Knowledge and intake of folic acid to prevent neural tube defects among pregnant women in urban China: a cross-sectional study

Abstract Background The prevalence of neural tube defects (NTDs) in China declined during 2000–2017 with periconceptional folic acid (FA) supplementation, which is effective in reducing the risk of birth defects. We aimed to assess the knowledge and actual use of FA among Chinese pregnant women and to explore factors associated with FA use before pregnancy. Methods All data were collected in face-to-face interviews during health visits among pregnant women. We collected information about knowledge and use of FA supplements and demographic, socioeconomic, and health status. One maternity and childcare hospital was chosen in each of four cities: Beijing, Huaibei, Kunming, and Haikou. In total, 435 pregnant women were randomly recruited for interviews conducted from June to December 2016. Results A total of 428 pregnant women were included in this survey. Of these, 82.0% (351/428) knew that FA can prevent NTDs, and 75.9% (325/428) knew the correct time to take FA. Overall, 65.9% (282/428) of women knew both that FA can prevent NTDs and the recommended time to take FA before pregnancy. Approximately 95.1% (407/428) of women reported having ever taken FA, only 46.3% (198/428) had begun to take FA supplementation before conception, and 64.5% (109/169) of women from rural areas failed to take FA before pregnancy. Women living in northern China (odds ratio [OR] = 1.81, 95% confidence interval [CI], 1.18–2.77), those with unplanned pregnancy (OR = 1.99, 95% CI 1.30–3.04), and highly educated women (OR = 2.37, 95% CI 1.45–3.88) were more likely to know about FA. Women who were homemakers (OR = 1.94, 95% CI 1.21–3.11) and had unplanned pregnancy (OR = 6.18, 95% CI 4.01–9.53) were less likely to begin taking FA before pregnancy. Conclusions Our survey showed that most pregnant women knew about FA. Although preconception intake of FA can help to reduce NTDs, improving the rate of FA intake before pregnancy is needed in urban areas of China, especially among homemakers and women from rural areas or with unplanned pregnancy. Campaigns are needed to increase awareness about FA and FA use before pregnancy among rural women, homemakers, and those with unplanned pregnancy and lower education levels.

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Level of folic acid awareness for the prevention of neural tube defects and associated factors among pregnant women in Adama, South East Ethiopia

10.21203/rs.2.13117/v1 ◽

2019 ◽

Author(s):

MESELECH AMBAW DESSIE ◽

Ayanaw Worku Berihun

Keyword(s):

Folic Acid ◽

Pregnant Women ◽

Neural Tube ◽

Neural Tube Defects ◽

Congenital Anomalies ◽

Associated Factors ◽

Healthcare Providers ◽

P Value ◽

Antenatal Visit ◽

Cross Sectional

Abstract Abstract Background: Neural tube defects are congenital anomalies of the brain, spinal cord, and their surrounding structures. Folic acid intake before and during the early weeks of pregnancy could reduce neural tube and other birth defects. Folic acid usage in the protective period of pregnancy against the neural tube defects is related to high level of awareness. This study aimed at evaluating the level of folic acid awareness for the prevention of neural tube defects and associated factors among pregnant women in Adama, South East Ethiopia. Method: A descriptive cross-sectional study design was used. 398 consented pregnant women attending antenatal care in Adama were the participants of the study. The women were selected by using a systematic random sampling method. A structured pre-tested interviewer-administered questionnaire was used to collect the data. The questionnaire was concerned with participants’ demographic information, and their awareness about folic acid, roles of folic acid, and the recommended time of intake. Data were analyzed using SPSS version 20 statical software. Simple and multiple binary logistic regression analyses were conducted. 95% confidence interval and p-value were used to evaluate the association between dependent and independent variables. Results: Of the interviewed women, 20.9% reported having heard or read something about folic acid supplements. But only 1.01% and 6.03% were aware of the recommended time of intake and the role of folic acid in preventing neural tube defects and other congenital anomalies respectively. The healthcare providers were the primary source of information about folic acid, which account 78.3%. Folic acid awareness was associated with age, educational status, household monthly income, week of pregnancy at the first antenatal visit, any complication during current pregnancy, and use of folic acid during current pregnancy. Conclusions: Most of the pregnant women were not aware of folic acid, its importance and the recommended time of intake for preventing neural tube defects. Further effort is required from policymakers, healthcare providers, the media, and community to increase women's awareness about folic acid. Keywords: Folic acid, Awareness, Neural tube defects

