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Preconceptional use of folic acid and knowledge about folic acid among low-income pregnant women in Korea

  • Kim, Jihyun (Department of Food and Nutrition, Chungbuk National University) ;
  • Yon, Miyong (Nutrition Management Service and Policy Team, Korea Health Industry Development Institute) ;
  • Kim, Cho-il (Nutrition Management Service and Policy Team, Korea Health Industry Development Institute) ;
  • Lee, Yoonna (Department of Food and Nutrition, Shingu College) ;
  • Moon, Gui-Im (Food Safety Evaluation Department, Ministry of Food and Drug Safety) ;
  • Hong, Jinhwan (Food Safety Evaluation Department, Ministry of Food and Drug Safety) ;
  • Hyun, Taisun (Department of Food and Nutrition, Chungbuk National University)
  • Received : 2016.10.14
  • Accepted : 2017.01.17
  • Published : 2017.06.01

Abstract

BACKGROUND/OBJECTIVES: Folic acid supplementation before pregnancy is known to significantly reduce the risk of having a baby with neural tube defects (NTDs). Therefore, it is important for women to be aware of the effects of folic acid supplementation before pregnancy. The purpose of this study was to investigate the awareness and preconceptional use of folic acid and to assess the current knowledge about folic acid among low-income pregnant women in Korea. SUBJECTS/METHODS: A questionnaire survey was conducted in 2012. Five hundred pregnant women were selected from the waiting list for the Nutriplus program implemented in public health centers using a multistage clustered probability sampling design. Data from 439 women were analyzed after excluding ones with incomplete answers. RESULTS: Among women who responded to the questionnaire, 65.6% had heard of folic acid before pregnancy, and 26.4% reported on the preconceptional use of folic acid. Women with a university degree or higher education were more likely to be aware of folic acid and to take folic acid in the preconception period. In a multivariate logistic regression, when age, education level, household income, employment status, gravidity, parity, and folic acid awareness were included in the model, folic acid awareness was a strong predictor of preconceptional folic acid use. As of interview, 85.4% and 77.7% of women were aware of the NTD-preventive role of folic acid and the appropriate time to take folic acid, respectively. The main sources of information on folic acid were healthcare professionals (41.2%), friends and family members (31.2%), and the media (26.5%). CONCLUSIONS: Our results suggest that public health strategies are needed to increase the preconceptional use of folic acid among Korean women.

Acknowledgement

Supported by : Ministry of Food and Drug Safety, National Research Foundation of Korea

