CONCORDANCE BETWEEN PERICONCEPTIONAL FOLIC ACID SUPPLEMENTATION AND CANADIAN CLINICAL GUIDELINES
Main Article Content
Keywords
Folic acid, neural tube defects, practice guidelines, guideline adherence, pregnancy, vitamins
Abstract
Background
In 2007, the Society of Obstetricians and Gynaecologists of Canada (SOGC) introduced new guidelines on periconceptional folic acid supplementation.
Objectives
To evaluate the concordance between the SOGC guidelines and actual vitamin/folic acid supplementation, and to identify maternal determinants of concordant folic acid use.
Methods
From May to July 2010, pregnant women attending the outpatient clinic at CHU Ste-Justine in Montreal were surveyed to assess use of folic acid. Data on socio-demographic factors, lifestyles, family and personal medical history, and periconceptional folic acid supplementation were collected using a selfadministrated questionnaire. Concordance between maternal reported intake of folic acid and SOGC guidelines was estimated accounting for pregnancy history, comorbidities, and lifestyles.
Results
A total of 361 eligible women gave informed consent; of these, 97 (27%) had periconceptional folic acid supplementation intake that was concordant with guidelines. Women with no personal history of neural tube defects (NTDs) were the most concordant with guidelines (36%), followed by women with a previous child with NTD (26%), and women with health risk factors for NTDs (18%). Women who smoked and drank alcohol had the lowest concordance with guidelines (4%). Women with planned pregnancies and higher income were more likely to be concordant with guidelines; whereas, smokers, alcohol and recreational drug user and women with health risk for NTDs were less likely to be concordant.
Conclusions
Concordance with clinical guidelines was low, even for women with a history of NTDs. Our findings highlight the need for public health programs to inform women to consume folic acid every day before and during pregnancy.
References
2. Heron M, Hoyert DL, Murphy SL, Xu J, Kochanek KD, Tejada-Vera B. Deaths: final data for 2006. Natl Vital Stat Rep 2009;57:1- 134.
3. Botto LD, Moore CA, Khoury MJ, Erickson JD. Neural-tube defects. N Engl J Med 1999;341:1509-19.
4. Laurence KM. The genetics and prevention of neural tube defects. In: Emery AEH, Rimoin DL, eds. Principles and practice of medical genetics. Vol 1. Edinburgh: Churchill Livingstone, 1983:231-45.
5. Donnelly JG. Folic acid. Crit Rev Clin Lab Sci 2001;38:183-223.
6. Finglas PM, Wright AJ, Wolfe CA, Hart DJ, Wright DM, Dainty JR. Is there more to folates than neural-tube defects? Proc Nutr Soc 2003;62:591-8.
7. Laurence KM, James N, Miller MH, Tennant GB, Campbell H. Double-blind randomised controlled trial of folate treatment before conception to prevent recurrence of neural-tube defects. Br Med J (Clin Res Ed) 1981;282:1509- 11.
8. MRC Vitamin Study Research Group. Prevention of neural tube defects: results of the Medical Research Council Vitamin Study. MRC Vitamin Study Research Group. Lancet 1991;338:131-7.
9. Czeizel AE, Dudás I. Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation. N Engl J Med 1992;327:1832-5.
10. Kirke PN, Daly LE, Elwood JH. A randomised trial of low dose folic acid to prevent neural tube defects. The Irish Vitamin Study Group. Arch Dis Child 1992;67:1442-6.
11. Lumley J, Watson L, Watson M, Bower C. Periconceptional supplementation with folate and/or multivitamins for preventing neural tube defects. Cochrane Database Syst Rev 2001:CD001056.
12. Van Allen MI, Fraser FC, Dallaire L, et al. Recommendations on the use of folic acid supplementation to prevent the recurrence of neural tube defects. Clinical Teratology Committee, Canadian College of Medical Geneticists. CMAJ 1993;149:1239-43.
13. Canadian Task Force on the Periodic Health Examination. Periodic health examination, 1994 update: 3. Primary and secondary prevention of neural tube defects. Canadian Task Force on the Periodic Health Examination. CMAJ 1994;151:159-66.