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Folic acid usage and associated factors in the prevention of neural tube defects among pregnant women in Ethiopia: cross-sectional study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-017-1506-2 ◽

2017 ◽

Vol 17 (1) ◽

Cited By ~ 9

Author(s):

Meselech Ambaw Dessie ◽

Ejigu Gebeye Zeleke ◽

Shimelash Bitew Workie ◽

Ayanaw Worku Berihun

Keyword(s):

Folic Acid ◽

Pregnant Women ◽

Neural Tube ◽

Neural Tube Defects ◽

Associated Factors ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional

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Level of folic acid awareness for the prevention of neural tube defects and associated factors among pregnant women in Adama, South East Ethiopia

10.21203/rs.2.13117/v2 ◽

2019 ◽

Author(s):

MESELECH AMBAW DESSIE ◽

Ayanaw Worku Berihun

Keyword(s):

Folic Acid ◽

Pregnant Women ◽

Neural Tube ◽

Neural Tube Defects ◽

Congenital Anomalies ◽

Associated Factors ◽

Healthcare Providers ◽

P Value ◽

Antenatal Visit ◽

Cross Sectional

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Comparison of blood folate levels among pregnant Chinese women in areas with high and low prevalence of neural tube defects

Public Health Nutrition ◽

10.1017/s1368980007246786 ◽

2007 ◽

Vol 10 (8) ◽

pp. 762-768 ◽

Cited By ~ 30

Author(s):

Aiguo Ren ◽

Le Zhang ◽

Ling Hao ◽

Zhiwen Li ◽

Yihua Tian ◽

...

Keyword(s):

Pregnant Women ◽

Neural Tube ◽

Neural Tube Defects ◽

Rural Women ◽

Urban Women ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Plasma Folate ◽

High Prevalence ◽

Low Prevalence

AbstractObjectiveTo characterise plasma and red-blood-cell (RBC) folate status among pregnant women in an area with an extremely high prevalence of neural tube defects, and to compare them with those of women from a low prevalence area.DesignA cross-sectional survey conducted in 2003.SettingOne county and one city from each of the high prevalence area and the low prevalence area in China.SubjectsFive hundred and sixty-two women in their first trimester of pregnancy in the high prevalence area and 695 pregnant women in the low prevalence area.ResultsWomen in the high prevalence area had less than half the plasma and RBC folate concentrations (12.2 and 440.0 nmol l− 1, respectively) of women in the low prevalence area (33.5 and 910.4 nmol l− 1, respectively). In the high prevalence area, 40% of rural women were deficient in RBC folate and 50% were deficient in plasma folate; 20% of urban women were deficient in RBC folate and 30% deficient in plasma folate. In contrast, only 4% (RBC folate) and 6% (plasma folate) of rural women, and 2% (RBC folate) and 1% (plasma folate) of urban women, were folate-deficient in the low prevalence area. Less than 10% of rural and about 26% of urban women in the high prevalence area took folic acid periconceptionally, compared with 70% and 60% of women in the low prevalence area.ConclusionsBlood folate deficiency is highly prevalent among pregnant women in an area of China with a very high prevalence of neural tube defects.

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Decomposing inequality in catastrophic health expenditure for self-reported hypertension household in Urban Shaanxi, China from 2008 to 2013: two waves’ cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2018-023033 ◽

2019 ◽

Vol 9 (5) ◽

pp. e023033 ◽

Cited By ~ 4

Author(s):

Yafei Si ◽

Zhongliang Zhou ◽

Min Su ◽

Xiao Wang ◽

Xin Lan ◽

...

