FOLATES IN THE PERICONCEPTIONAL PERIOD - ARE WOMEN GETTING ENOUGH

Objective To examine the prevalence of folic acid supplementation prio r to conception and in the first trimester of pregnancy, and to identi fy sociodemographic variables associated with the use of supplements. Design Observational study. Setting District general hospital in the s outh in England. Population Nine hundred and sixty-three randomly sele cted pregnant nulliparous caucasian women recruited from May 1994 to F ebruary 1996 inclusive. Methods Questionnaire administered at approxim ately 16 weeks gestation. Main outcome measures Intakes of supplementa l folic acid before conception and during pregnancy. Results 31.5% (30 3/963) (95% CI 28.5-34.4) of pregnant women reported using supplements containing folic acid prior to conception. The proportion using pre-c onceptional folic acid increased by approximately 1% per month during the 22 months of the study. 38.1% (367/962) (35.1 to 41.2) of women be gan taking folic acid only after the confirmation of pregnancy, and th is proportion appeared constant over time. Young age, smoking and low educational attainment were statistically significant predictors of fa ilure to use folic acid both before and during pregnancy. Conclusions Use of folic acid before conception in nulliparous women is much highe r than the 2% to 3% reported in earlier studies of all pregnant women, and appears to be increasing. However, many women still only begin ta king folic acid after conception, despite current health education str ategies. New approaches, focusing on women who are currently least lik ely to take folic acid those who are young, are of low educational bac kgrounds, and are smokers - may now be required. Given the inevitably of unplanned pregnancies, efforts must also be made to increase the cu rrently static uptake of folic acid immediately after the confirmation of pregnancy.