14. Canada Gazette Part II. Regulatory impact analysis statement. Vol SOR/98-550. 132(24) ed; 1998:3029-33.
15. De Wals P, Tairou F, Van Allen MI, et al. Reduction in neural-tube defects after folic acid fortification in Canada. N Engl J Med 2007;357:135-42.
16. Green-Raleigh K, Carter H, Mulinare J, Prue C, Petrini J. Trends in folic Acid awareness and behavior in the United States: the Gallup Organization for the March of Dimes Foundation surveys, 1995-2005. Matern Child Health J 2006;10:S177-82.
17. de Jong-Van den Berg LT, Hernandez-Diaz S, Werler MM, Louik C, Mitchell AA. Trends and predictors of folic acid awareness and periconceptional use in pregnant women. Am J Obstet Gynecol 2005;192:121-8.
18. Wilson RD, Johnson JA, Wyatt P, et al. Preconceptional vitamin/folic acid supplementation 2007: the use of folic acid in combination with a multivitamin supplement for the prevention of neural tube defects and other congenital anomalies. J Obstet Gynaecol Can 2007;29:1003-26.
19. Éduc'alcool. Alcool et santé: Les effets de la consommation régulière et modérée d'alcool, Version intégrale. Montréal; 2005:12.
20. Cheschier N, ACOG Committee on Practice Bulletins-Obstetrics. ACOG practice bulletin. Neural tube defects. Number 44, July 2003. (Replaces committee opinion number 252, March 2001). Int J Gynaecol Obstet 2003;83:123-33.
21. Van Allen MI, McCourt C, Lee NS. Preconception health: folic acid for the primary prevention of neural tube defects. A resource document for health professionals Ottawa, Ontario: Minister of Public Works and Government Services Canada; 2002.
22. Wolff T, Witkop CT, Miller T, Syed SB. Folic acid supplementation for the prevention of neural tube defects: an update of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2009;150:632-9.
23. EUROCAT Folic acid working group. Special Report : Prevention of Neural Tube Defects by Periconceptional Folic Acid Supplementation in Europe (updated version December 2009). Northern Ireland: University of Ulster; 2009:31.
24. Hoyo C, Murtha AP, Schildkraut JM, et al. Folic acid supplementation before and during pregnancy in the Newborn Epigenetics STudy (NEST). BMC Public Health 2011;11:46-53.
25. Public Health Agency of Canada. Canadian Perinatal Health Report, 2008 Edition. Ottawa: Minister of Health; 2008.
26. Nilsen RM, Vollset SE, Gjessing HK, et al. Patterns and predictors of folic acid supplement use among pregnant women: the Norwegian Mother and Child Cohort Study. Am J Clin Nutr 2006;84: 1134-41.
27. Ferreira E, Atkinson S, Gauthier L, Bussières JF, Rey E, Dumont M. Characteristics associated with adequate folic acid supplementation in a multicultural urban setting. Can J Hosp Pharm 2006; 59:22-8.
28. Meijer WM, De Smit DJ, Jurgens AA, de Jong- Van den Berg LT. Pharmacists' role in awareness about folic acid: the process of introducing an intervention in pharmacy practice. Int J Pharm Pract 2004;12:29-35.
29. US Food and drug administration. FDA approves combination contraceptive containing a folate. http://www.fda.gov/NewsEvents/Newsroom/Pre ssAnnouncements/ucm227237.htm (August 18, 2011).
30. Burton A, Wilson S, Gillies AJ. Folic acid: Is self reported use of supplements accurate? J Epidemiol Community Health 2001;55:841-2.
31. Statistics Canada. Births 2008. In: Health Statistics Division, ed: Ministry of Industry; 2011:56.
32. Institut de la Statistique du Québec. Répartition de la population de 15 ans et plus selon le niveau de scolarité, le sexe et le groupe d'âge. http://www.stat.gouv.qc.ca/donstat/societe/educa tion/ (July 6, 2011).