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Health Expenditure ◽

Economic Status ◽

Cross Sectional Study ◽

Catastrophic Health Expenditure ◽

Urban China ◽

Shaanxi Province ◽

Vulnerable Groups ◽

Cross Sectional

ObjectiveDespite the latest wave of China’s healthcare reform initiated in 2009 has achieved unprecedented progress in rural areas, little is known for specific vulnerable groups’ catastrophic health expenditure (CHE) in urban China. This study aims to estimate the trend of incidence, intensity and inequality of CHE in hypertension households (households with one or more than one hypertension patient) in urban Shaanxi, China from 2008 to 2013.MethodsBased on the fourth and the fifth National Health Service Surveys of Shaanxi, we identified 460 and 1289 households with hypertension in 2008 and 2013, respectively for our analysis. We classified hypertension households into two groups: simplex households (with hypertension only) and mixed households (with hypertension plus other non-communicable diseases). CHE would be identified if out-of-pocket healthcare expenditure was equal to or higher than 40% of a household’s capacity to pay. Concentration index and its decomposition based on Probit regressions were employed to measure the income-related inequality of CHE.ResultsWe find that CHE occurred in 11.2% of the simplex households and 22.1% of the mixed households in 2008, and the 21.5% of the simplex households and the 46.9% of mixed households incurred CHE in 2013. Furthermore, there were strong pro-poor inequalities in CHE in the simplex households (−0.279 and −0.283) and mixed households (−0.362 and −0.262) both in 2008 and 2013. The majority of observed inequalities in CHE could be associated with household economic status, household head’s health status and having elderly members.ConclusionWe find a sharp increase of CHE occurrence and the sustained strong pro-poor inequalities for simplex and mixed households in urban Shaanxi Province of China from 2008 to 2013. Our study suggests that more concerns are needed for the vulnerable groups such as hypertension households in urban areas of China.

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Factors associated with not using folic acid supplements preconceptionally

Public Health Nutrition ◽

10.1017/s1368980013002656 ◽

2013 ◽

Vol 17 (10) ◽

pp. 2344-2350 ◽

Cited By ~ 13

Author(s):

Judith Manniën ◽

Ank de Jonge ◽

Martina C Cornel ◽

Evelien Spelten ◽

Eileen K Hutton

Keyword(s):

Folic Acid ◽

The Netherlands ◽

Pregnant Women ◽

Neural Tube ◽

Neural Tube Defects ◽

Lifestyle Factors ◽

Folic Acid Intake ◽

Factors Associated ◽

Acid Intake ◽

Folic Acid Supplements

AbstractObjectiveNeural tube defects are among the most common birth defects worldwide. Folic acid intake from one month before to three months after conception reduces the likelihood of neural tube defects by at least 50 %. Since 1995, several campaigns have been organised in the Netherlands which resulted in 51 % of pregnant women using folic acid supplements during the entire recommended period in the northern part of the Netherlands in 2005. Our research question was to gain insight into the current prevalence and factors associated with inadequate pregnancy-related use of folic acid supplements.DesignData from the DELIVER study were used, which is a population-based cohort study.SettingTwenty midwifery practices across the Netherlands in 2009 and 2010.SubjectsIn total 5975 pregnant women completed a questionnaire covering items on sociodemographic and lifestyle factors, including folic acid intake.ResultsOf our study population, 55·5 % (3318/5975) used folic acid supplements before conception. Several sociodemographic and lifestyle factors were associated with no preconception use of folic acid, of which non-Western ethnicity and not having a partner had the largest effect size.ConclusionsIn the Netherlands, the folic acid intake before conception is suboptimal and has not improved over recent years. Fortification of staple foods with folic acid should be reconsidered as it would provide a more effective means of ensuring an adequate intake, especially for those groups of women who are unlikely to plan their pregnancies or to receive or respond to health promotion messages.

