Prevalence of folic acid supplement consumption before and during pregnancy, and its determinants among community health center referrals

Folic acid supplementation during preconception period in sub-Saharan African countries: A systematic review and meta-analysis

INTRODUCTION

Neural tube defects (NTDs) are serious congenital anomalies of the central nervous system caused by disruptions in early embryonic development. The prevalence is about twice as common in low- and middle-income countries and more prevalent in sub-Saharan Africa. Folic acid deficiency is a major risk factor and common during pregnancy. However, limited research on preconception folic acid supplementation in this region highlights the need for systematic reviews and targeted interventions to improve maternal and fetal health.

METHODS

We conducted a systematic literature search in EMBASE, MEDLINE, Scopus, CINAHL, Google Scholar, and Google for studies on the proportion of folic acid supplementation during the preconception period, covering publications up to January 2024. Study quality was assessed using the Newcastle-Ottawa Scale. Heterogeneity was evaluated with Cochrane Q and I2 statistics, and small study effects were tested with Egger's test at a 5% significance level. The certainty of evidence was assessed using the GRADE approach. A random-effects model was used to estimate the pooled proportion of FA supplementation during the preconception period in sub-Saharan African countries.

RESULT

This systematic review included 28 studies with a total of 12,562 participants. The highest (45.2%) and lowest (1.9%) proportion of folic acid supplementation during preconception period were recorded in the southern and Amhara regions of Ethiopia, respectively. The estimated pooled proportion of folic acid supplementation among women in Sub-Saharan Africa (SSA) during preconception period was (14.10%; 95% CI: 11.22-16.98) with significant heterogeneity between studies (I2 = 97.71%, p = 0.001). In sub-group analysis based on corresponding countries the highest estimated folic acid supplementation proportion during preconception period was found in studies conducted in Kenya ((22%; 95% CI: 19%-25%), I2 = 97.7%), followed by studies conducted in Ghana (20%; 95% CI: 7%-33%), I2 = 96.9%). The majority of the studies included in the analysis are of high quality, with quality scores ranging from 7 to 8. The certainty of evidence was assessed using the GRADE approach, resulting in a low overall rating.

CONCLUSION

The results of this systematic review and meta-analysis indicated that folic acid supplementation during preconception period is significantly low among mothers in sub-Saharan African countries, despite being one of the best approaches to improve birth outcomes. Therefore, healthcare organizations, governments, policymakers, and other stakeholders involved in folic acid supplementation must collaborate on developing strategies to improve its uptake during the preconception period.

Predictors of receiving care and folic acid supplementation prior to pregnancy: a large cross-sectional study in Shiraz, Iran

BACKGROUND AND AIM

Preconceptional care aims to improve health and is influenced by various factors including health literacy. Considering the importance and necessity of high quality preconceptional care, this study aimed to determine the predictors of receiving care and folic acid supplementation prior to pregnancy.

METHODS

This cross-sectional study included 693 participants with pregnancies of less than 14 weeks gestation referred to health centers and gynecologists in Shiraz city, Iran. Multi-stage sampling occurred from May 2021 to February 2022 in 18 comprehensive urban health centers and 20 gynecology offices via the proportional allocation method. Data was collected using a questionnaire consisting of 3 parts: 1) individual and fertility characteristics, 2) information related to the components of preconceptional care and 3) health literacy. This was completed by individual participants who self-reported their responses.

RESULTS

Examining the frequency of the variables related to individual characteristics revealed that the mean age of participants in the study was 30.32 with a standard deviation of 5.29 years and more than half (59.3%) had a university level education. The receipt of pre-conceptual care was found to have a statistically significant relationship with the following: level of education, employment status, length of marriage, number of pregnancies, week of pregnancy and whether it was planned or not, along with health literacy (P < 0.05). Folic acid supplementation was found to have a statistically significant relationship with the following: level of education, financial status of the family, length of marriage, number of pregnancies and current pregnancy status (P < 0.05). In examining the predictive effect of individual variables and health literacy in the logistic regression model with the outcome of receiving preconceptional care and folic acid supplementation, length of marriage, health literacy, occupational status, and pregnancy planning status variables remained in the model following analysis.

CONCLUSION

Several factors had a statistically significant relationship with receiving pre-conceptual care and folic acid supplementation. In order to improve pre-conceptual care and increase folic acid supplementation, special attention must be paid to improving health literacy, increasing levels of education and reducing unplanned pregnancies.

A Scoping Review of Barriers and Facilitators for Preconception Care: Lessons for Global Health Policies and Programs

Preconception care (PCC) encompasses a set of actions taken before pregnancy to support the health and well-being of women before conception to improve maternal and child health (MCH) outcomes. The utilization of PCC services is influenced by multifaceted factors that can either enable or impede women's capacity to access and utilize them effectively. This scoping review examined the barriers and facilitators influencing the utilization of PCC services among women of reproductive age (15-49 years) at both individual and community levels. Through an extensive review of published articles from 2004 to 2021, including peer-reviewed sources, barriers and facilitators were identified. At the individual level, barriers included limited knowledge about PCC, neglect of self-health, and financial constraints. Community-level barriers encompassed insufficient supply of supplements, restricted access to health care, high health care costs, and setbacks due to delayed delivery of MCH services. Conversely, individuals reported that credible sources of information, such as friends, family, and community health volunteers, facilitated their engagement with PCC services. At the community level, facilitators included government-regulated supply chains for supplements and the involvement of community workers in health monitoring. Understanding and addressing these factors can help improve the utilization of PCC services among women of reproductive age (WRA) and improve MCH outcomes.

Risk factors of congenital anomalies of the kidney and urinary tract (CAKUT): Exposure to mobile phones during pregnancy

Background/aim

Congenital anomalies of the kidney and urinary tract(CAKUT) are the leading causes of childhood chronic kidney disease (CKD). The etiology of most of the cases is thought to be multifactorial. In this study, risk factors for CAKUT and the effect of mobile phone-related electromagnetic field (EMF) exposure during pregnancy were investigated.

Materials and methods

Fifty-seven cases and 57 healthy controls under 2 years of age were included and their mothers were subjected to a questionnaire. Groups were compared for parents' demographics, pregestational (chronic disease, body mass index, use of the folic acid supplements) and antenatal variables (gestational disease, weight gain during pregnancy,) and exposures during pregnancy. To assess mobile phone-related radiation exposure, all participants were asked about their daily call time, the proximity of the phone when not in use, and the models of their mobile phones. The specific absorption rate (SAR) of the mobile phones and the effective SAR value (SAR × call time) as an indicator of EMF exposure were recorded.

Results

Excess weight gain according to BMI during pregnancy was related to an increased risk of CAKUT (p=0.012). Folic acid use before pregnancy was protective for CAKUT (p = 0.028). The call time of mothers of the CAKUT group was significantly longer than the control (p = 0.001). An association was observed between higher effective SAR values and increased risk of CAKUT (p = 0.03). However the proximity of the mobile phone to the mother's body when not in use was not found as a risk factor.

Conclusion

The etiology of CAKUT is multifactorial. Our results suggest that prolonged phone call and higher EMF exposure during pregnancy increases the risk of CAKUT in the offspring.