References

  1. Wallingford JB, Niswander LA, Shaw GM, Finnell RH. The continuing challenge of understanding, preventing, and treating neural tube defects. Science 2013;339:1222002. https://doi.org/10.1126/science.1222002
  2. International Clearinghouse for Birth Defects Surveillance and Research. Annual report 2013 [Internet]. Rome: International Clearinghouse for Birth Defects Surveillance and Research; 2013 [cited 2016 August 15]. Available from: http://www.icbdsr.org/.
  3. European Surveillance of Congenital Anomalies. Prevalence tables [Internet]. Ispra: European Surveillance of Congenital Anomalies; 2015 [cited 2016 August 15]. Available from: http://www.eurocat-network.eu/accessprevalencedata/prevalencetables.
  4. Kim HJ, Kim YK, Koh DK, Kim JH, Choi BW. A prospective epidemiological study on birth defects: a community based pilot study. J Korean Pediatr Soc 2000;43:738-45.
  5. Yang JH, Kim YJ, Chung JH, Kim MY, Ryu HM, Ahn HK, Han JY, Yang SH, Kim A, Kim HS, Lee PJ, Kim SS, Kim YJ, Koh KS, Shin JC, Cho YK, Yoon BH. A multi-center study for birth defect monitoring systems in Korea. J Korean Med Sci 2004;19:509-13. https://doi.org/10.3346/jkms.2004.19.4.509
  6. Park JW, Jun JK, Koo JN, Seo DK, Moon JB, Suh YH, Kim SI, Oh KJ, Hong JS, Kim BJ, Park HJ, Park H, Kang HT, Bae S, Kim JH, Lee K, Hong YC, Cho SH. Prevalence of congenital anomalies in Korea: multi-center study. Korean J Ultrasound Obstet Gynecol 2011;13: 148-56.
  7. Prevention of neural tube defects: results of the Medical Research Council Vitamin Study. MRC Vitamin Study Research Group. Lancet 1991;338:131-7. https://doi.org/10.1016/0140-6736(91)90133-A
  8. Czeizel AE, Dudas I. Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation. N Engl J Med 1992;327:1832-5. https://doi.org/10.1056/NEJM199212243272602
  9. Centers for Disease Control and Prevention (US). Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects [Internet]. Atlanta (GA): Centers for Disease Control and Prevention; 1992 [cited 2016 August 15]. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/00019479.htm.
  10. The Korean Nutrition Society. Dietary Referece Intakes for Koreans. 1st rev. ed. Seoul: The Korean Nutrition Society; 2010.
  11. World Health Organization. Periconceptional folic acid supplementation to prevent neural tube defects [Internet]. Geneva: World Health Organization; 2016 [cited 2017 January 4]. Available from: http://www.who.int/elena/titles/folate_periconceptional/en/.
  12. Gomes S, Lopes C, Pinto E. Folate and folic acid in the periconceptional period: recommendations from official health organizations in thirty-six countries worldwide and WHO. Public Health Nutr 2016;19:176-89. https://doi.org/10.1017/S1368980015000555
  13. Kim MH, Han JY, Cho YJ, Ahn HK, Kim JO, Ryu HM, Kim MY, Yang JH, Nava-Ocampo AA. Factors associated with a positive intake of folic acid in the periconceptional period among Korean women. Public Health Nutr 2009;12:468-71. https://doi.org/10.1017/S1368980008002115
  14. Park E, Lee HC, Han JY, Choi JS, Hyun T, Han Y. Intakes of iron and folate and hematologic indices according to the type of supplements in pregnant women. Clin Nutr Res 2012;1:78-84. https://doi.org/10.7762/cnr.2012.1.1.78
  15. Kim H, Kim KN, Hwang JY, Ha EH, Park H, Ha M, Kim Y, Hong YC, Chang N. Relation between serum folate status and blood mercury concentrations in pregnant women. Nutrition 2013;29:514-8. https://doi.org/10.1016/j.nut.2012.08.012
  16. Jang HB, Han YH, Piyathilake CJ, Kim H, Hyun T. Intake and blood concentrations of folate and their association with health-related behaviors in Korean college students. Nutr Res Pract 2013;7:216-23. https://doi.org/10.4162/nrp.2013.7.3.216
  17. Hwang EJ. Development of a screening tool for identifying risk of folate deficiency among women of child-bearing age [master's thesis]. Cheongju: Chungbuk National University; 2014.
  18. Al-Wassia H, Shah PS. Folic acid supplementation for the prevention of neural tube defects: promotion and use. Nutr Diet Suppl 2010; 2:105-16.
  19. Crider KS, Bailey LB, Berry RJ. Folic acid food fortification-its history, effect, concerns, and future directions. Nutrients 2011;3:370-84. https://doi.org/10.3390/nu3030370
  20. Yila TA, Araki A, Sasaki S, Miyashita C, Itoh K, Ikeno T, Yoshioka E, Kobayashi S, Goudarzi H, Baba T, Braimoh T, Minakami H, Endo T, Sengoku K, Kishi R. Predictors of folate status among pregnant Japanese women: the Hokkaido Study on Environment and Children's Health, 2002-2012. Br J Nutr 2016;115:2227-35. https://doi.org/10.1017/S0007114516001628
  21. Branum AM, Bailey R, Singer BJ. Dietary supplement use and folate status during pregnancy in the United States. J Nutr 2013;143:486-92. https://doi.org/10.3945/jn.112.169987
  22. Korea Health Industry Development Institute. Dietary intake survey of physiologically vulnerable population for risk assessment [Internet]. Cheongwon: Korea Health Industry Development Institute; 2014 [cited 2016 August 15]. Available from: https://www.khidi.or.kr/board/view?pageNum=2&rowCnt=10&no1=78&linkId=100750&menuId= MENU00085&maxIndex=00001786749998&minIndex=00001000799998&schType=1&schText=&boardStyle=&categoryId=09&continent=&country=.
