pediatr Res 2007; 62:319-24. [PMID: 17622947 DOI: 10.1203/pdr.0b013e318123fba2] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Homocysteine is associated with endothelial dysfunction and cardiovascular disease, and elevated concentrations of homocysteine have been found in preeclampsia. The purpose of this study was to investigate maternal and fetal concentrations of total homocysteine and related metabolites (including cysteine, choline, and betaine), and possible associations with infant birth weight. Women with preeclampsia (n=47) and controls (n=51), who underwent cesarean section, were included. Maternal plasma, umbilical vein, and artery plasma were analyzed. Median concentrations of homocysteine, cysteine, choline, and betaine were significantly higher in women with preeclampsia than controls, both in maternal and fetal plasma. There were no differences in folate and vitamin B12 concentrations between the groups, neither for maternal nor fetal samples. Maternal homocysteine concentration was a negative predictor for birth weight only in the preeclampsia group. Elevated homocysteine and cysteine concentration in maternal circulation in preeclampsia is reflected in the fetal circulation. The clinical significance of elevated homocysteine and cysteine concentrations in maternal and fetal compartments in preeclampsia remain to be explored, both regarding fetal growth and development of disease later in life.
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Affiliation(s)
- Kristin Braekke
- Department of Pediatric Intensive Care, Ulleval University Hospital, 0407 Oslo, Norway.
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Brantsaeter AL, Haugen M, Hagve TA, Aksnes L, Rasmussen SE, Julshamn K, Alexander J, Meltzer HM. Self-reported dietary supplement use is confirmed by biological markers in the Norwegian Mother and Child Cohort Study (MoBa). ANNALS OF NUTRITION AND METABOLISM 2007; 51:146-54. [PMID: 17536192 DOI: 10.1159/000103275] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Accepted: 02/16/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS A food frequency questionnaire (FFQ) and a database for dietary supplements were developed for use in the Norwegian Mother and Child Cohort Study (MoBa). The aim of the present study was to investigate the relation between reported use and biomarkers in supplement and non-supplement users and to validate self-reported intake of dietary supplements in mid pregnancy. METHOD 120 women were recruited from MoBa, and 119 subjects completed the MoBa FFQ and a 4-day weighed food diary. Information on supplement use was collected by both methods. Venous blood specimens and 24-hour urine samples were obtained for measurement of dietary biomarkers. RESULTS Biomarker concentration/excretion and intake differed significantly between supplement and non-supplement users for vitamin D, carotenoids, folate, the n-6/n-3 fatty acid ratio and iodine (p < 0.05 for all variables). Flavonoid excretion was higher in flavonoid-supplement users (p < 0.05). Significant correlations between total dietary intake (food and supplements) and biomarker concentration/excretion were found for vitamin D (r = 0.45, p < 0.001), folate (r = 0.26, p = 0.005), the n-6/n-3 fatty acid ratio (r = 0.36, p < 0.001) and iodine (r = 0.42, p < 0.001). CONCLUSION The biochemical indicators examined in this study confirmed differences in self-reported micronutrient intake between supplement and non-supplement users for vitamin D, beta-carotene, folate, n-3 fatty acids, flavonoids and iodine.
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Affiliation(s)
- Anne Lise Brantsaeter
- Division of Environmental Medicine, Department of Food Toxicology, Norwegian Institute of Public Health, Oslo, Norway.
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Knudsen VK, Orozova-Bekkevold I, Rasmussen LB, Mikkelsen TB, Michaelsen KF, Olsen SF. Low compliance with recommendations on folic acid use in relation to pregnancy: is there a need for fortification? Public Health Nutr 2007; 7:843-50. [PMID: 15482608 DOI: 10.1079/phn2004630] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AbstractObjective:As a means to prevent neural tube defects (NTDs), women planning pregnancy in Denmark are recommended to take a dietary supplement of 400 μg folic acid daily during the periconceptional period. We examined compliance with this recommendation in a national survey.Design:Cohort study on pregnant women in Denmark.Setting:The Danish National Birth Cohort (DNBC).Subjects:From November 2000 to February 2002, 22 000 pregnant women were recruited for DNBC. Use of dietary supplements was recorded at enrolment. Compliance with the recommendation was related to an information campaign that took place during the second half of 2001, and to lifestyle factors provided in a telephone interview by the end of the first trimester of pregnancy.Results:An increase was seen in the proportion of women complying with the recommendation in the study period and this coincided with the information campaign events. However, even at the end of the period, only 22.3% of the women who had planned their pregnancy fully complied with the recommendation. No increase at all was seen in periconceptional folic acid use among women with unplanned pregnancies. Young age, low education and smoking were identified as factors that determined non-compliance.Conclusions:Alternative and more effective strategies are needed if the Danish population is to benefit fully from the knowledge that folic acid prevents NTDs. Future strategies should not only target vulnerable groups, such as the less educated and the young, but also women who get pregnant without planning this. The only possible way to reach the last group may be through fortification of foods with folic acid.
