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Folate and Pregnancy: New Report Shows that Women Still Aren't Getting the Word

by Marjorie Greenfield, M.D.
reviewed by Laura Jana, M.D., F.A.A.P.
In the early 1990s, researchers established the important role that folic acid plays in healthy fetal development. Taking folic acid, or folate, before conceiving and throughout the first trimester helps a mother ensure that her child won't develop certain brain and spinal cord defects, including spina bifida. This information was widely published, but a report released by the March of Dimes on September 5, 2001, makes it clear that many women still aren't getting this vital message.

How the survey was conducted
The March of Dimes' report is based on seven years' worth of national surveys of women in their childbearing years. The women were asked what they knew about folic acid, and when and how much they took.

Survey results
The findings were disappointing:
  • Despite the many years of educational campaigns, only 7 percent of the respondents knew that they should take folic acid before becoming pregnant.


  • Only 29 percent of women between the ages of 18 and 45 said that they regularly took a multivitamin, the best way to get enough folate to prevent birth defects.


  • Women at the younger end of the scale (18 to 24) were actually less likely to be taking vitamins--only 22 percent.


  • While 79 percent of the respondents were aware that there was some benefit to taking folic acid, only 22 percent said that they got that information from their healthcare practitioners. Most of those were probably already pregnant at the time they were given the information--too late to protect the baby.


  • Twenty percent of the women who did not take a vitamin said they would if their doctor or healthcare provider recommended it.


  • The awareness of the importance of folate has increased since the first survey in 1995, but the number of non-pregnant women taking vitamins regularly only increased by one percentage point. In 2001, fewer women took vitamins (29 percent) than in the year 2000 (34 percent).
The good news
Although many women are not aware of the need for folic acid before conception and doctors are reportedly missing many opportunities to educate their patients, there actually has been an increase in the folate levels of women of childbearing age. There also has been a decrease in the incidence of folate-related birth defects over the past few years. Why? Because starting in 1998, the government required that U.S. grain products be fortified with folic acid. This action alone increased the average consumption of folate by women not taking supplements by about 100 micrograms, enough to prevent some cases of spina bifida. But more can be done.

The take-home message
While many women and their doctors know that folic acid is important, the principle that folate needs to be taken before conception isn't getting across. Since most pregnancies are not actively planned, women who are capable of becoming pregnant should take 400 micrograms of supplemental folic acid in the form of a daily multivitamin or folate tablet. This strategy may be able to prevent half of all the cases of spina bifida in the U.S. Clearly, healthcare professionals can play a key role here, since many survey respondents indicated that they would take vitamins if their doctors recommended them.

What should I do?
Any vitamin that claims it contains a "women's formula" will have the necessary amount of folic acid. So if you are capable of becoming pregnant, take a vitamin even if you aren't trying to conceive, and remind your friends to do the same. Also, consider asking your doctor or nurse to tell other patients about the U.S. Public Health Service's recommendation that all women of childbearing age take a folic acid supplement or multivitamin. If we all participate in the public awareness campaign, we can have a huge impact on the health of our nation's children!


Read the March of Dimes Report


More information:
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 RELATED INFORMATION
*  Folate Supplements Before and During Pregnancy
*  Healthy Eating during Pregnancy
*  Getting Pregnant
*  Fetal Development
*  Medications in Pregnancy
*  Media Watch


Created September 05, 2001
Reviewed September 05, 2001
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