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Folic acid awareness and intake among women in areas with high prevalence of neural tube defects in China: a cross-sectional study

Public Health Nutrition ◽

10.1017/s1368980011000097 ◽

2011 ◽

Vol 14 (7) ◽

pp. 1142-1147 ◽

Cited By ~ 12

Author(s):

Ziqian Zeng ◽

Ping Yuan ◽

Yanping Wang ◽

Xi Ma ◽

Jun Zhu

Keyword(s):

Folic Acid ◽

Neural Tube ◽

Neural Tube Defects ◽

Low Income ◽

Reproductive Age ◽

Intake Rate ◽

Childbearing Age ◽

Cross Sectional Survey ◽

Cross Sectional ◽

High Prevalence

AbstractObjectiveTo measure folic acid awareness and intake rates among women of childbearing age in certain areas of China with a high prevalence of neural tube defects (NTD).DesignA cross-sectional survey was carried out utilising a nineteen-item questionnaire enquiring into individual women's knowledge of, attitude towards and practice of folic acid supplementation.SettingA total of 293 low-income counties in six provinces of China.SubjectsWomen aged 19–44 years from six provinces with a high prevalence of NTD recruited from June to August 2008.ResultsAmong 33 025 participants, 57 % had heard of folic acid but only 15 % knew all of the core information. The intake rate was 12 %; only 8 % took the recommended dose and only 4 % of non-pregnant women took folic acid. Some women did not take folic acid because they did not know that they should take it (49 %) or they had misconceptions about it (24 %). According to logistic regression analysis, rural residence was a risk factor for folic acid awareness. Ethnicity, educational level, average annual income per person and pregnancy were the influencing factors of folic acid awareness and folic acid intake.ConclusionsAlthough more than half of the respondents had heard of folic acid, the intake rate was still very low in areas with a high prevalence of NTD. Thus, more efforts are needed to increase folic acid awareness and intake among women of reproductive age in these areas.

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A China Healthy Diet Index-based evaluation of dietary quality among pregnant women in coastal areas across trimesters and residential areas

10.21203/rs.3.rs-95539/v1 ◽

2020 ◽

Author(s):

Zhengyuan Wang ◽

Jiaying Shen ◽

Yiwen Wu ◽

Xueying Cui ◽

Qi Song ◽

...

Keyword(s):

Pregnant Women ◽

Rural Women ◽

Rural Areas ◽

Urban Areas ◽

Daily Intake ◽

Late Pregnancy ◽

Coastal Areas ◽

Healthy Diet ◽

Dietary Quality ◽

Residential Areas

Abstract Background: Good dietary quality among pregnant women is critical for maternal and fetal health. Comprehensive assessments of large representative samples are lacking. Methods: Pregnant women were enrolled using a multistage, stratified, random-sampling method in Shanghai. We used a personal food frequency questionnaire and a household condiment weighing method for dietary assessments. Participants’ scores on the China Healthy Diet Index (CHDI) were analyzed to evaluate diet quality.Results: Significant differences in the median daily intake of almost all food types were found across all trimesters, and all food types were found across all residential areas (urban, suburban and rural). Significant differences were found in the median total CHDI scores across trimesters, and on all CHID components, except whole grains, dry beans and tubers, across all residential areas; 13.7% of participants scored below 60 points, indicating “poor” dietary quality. Significant differences in CHDI scores were found across trimesters and residential areas. Participants in early and middle pregnancy had lower scores than those in late pregnancy. Women in urban areas had higher scores than those in suburban and rural areas.Conclusions: Pregnant women living in coastal areas of China suffer from an unbalanced diet of average quality. Pregnant women in the early and middle stages of pregnancy had worse scores than those in the late stage, while suburban and rural women had worse scores than urban women.