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Affiliation(s)
- Vibeke K Knudsen
- Maternal Nutrition Group, Danish Epidemiology Science Centre, Statens Serum Institut, Copenhagen S, Denmark.
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Nilsen RM, Vollset SE, Gjessing HK, Magnus P, Meltzer HM, Haugen M, Ueland PM. Patterns and predictors of folic acid supplement use among pregnant women: the Norwegian Mother and Child Cohort Study. Am J Clin Nutr 2006; 84:1134-41. [PMID: 17093167 DOI: 10.1093/ajcn/84.5.1134] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Patterns and predictors of maternal folic acid supplement use have not been examined in large prospective studies of pregnant women. OBJECTIVE We examined the patterns and predictors of maternal folic acid supplement use from 2 mo before pregnancy through the eighth month of pregnancy. DESIGN Data from 22 500 women in the Norwegian Mother and Child Cohort Study with deliveries recorded in 2000-2003 were analyzed. RESULTS Folic acid supplement use increased from 11.8% at 2 mo before pregnancy to 46.9% at gestational month 3, but decreased to 26.0% at gestational month 8. Of 16 116 women (71.6%) who had taken folic acid supplements at some time before or during pregnancy, 72.4% had started use after becoming pregnant. Ten percent of the women had used supplements regularly from 1 mo before pregnancy throughout the first trimester. These women more frequently reported higher maternal and paternal education, planned pregnancies, infertility treatments, or chronic diseases. They were also more likely to be older, married, and nonsmokers and to have higher income and lower parity. CONCLUSIONS Most women started folic acid supplementation too late with respect to the prevention of neural tube defects. More effective intervention programs to improve periconceptional intakes of folic acid are needed and should consider both demographic and socioeconomic factors.
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Affiliation(s)
- Roy M Nilsen
- Section for Epidemiology and Medical Statistics, Department of Public Health and Primary Health Care and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.
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Muskiet FAJ, Kemperman RFJ. Folate and long-chain polyunsaturated fatty acids in psychiatric disease. J Nutr Biochem 2006; 17:717-27. [PMID: 16650750 DOI: 10.1016/j.jnutbio.2006.02.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2005] [Revised: 11/15/2005] [Accepted: 02/01/2006] [Indexed: 12/25/2022]
Abstract
Schizophrenia, autism and depression do not inherit by Mendel's law, and the search for a genetic basis seems unsuccessful. Schizophrenia and autism relate to low birth weight and pregnancy complications, which are associated with developmental adaptations by "programming". Epigenetics might constitute the basis of programming and depend on folate status and one-carbon metabolism in general. Early folate status of patients with schizophrenia might be compromised as suggested by (i) coinciding incidences of schizophrenia and neural tube defects (NTDs) in the Dutch hunger winter, (ii) coinciding seasonal fluctuations in birth of patients with schizophrenia and NTDs, (iii) higher schizophrenia incidence in immigrants and (iv) higher incidence in methylene tetrahydrofolate reductase 677C-->T homozygotes. Recent studies in schizophrenia and autism point at epigenetic silencing of critical genes or chromosomal loci. The long-chain polyunsaturated fatty acids (LCPUFA), arachidonic acid (AA, from meat) and docosahexaenoic acid (fish) are components of brain phospholipids and modulators of signal transduction and gene expression. Patients with schizophrenia and, possibly, autism exhibit abnormal phospholipid metabolism that might cause local AA depletion and impaired eicosanoid-mediated signal transduction. National fish intakes relate inversely with major and postpartum depressions. Five out of six randomized controlled trials with eicosapentaenoic acid (fish) have shown positive effects in schizophrenia, and 4 of 6 were favorable in depression and bipolar disorders. We conclude that folate and LCPUFA might be important in both the etiology and severity of at least some psychiatric diseases.
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Affiliation(s)
- Frits A J Muskiet
- Department of Pathology and Laboratory Medicine, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
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Abstract
Despite worldwide public-health campaigns recommending periconceptional daily supplementation of synthetic folic acid to reduce the risk of neural tube defects, many women are not following these recommendations. At the same time, in most European countries no decline in defects has been recorded in recent years. Vulnerable groups are those with a low standard of education, young people, and women with unplanned pregnancies. Furthermore, in most countries without mandatory fortification, the general population is not consuming the recommended 0.4 mg of food folate per day. Voluntary fortification improves the situation, but does not reach all parts of the population. In the USA, Canada, and Chile, mandatory fortification of flour substantially improved folate and homocysteine status, and neural tube defects rates fell by between 31% and 78%. Nevertheless, many countries do not choose mandatory folic acid fortification, in part because expected additional health benefits are not yet scientifically proven in clinical trials, in part because of feared health risks, and because of the issue of freedom of choice. Thus, additional creative public-health approaches need to be developed to prevent neural tube defects and improve the folate status of the general population.
