Investigating Folic Acid Supplement Use by Pregnant Women

This comparative paper reviews the role played by knowledge of folic acid in pregnant women’s nutrition and how that helps to improve the health wellbeing of pregnant women in medical practice. In answering the question, the paper does a comparative study of two peer-reviewed research papers. The medical issue covered by this paper is the determination of challenges affecting the adoption of folic acid as a relevant supplement for reducing neural tube defects (NTDs) in fetuses and iodine deficiencies among pregnant women in the world (Imbard, Benoist, & Blom, 2013).

El-mani, Charlton, Flood, and Mullan (2014) conducted an exploratory cross-sectional study to determine knowledge, attitudes, and practices of pregnant women that influence their nutrient intake. Besides, the study was evaluating the exposure of the participants to health messages of supplementing their diet with folic acid as a way to reduce the risk of neural tube defects (NTDs) and iodine deficiency. The study was conducted in New South Wales in Australia. It used a survey study design with questionnaires about knowledge and practices of nutritional supplement use being the instruments for collecting data among fifty-two conveniently sampled pregnant women. Researchers conducted the cross-sectional survey between October 2012 and February 2013 using a pre-tested self-administered questionnaire with the main themes being knowledge of folic acid and iodine, dietary sources of the two nutrients, health problems associated with deficiencies of the two nutrients when a woman is pregnant and the mandatory folic acid and fortification programs carried out in Australia (El‐mani, Charlton, Flood, & Mullan, 2014).

The study collected sociodemographic data for age, annual household income, and education level and relied on online information about the annual cost of supplements for the nutrients studies, and this was from Australian-based pharmacies that the women would access.

In coming up with a relevant sample size, El-mani, Charlton, Flood, and Mullan (2014) opted for birth estimates in the study region obtained from the Australian Bureau of Statistics. Upon calculation based on an n-2388 value of total births in the period of study, they determined a sample size of 134 pregnant women was required to represent the Wollongong region that was specific to the study. Out of the number, the study aimed for a sample size of 200 pregnant women and considered private obstetrician practices and miscellaneous venues frequented by pregnant women as recruitment areas. With statistical analysis, they were able to investigate the relationship between sociodemographic factors and the proportion of women taking recommended daily doses of folic acid and iodine supplements.

Their results show that women 36% of women take supplements before the pregnancy, while 47% take them when they discover the pregnancy. In addition, the study shows that sources of information for folic acid supplements are higher than those of iodine supplements, with 52% of women relying on general practitioners for their information and only 5.9% of women relying on dieticians/nutritionists for their information on folic acid. Written information, books, and the internet collectively were also substantial sources of information for both supplements. Other notable sources were obstetricians, midwives or nurses, and pharmacists.

The study confirms the low level of knowledge concerning iodine supplements and low-level knowledge about mandatory programs also supported by Boykin and Mager (2015). This is an indication of overall knowledge gaps that practitioners need to look at. The use of a convenient sampling design might hinder the operability of the findings in other populations. Also, the unique nature of sociodemographic factors in the studied population and varied sources of information limits its transferability to other populations in the world.

A second study reviewed in this paper is by Vandevijvere, Amsalkhir, Van Oyen, and Moreno-Reyes (2012), which was a national cross-sectional survey in Belgium seeking the determinants of folate status in pregnant women. The study identifies its significance as the increase in knowledge of folic acid deficiency factors to promote the proper prevention of neural tube defects (NTD) in the fetus. In doing so, it relies on a multi-stage proportionate-to-size sampling design. In addition to the use of a questionnaire to collect information on participating pregnant mothers, the study also collects blood samples. The questionnaires are answered in real-time with each participant having a face-to-face session with a nurse. The study then measures erythrocyte (red blood cells) folate concentration.

The study was specific to include pregnant women in Belgium in their first to the third trimester of pregnancy from September 2010 to June 2011 and the use of a multi-stage proportionate-to-size stratified other study recommendations informed sampling design for looking at iodine deficiency. In this regard, the researchers divided the country into two and ordered hospitals by provinces, and then focused on the number of deliveries in the preceding year. The number helped to cluster 60 hospitals in each region, and then 30 clusters were randomly selected, and the first hospital in each cluster was asked to participate. The study took all gynecologists in the participating hospitals to limit any gynecologist effect. The questionnaire included sociodemographic characteristics, trimester of pregnancy, smoking, and alcohol usage behavior when pregnant and in the previous four weeks as well as diseases and medication use. They also asked about the use of food supplements.

Findings by Vandevijvere et al. (2012) show that about 35% of the women taking part in the study had RBC folate concentration of less than 400 ng/ml and were therefore below the required threshold of preventing NTD. Besides, 13% of the women’s RBC folate concentration was below 300 ng/ml. However, the study found no significant indication of folate deficiency, where RBC folate concentration is below 140 ng/ml, and it also indicates folate levels being higher for women in their third trimester compared to those in the first trimester of pregnancy. Planned pregnancy and non-smoking were also associated with high RBC folate concentration. The study confirms other findings by studies done in Brussels, the UK, and Hungary infertility therapy before current pregnancy and multivitamin intake, as well as high education levels, associated with a high probability of taking folic acid.

In conclusion, both studies by Vandevijvere et al. (2012) and El-mani, Charlton, Flood, and Mullan (2014) show that there is a need for improving the design of folic acid supplementation policies and to increase awareness among pregnant women. Both studies highlight the role of information in influencing behavior change among pregnant women and one study supports strutting of intervention through primary caregivers because they have the largest informational impact on pregnant women. This was confirmed by the high correlation between infertility therapy and high folic acid supplement intake. Both studies did not address the issue of folic acid supplement availability, and their survey results do not indicate availability as an issue limiting uptake. Their contribution to the medical question of preventing NTD in the fetus is that knowledge is influential for pregnant women’s behavior change.


Boykin, C. M., & Mager, D. N. A. (2015). Ohio pharmacy students’ knowledge of folic acid and neural tube defects. Currents in Pharmacy Teaching and Learning, 7(2), 273 – 276.

El‐mani, S., Charlton, K. E., Flood, V. M., & Mullan, J. (2014). Limited knowledge about folic acid and iodine nutrition in pregnant women reflected in supplementation practices. Nutrition & Dietetics, 71(4), 236-244.

Imbard, A., Benoist, J.-F., & Blom, H. J. (2013). Neural tube defects, folic acid and methylation. International Journal of Environmental Research and Public Health,, 10(9), 4352 – 4389.

Vandevijvere, S., Amsalkhir, S., Van Oyen, H., & Moreno-Reyes, R. (2012). Determinants of folate status in pregnant women: results from a national cross-sectional survey in Belgium. European Journal of Clinical Nutrition, 66, 1172-1177.

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