Most women of childbearing age not taking folic acid supplements

NEW YORK (Reuters Health) – Although all women of childbearing age are recommended to take 400 micrograms of folic acid daily to prevent possible birth defects should they become pregnant, findings from two new studies indicate that most eligible women, especially those between 18 and 24 years of age, do not.

The results of both studies appear in the Morbidity and Mortality Weekly Report for January 11.

In the first study, researchers from the Centers for Disease Control and Prevention in Atlanta and elsewhere assessed awareness, knowledge, and use of folic acid supplements among US women of childbearing age (18 to 45 years) by analyzing data from annual surveys conducted by the Gallup Organization from 2003 to 2007.

The report shows that throughout the entire study period, the percentage of women taking a folic acid-containing supplement daily never exceeded 48%, except for women with confirmed pregnancy. In 2007, the percentage of all eligible women using such supplements was 40%.

The lowest prevalence of folic acid supplementation was seen in women between 18 and 24 years of age — 24% to 31%. Women in this age group also had lower awareness (61%) and knowledge (6%) about folic acid use than women in other age groups.

Correlates of using folic acid-containing supplements included white race, non-Hispanic ethnicity, higher education, and greater household income.

No significant improvements in folic acid supplementation, knowledge, or awareness were noted during the study period.

In the second study, researchers from the Puerto Rico Department of Health and the CDC examined folic acid knowledge and consumption among women 18 to 44 years of age and the prevalence of neural tube defects in Puerto Rico from 1996 to 2006. To do this, the investigators analyzed data from the Birth Defects Surveillance System (BDSS) and from the Behavioral Risk Factor Surveillance System (BRFSS).

The findings indicate that folic acid knowledge and consumption rose from 1997 to 2003, but then declined from 2003 to 2006. During the first period, the prevalence of neural tube defects fell, whereas no significant change occurred during the second period.

Specifically, in 1997, just 22.4% of women were aware that folic acid use is recommended to prevent birth defects and only 20.2% of women used folic acid supplements. By 2003, the corresponding percentages had risen to 72.0% and 30.9%, but by 2006 they had dropped to 56.5% and 24.8%. As in the first study, women between 18 and 24 years of age were the least likely to use folic acid supplements.

“These findings warrant the continued promotion of folic acid consumption among all women of childbearing age and especially among women aged 18 to 24 years,” the first report concludes. “Folic acid education that promotes consumption of folic acid from various sources, in addition to foods rich in folate, can increase the possibility of all women consuming the recommended daily amount of 400 micrograms.”

Mor Mortal Wkly Rep CDC Surveill Summ 2008;57:5-13.