Researchers assessed FA use among pregnant women in the Calabria region, determining whether their intake met recommendations and exploring potential predictors that shape these practices.
They said the results ‘expose a universal public health challenge’ that high awareness of FA does not naturally translate into timely, effective prevention.
“To effectively eliminate the global burden of NTDs (neural tube defects) , a paradigm shift is urgently required,” they wrote in the journal Nutrients. “Public health frameworks must transition from merely educating patients to systematically empowering primary care networks to deliver early, proactive counseling.
“Concurrently, these findings strongly advocate for the adoption of equitable, population-level interventions, such as mandatory food fortification.”
Supplementation reduces birth defect risks
Studies show that adequate folic acid intake can reduce the risk of NTDs by 50–70%. It may also help reduce the risk of other birth defects, such as heart and limb abnormalities, and prevent certain health problems in mothers, including megaloblastic anemia and peripheral neuropathy.
International health organizations like the USPSTF and the World Health Organization recommend that women who are planning a pregnancy or could become pregnant take 400–800 micrograms of folic acid daily. It is advised that women should begin taking it at least one month before conception and continue through the first two to three months of pregnancy.
However, according to the researchers, many women in Italy do not follow these recommendations, and folic acid intake can vary across various regions.
“Given the established importance of FA throughout pregnancy, the primary objective of the present study was to characterize FA utilization patterns and evaluate their correlation with participants’ characteristics and knowledge,” they wrote of the new study.
Study finds low pre-pregnancy supplement use
The researchers conducted the cross-sectional study between April and September 2023 involving 421 pregnant women to assess their knowledge and use of folic acid.
Through face-to-face interviews, they collected information on participants’ sociodemographic characteristics, pregnancy history, awareness of folic acid and supplementation practices. The researchers assessed whether women followed recommendations to take 400–800 μg of folic acid daily, starting at least one month before conception and continuing through the first two to three months of pregnancy.
The study found that 92.2% of participants took folic acid, and 79.3% correctly identified it as a vitamin. However, only 25.8% started supplementation at least four weeks before conception, while just 22.6% of women with planned pregnancies met all the recommended criteria for adequate intake.
Healthcare professional recommendations and planned pregnancies were the strongest factors associated with preconception supplementation, and women who received advice from a healthcare professional were substantially more likely to start taking folic acid before conception. Older women and those with a university degree were also more likely to begin supplementation early.
“Despite widespread general knowledge, timely preconceptional FA use remains low, reflecting a ‘knowing–doing’ gap and an over-reliance on specialist-driven prescription,” the researchers noted.
“This evidence suggests that current global public health paradigms, which have predominantly focused on the “what” and “why” of FA supplementation, have reached a ceiling effect.
“To bridge this critical gap, future health literacy interventions must shift their primary focus from basic awareness to the crucial ‘when’, aggressively emphasizing the narrow, early developmental window during which supplementation is effective.”
Source: Nutrients; doi: https://doi.org/10.3390/nu18203332; “Folic Acid Supplementation Adherence During Pregnancy: Evidence from a Cross-Sectional Survey in Italy.” Authors: Licata, F. et al.