  23. Abdulrazzaq YM, Al-Gazali LI, Bener A, Hossein M, Verghese M, Dawodu A, Padmanabhan R. Folic acid awareness and intake survey in the United Arab Emirates. Reprod Toxicol 2003;17:171-6. https://doi.org/10.1016/S0890-6238(02)00120-X
  24. Gjergja R, Stipoljev F, Hafner T, Tezak N, Luzar-Stiffler V. Knowledge and use of folic acid in Croatian pregnant women--a need for health care education initiative. Reprod Toxicol 2006;21:16-20. https://doi.org/10.1016/j.reprotox.2005.07.005
  25. Bener A, Al Maadid MG, Al-Bast DA, Al-Marri S. Maternal knowledge, attitude and practice on folic acid intake among Arabian Qatari women. Reprod Toxicol 2006;21:21-5. https://doi.org/10.1016/j.reprotox.2005.07.004
  26. Ren A, Zhang L, Li Z, Hao L, Tian Y, Li Z. Awareness and use of folic acid, and blood folate concentrations among pregnant women in northern China--an area with a high prevalence of neural tube defects. Reprod Toxicol 2006;22:431-6. https://doi.org/10.1016/j.reprotox.2006.02.003
  27. Nawapun K, Phupong V. Awareness of the benefits of folic acid and prevalence of the use of folic acid supplements to prevent neural tube defects among Thai women. Arch Gynecol Obstet 2007;276:53-7. https://doi.org/10.1007/s00404-006-0305-1
  28. Jou HJ, Hsu IP, Liu CY, Chung SH, Chen SM, Gau ML. Awareness and use of folic acid among pregnant women in Taipei. Taiwan J Obstet Gynecol 2010;49:306-10. https://doi.org/10.1016/S1028-4559(10)60066-6
  29. Mallard SR, Houghton LA. Folate knowledge and consumer behaviour among pregnant New Zealand women prior to the potential introduction of mandatory fortification. Asia Pac J Clin Nutr 2012;21:440-9.
  30. Ministry of Health and Welfare (KR). The minimum cost of living in 2012 [Internet]. Cheongwon: Ministry of Health and Welfare; 2011 [cited 2017 March 6]. Available from: http://www.mohw.go.kr/front_new/jb/sjb0406ls.jsp?PAR_MENU_ID=03&MENU_ID=030406.
  31. Ray JG, Singh G, Burrows RF. Evidence for suboptimal use of periconceptional folic acid supplements globally. BJOG 2004;111:399-408. https://doi.org/10.1111/j.1471-0528.2004.00115.x
  32. Ministry of Health and Welfare (KR). Our Happy Kids: Policy Guide for Supporting Pregnancy to Child Care. Seoul: Ministry of Health and Welfare; 2011.
  33. Coll O, Pisa S, Palacio M, Quinto L, Cararach V. Awareness of the use of folic acid to prevent neural tube defects in a Mediterranean area. Eur J Obstet Gynecol Reprod Biol 2004;115:173-7. https://doi.org/10.1016/j.ejogrb.2003.12.009
  34. Kondo A, Morota N, Date H, Yoshifuji K, Morishima T, Miyazato M, Shirane R, Sakai H, Pooh KH, Watanabe T. Awareness of folic acid use increases its consumption, and reduces the risk of spina bifida. Br J Nutr 2015;114:84-90. https://doi.org/10.1017/S0007114515001439
  35. Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention. Korea Health Statistics 2014: Korea National Health and Nutrition Examination Survey (KNHANES VI-2). Cheongju: Korea Centers for Disease Control and Prevention; 2015.
  36. Lee EJ, Kim MH, Cho MS, Kim YJ, Kim WY. A study on nutrient intakes and hematological status in women of child-bearing age: comparison between non-pregnant and pregnant women. Korean J Nutr 2003;36:191-9.
  37. Hwang JY, Lee JY, Kim KN, Kim H, Ha EH, Park H, Ha M, Kim Y, Hong YC, Chang N. Maternal iron intake at mid-pregnancy is associated with reduced fetal growth: results from Mothers and Children's Environmental Health (MOCEH) study. Nutr J 2013;12:38. https://doi.org/10.1186/1475-2891-12-38
  38. Hong SC, Ha EH, Han JY, Park HS, Ha M, Kim Y, Hong YC, Nava-Ocampo AA, Koren G. The relationship between folic acid supplementation and serum folate level in early pregnancy and pregnancy outcomes: MOCEH (Mothers and Children's Environmental Health) study. J Popul Ther Clin Pharmacol 2011;18:e344.
  39. Daly LE, Kirke PN, Molloy A, Weir DG, Scott JM. Folate levels and neural tube defects. Implications for prevention. JAMA 1995;274: 1698-702. https://doi.org/10.1001/jama.1995.03530210052030
  40. Chivu CM, Tulchinsky TH, Soares-Weiser K, Braunstein R, Brezis M. A systematic review of interventions to increase awareness, knowledge, and folic acid consumption before and during pregnancy. Am J Health Promot 2008;22:237-45. https://doi.org/10.4278/06051566R2.1
  41. Amitai Y, Fisher N, Haringman M, Meiraz H, Baram N, Leventhal A. Increased awareness, knowledge and utilization of preconceptional folic acid in Israel following a national campaign. Prev Med 2004;39:731-7. https://doi.org/10.1016/j.ypmed.2004.02.042
  42. de Walle HE, de Jong-van den Berg LT. Ten years after the Dutch public health campaign on folic acid: the continuing challenge. Eur J Clin Pharmacol 2008;64:539-43. https://doi.org/10.1007/s00228-007-0446-6

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