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Affiliation(s)
- Monika Eichholzer
- Institute of Social and Preventive Medicine, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland.
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Watson LF, Brown SJ, Davey MA. Use of periconceptional folic acid supplements in Victoria and New South Wales, Australia. Aust N Z J Public Health 2006; 30:42-9. [PMID: 16502951 DOI: 10.1111/j.1467-842x.2006.tb00085.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To determine the proportion of women who took folate supplementation prior to conception and in the first three months of pregnancy and/or increased folate dietary intake; to determine how folate supplementation varied with socio-demographic factors; and to describe the ways women had seen or heard about folate prior to pregnancy. METHODS Two population-based surveys were used: the Victorian Survey of Recent Mothers 2000 and the 2001 NSW Child Health Survey. RESULTS Thirty-six per cent of women in Victoria reported taking periconceptional folate supplements compared with 46% in NSW. In Victoria, 8%, and in NSW, 28% of women had increased dietary folate intake. In both surveys younger women, women with less education, less income, of non-English speaking background and women who were not married were less likely to take folate supplements in the recommended period. In Victoria, multiparous women were significantly less likely to take supplements. In NSW, women with an unplanned pregnancy and those living in rural areas were significantly less likely to take periconceptional folate supplements. Fifty-three per cent of women cited a general practitioner or obstetrician as a source of folate information and 45% cited family or friends; both of these sources were significantly associated with periconceptional folate supplementation. CONCLUSIONS Less than 50% of women took periconceptional folate supplements. Among socially disadvantaged groups, the proportion was significantly lower. IMPLICATIONS Since women are unlikely to achieve adequate folate intake periconceptionally without deliberate action, there remains the need for a multifaceted approach to providing women with information about folate. Future surveys are needed to monitor usage and knowledge.
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Affiliation(s)
- Lyndsey F Watson
- Mother and Child Health Research, La Trobe University, Bundoora, Victoria 3086.
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Bener A, Al Maadid MGA, Al-Bast DAE, Al-Marri S. Maternal knowledge, attitude and practice on folic acid intake among Arabian Qatari women. Reprod Toxicol 2006; 21:21-5. [PMID: 16112540 DOI: 10.1016/j.reprotox.2005.07.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2004] [Revised: 05/31/2005] [Accepted: 07/06/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Periconceptional folic acid supplementation is effective in preventing primary and secondary neural tube defects (NTDs) and other congenital defects. It is important to estimate folate intake and knowledge in women of child-bearing age, in relation to risk of congenital anomalies. AIM The aim of this study was to determine the level of knowledge about the usefulness of periconceptional folic acid supplementation in a sample of women in the child-bearing age. DESIGN This is a cross-sectional survey. SETTING Eleven primary health care centers and women's hospital in Qatar. SUBJECTS A multistage sampling design was used and a representative sample of 1,800 Qatari women aged between 18 and 45 years were surveyed during the period June to November 2004. One thousand four hundred and eighty women (82.2%) expressed their consent to participate in this study. METHODS A confidential, anonymous questionnaire was completed by the selected subjects assessing folic acid awareness. Questionnaires were administered to women who were seeking routine antenatal care at health centers and Women's Hospital. Questions covered knowledge and use of folic acid supplements, pregnancy intention, and demographic and socioeconomic characteristics. Factors affecting study outcomes were examined individually by computing crude odd ratios and adjusted for other covariates using unconditional logistic regression. RESULTS Out of 1480 women surveyed, 53.7% of them reported that they heard of folate. Of these, only half of the subjects knew that folate was something important. Overall, 20.3% of the respondents took folic acid. The most common information sources on folate were physicians (63.4%), and newspapers/magazine/books (21.7%). From those who heard of folate, only 14% knew that it can prevent birth defects. 40.6% of the subjects who heard folate were aware that green leafy vegetables were fortified with folic acid. In univariate analysis, awareness of folic acid was significantly associated with education of mother. Again, higher educated women (41.3%) knew more about folic acid and used it more often in the periconceptional and first trimester period. CONCLUSION Awareness and use of folic acid was less prevalent among Qatari women. Educated women were aware of the importance of the intake of folic acid. The study findings suggested possible avenue for intervention to increase awareness and intake of folic acid.
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Affiliation(s)
- Abdulbari Bener
- Department of Medical Statistics & Epidemiology, Hamad General Hospital, Hamad Medical Corporation & University of Qatar, PO Box 3050, Doha, Qatar.