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Predictors of Anaemia prevalence among pregnant women in urban Ghana: a cross-sectional study

10.21203/rs.2.13559/v1 ◽

2019 ◽

Author(s):

Jones Asafo Akowuah ◽

Ebenezer Owusu-Addo ◽

Ama Opuni Antwiwaa

Keyword(s):

Public Health ◽

Folic Acid ◽

Adverse Effects ◽

Pregnant Women ◽

Urban Areas ◽

Health Facilities ◽

Health Concern ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Iron Sulphate

Abstract Background Anaemia during pregnancy is a major public health concern. Despite its wide scope and adverse effects including increased maternal and perinatal morbidity and mortality, and long-term adverse effects in the new born, extensive interventions using upstream approaches to public health have largely not been implemented. This study investigated the prevalence and associated factors of anaemia in pregnant women in four health facilities in the Kwabre East Municipality of Ghana.Method A cross-sectional survey with a two-stage sampling technique was conducted on 220 pregnant women who attended antenatal care at the selected health facilities. Interview-based structured questionnaires were used. Bivariate and multivariate logistic regression were used to identify predictors.Results The prevalence of anaemia was 11.4%. Few women (25) were anaemic and morphologically, 14 had normocytic normochromic (56%) anemia and 9 had Microcytic hypochromic (36) anaemia. Iron deficiency was reported in 19 (8.6%) pregnant women. Iron sulphate intake (AOR [95% CI] = 3.16 [1.15, 7.37], ANC follow-up during pregnancy (AOR [95% CI] = 3.07 [1.59, 7.99], household size of ≥ 5 (AOR [95% CI] = 3.58 [1.75, 9.52], folic acid intake (AOR [95% CI] = 5.29 [2.65, 12.39] and the period in pregnancy AOR [95% CI]= ≥36 weeks 3.2 (1.3–4.5) were independent predictors of anemia.Conclusion Though anaemia prevalence has been low in urban areas as previously reported, collaborated healthcare measures that aim at eradicating the menace are encouraged. Maternal health care interventions including the administration of folic acid, regular iron sulphate intake and intensive education on early ANC are recommended.

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Magnitude of Neural Tube Defects and Associated Risk Factors at Three Teaching Hospitals in Addis Ababa, Ethiopia

BioMed Research International ◽

10.1155/2018/4829023 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10 ◽

Cited By ~ 11

Author(s):

Abel Gedefaw ◽

Sisay Teklu ◽

Birkneh Tilahun Tadesse

Keyword(s):

Risk Factors ◽

Folic Acid ◽

Neural Tube ◽

Neural Tube Defects ◽

Family Income ◽

Addis Ababa ◽

Teaching Hospitals ◽

Local Data ◽

Cross Sectional ◽

Total Prevalence

There is scarcity of data on prevalence of neural tube defects (NTDs) in lower-income countries. Local data are important to understand the real burden of the problem and explore risk factors to design and implement preventive approaches. This study aimed to determine prevalence and risk factors of NTDs. A hospital-based cross-sectional and unmatched case-control study was conducted at three teaching hospitals of Addis Ababa University. NTDs were defined as cases of anencephaly, spina bifida, and encephalocele based on ICD-10 criteria. The prevalence of NTDs was calculated per 10,000 births for both birth and total prevalence. During seven months, we observed 55 cases of NTDs out of 8677 births after 28 weeks of gestation—birth prevalence of 63.4 per 10,000 births (95% confidence interval (CI), 51–77). A total of 115 cases were medically terminated after 12 weeks of gestation. Fifty-six of these terminations (48.7%) were due to NTDs. Thus, total prevalence of NTDs after 12 weeks’ gestation is 126 per 10,000 births (95% CI, 100–150). Planned pregnancy (adjusted odds ratio (aOR), 0.47; 95% CI, 0.24–0.92), male sex (aOR, 0.56; 95% CI, 0.33–0.94), normal or underweight body mass index (aOR, 0.49; 95%, 0.29–0.95), and taking folic acid or multivitamins during first trimester (aOR, 0.47; 95%, 0.23–0.95) were protective of NTDs. However, annual cash family income less than $1,300 USD (aOR, 2.5; 95%, 1.2–5.5), $1,300–1,800 USD (aOR, 2.8; 95%, 1.3–5.8), and $1,801–2,700 USD (aOR, 2.6; 95%, 1.2–5.8) was found to be risk factors compared to income greater than $2,700 USD. The prevalence of NTDs was found to be high in this setting. Comprehensive preventive strategies focused on identified risk factors should be urgently established. More studies on prevention strategies, including folic acid supplementations, should be conducted in the setting.

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