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Letters

Folic acid supplementation before pregnancy remains inadequate

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7223.1499 (Published 04 December 1999) Cite this as: BMJ 1999;319:1499
  1. W J Huttly, researcher,
  2. N J Wald, professor,
  3. J C Walters, project coordinator
  1. Department of Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, St Bartholomew's and Royal London School of Medicine and Dentistry, London EC1M 6BQ

    EDITOR—Women who take folic acid when trying to conceive have been shown to have a lower risk of a pregnancy affected by neural tube defects.1 The UK Department of Health has recommended that folic acid is taken by all women planning a pregnancy.2

    The request card used in antenatal screening for Down's syndrome and open neural tube defects provides a simple and useful opportunity to determine the proportion of women who take folic acid supplements before pregnancy. In March 1997 St Bartholomew's Hospital Medical College introduced a revised request card for women requesting screening on an individual and fee paying basis (private screening). The following question was added: “Did you take a daily supplement containing folic acid before becoming pregnant (if so enter 1), or as soon as you knew you were pregnant (if so, enter 2) If neither enter 0.”

    In November 1997 the same question was added to the request card used for the NHS funded screening programme at Stepping Hill Hospital, Stockport.

    The proportion of women completing the question was 78% among women screened privately and 88% among women having NHS screening. The table shows the response of women who completed the question between 1 January 1998 and 31 December 1998.

    Use of folic acid supplements among women undergoing antenatal screening for Down's syndrome and neural tube defects in 1998. Values are numbers (percentages) of women

    View this table:

    Overall, 45% of women took a folic acid supplement immediately before becoming pregnant. Our results confirm the increase in the use of folic acid supplements before pregnancy in the United Kingdom. For example, other studies have reported rates of use of 1.8% in 1993,3 18.2% in 1994,4 27% in 1995,5 and 30.6% in 1997,6 suggesting that public education regarding folic acid has had some success. Unfortunately, however, our results show that six years after the Department of Health recommendation on the intake of folic acid before pregnancy,2 over half of pregnancies occur in women who have not taken folic acid at the right time. The finding underlines the importance of a population approach in which flour is fortified with folic acid. This would reach all pregnant women.

    References

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