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Ludwig AK, Katalinic A, Steinbicker V, Diedrich K, Ludwig M. Antenatal care in singleton pregnancies after ICSI as compared to spontaneous conception: data from a prospective controlled cohort study in Germany. Hum Reprod 2005; 21:713-20. [PMID: 16311297 DOI: 10.1093/humrep/dei390] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The aim was to compare the antenatal care and the intake of vitamins and medications of infertility patients with singleton pregnancies after ICSI to women with a spontaneously conceived singleton pregnancy. METHODS The data on the antenatal care of 2055 singleton pregnancies after ICSI from a prospective controlled multicentre study in Germany were analysed. The prospectively collected data of the control group of 7861 singletons were retrospectively assessed for the present analysis. RESULTS The ICSI patients were significantly older (32.9 versus 27.0 years, P<0.019) and more likely to be obese (body mass index>or=30 kg/m2: 13.9 versus 4.8%, P<0.001) than the controls. The control mothers were significantly more likely to smoke (19.2%) or to consume alcohol (23.5%) during pregnancy than the ICSI mothers (7.4 and 0.6% respectively). Only 38.1% of ICSI patients took folic acid before conception. Only 61.7% of ICSI patients received an iodine supplementation at some point during pregnancy. ICSI patients went more regularly to the routine antenatal care consultations at the gynaecologist and had ultrasound examinations performed more regularly than the controls. The absolute number of ultrasound examinations was significantly higher in the ICSI group (13.6+/-6.0 versus 4.1+/-2.4). CONCLUSION In spite of the intensive use of antenatal medical care by patients pregnant after ICSI, simple methods, such as the use of supplementary iodine and periconceptional folic acid, were used rarely. This indicates that counselling pregnant patients after ICSI about periconceptional and antenatal care seems to be insufficient in Germany and must be improved.
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Affiliation(s)
- A K Ludwig
- Department of Gynaecology and Obstetrics, Institute of Cancer Epidemiology, University of Schleswig-Holstein, Campus Lübeck, Germany.
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Abstract
Spina bifida results from failure of fusion of the caudal neural tube, and is one of the most common malformations of human structure. The causes of this disorder are heterogeneous and include chromosome abnormalities, single gene disorders, and teratogenic exposures. However, the cause is not known in most cases. Up to 70% of spina bifida cases can be prevented by maternal, periconceptional folic acid supplementation. The mechanism underlying this protective effect is unknown, but it is likely to include genes that regulate folate transport and metabolism. Individuals with spina bifida need both surgical and medical management. Although surgical closure of the malformation is generally done in the neonatal period, a randomised clinical trial to assess in utero closure of spina bifida has been initiated in the USA. Medical management is a lifelong necessity for individuals with spina bifida, and should be provided by a multidisciplinary team.
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Affiliation(s)
- Laura E Mitchell
- Institute of Bioscience and Technology, The Texas A&M University System Health Science Center, TX 77030-3303, USA.
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Abstract
OBJECTIVE To systematically summarise the available evidence concerning the rate of folic acid supplement use pre- and periconceptionally, to identify those characteristics associated with low rates of use and to assess whether folic acid public awareness campaigns are associated with higher folic acid use. DESIGN Systematic overview. SETTING Survey studies. POPULATION Women of reproductive age, most of whom were currently or recently pregnant. METHODS Two investigators searched MEDLINE, Embase and Nutriotiongate databases between 1990 and 2003. Bibliographies of retrieved references were scanned for other relevant publications, and authors were contacted if necessary. Studies were included that evaluated the rate of folic acid supplement use either before conception or in early pregnancy. MAIN OUTCOME MEASURES Rate of preconceptional and/or periconceptional folic acid use, rate of planned pregnancy in each study, as well as significant characteristics differentiating non-users from users of folic acid, including the effect of folic acid awareness campaigns. RESULTS A total of 52 studies were included. In 34 studies, reported preconceptional folic acid use varied from 0.9% to 50%. In 49 studies, the reported rate of periconceptional supplement use ranged from 0.5% to 52%. Significant predictors of reduced periconceptional folic acid use were a low level of formal education, immigrant status, young maternal age, lack of a partner and an unplanned pregnancy. Four studies examined the effect of mass media campaigns on periconceptional folic acid use; the reported rates increased significantly, by a factor of 1.7 to 7.2, but in no study was the post-campaign rate above 50%. CONCLUSIONS In many countries, fewer than 50% of women take periconceptional folic acid supplements. Consideration should be given to the practical advantages of folic acid fortification of centrally processed foods, such as wheat, corn and rice flour, while further promoting vitamin tablet supplement use and planned pregnancy.
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Affiliation(s)
- Joel G Ray
- Inner City Health Programme, Department of Medicine, St Michael's Hospital, University of Toronto, Ontario, Canada
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Current awareness in prenatal diagnosis. Prenat Diagn 2003; 23:772-8. [PMID: 14533646 DOI: 10.1002/pd.533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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