Factors associated with iron and folic acid supplementation among pregnant women aged 15-45 years attending Naroosura health centre, Narok County, Kenya

Background: Iron and folic acid are very important nutrients to mothers during pregnancy. Their deficiencies are risk factors for anaemia, preterm delivery and low birth weight. This study aimed to investigate the supplementation of iron and folic acid and the associated factors among pregnant women attending Naroosura health centre, Narok County, Kenya.Methods: This study employed a descriptive cross-sectional study design. Data collection took a period of one month where a total of 123 mothers participated. A self-administered semi-structured questionnaire was used for data collection. Chi-square test was conducted to find associations at a significance level of 0.05.Results: Of the study participants, nearly a third (31.7%) took iron and folic acid supplements daily, over a half (57.7%) indicated that taking iron and folic acid supplements was important to them, about a quarter (24.4%) reported that use of iron and folic acid supplements reduces birth defects and about a third (32%) consumed foods rich in iron and folic acid. Supplementation of iron and folic acid was significantly associated with residence (ꭓ2=4.311, df=1, p=0.038), monthly household income (ꭓ2=10.870, df=4, p=0.028), reduced birth defects (χ2=6.131, df=1, p=0.013) and consumption of iron and folic acid rich foods (χ2=4.163, df=1, p=0.041).Conclusions: The intake as well as supplementation of iron and folic acid is still low. Therefore, both the intake and supplementation of iron and folic acid need to be scaled up.

Health behaviours in 131,182 UK women planning pregnancy

Background A woman’s health at the time of conception lays the foundation for a healthy pregnancy and the lifelong health of her child. We investigated the health behaviours of UK women planning pregnancy. Methods We analysed survey data from the ‘Planning for Pregnancy’ online tool (Tommy’s, UK). We described all women planning pregnancy and compared the frequency of non-adherence to preconception recommendations in women who had already stopped contraception (active planners) and those who had not (non-active planners). Results One hundred thirty-one thousand one hundred eighty-two women from across the UK were included, of whom 64.8% were actively planning pregnancy. Of the whole cohort, twenty percent were smokers and less than one third took folic acid supplements (31.5%). Forty two percent engaged in less than the recommended 150 min of weekly physical activity and only 53.3% consumed five portions of fruit or vegetables 4 days a week. Smokers were 1.87 times more likely to be active planners than non-smokers (95% CI 1.79–1.94), and women who took folic acid were 7 times more likely to be active planners (95% CI 6.97–7.59) compared to women who did not. Smoking, drug use and lack of folic acid supplementation were common in younger women and those who were underweight. Conclusions This unique survey of UK women has identified poor adherence to preconception recommendations in those planning pregnancies and supports the need for a greater public health focus on preconception health. This study provides a contemporary basis from which to inform preconception health advice and a benchmark to measure changes over time.

Utilization of preconception care and its impacts on health behavior changes among expectant couples in Shanghai, China

Background Preconception care is an opportunity for detecting potential health risks in future parents and providing health behavior education to reduce morbidity and mortality for women and their offspring. Preconception care has been established in maternal and child health hospitals in Shanghai, China, which consists of health checkups, health education and counseling. This study investigated factors associated with the utilization of preconception care, and the role of preconception care on health behavior changes before conception among pregnant women and their partners. Methods A cross-sectional study was conducted among pregnant women at three maternal and child health hospitals in Shanghai. The participants were invited to complete a self-administered questionnaire on the utilization of preconception care and health behavioral changes before conception. Results Of the 948 recruited pregnant women, less than half (42.2%) reported that they had utilized preconception care before the current pregnancy. Unplanned pregnancy, unawareness of preconception care and already having a general physical examination were the main reasons for not attending preconception care. The two main sources of information about preconception care were local community workers and health professionals. Younger women and the multipara were less likely to utilize preconception care. Women who utilized preconception care were more likely to take folic acid supplements before conception [Adjusted Odds Ration (aOR) 3.27, 95% Confidence Interval (CI) 2.45–4.36, P < 0.0001]. The partners of pregnant women who had attended preconception care services were more likely to stop smoking [aOR 2.76, 95%CI 1.48–5.17, P = 0.002] and to stop drinking [aOR 2.13, 95%CI 1.03–4.39, P = 0.041] before conception. Conclusions Utilization of preconception care was demonstrated to be positively associated with preconception health behavior changes such as women taking folic acid supplements before pregnancy, their male partner stopping smoking and drinking before conception. Future studies are needed to explore barriers to utilizing preconception care services and understand the quality of the services. Strategies of promoting preconception care to expectant couples, especially to young and multipara women, should be developed to further improve the utilization of the services at the community level.

Associations between periconceptional lifestyle behaviours and adverse pregnancy outcomes

Background While the potential adverse outcomes of prenatal exposure to unhealthy lifestyle are widely evidenced, little is known about these exposures in the periconception period. We investigated the associations between lifestyle behaviours and adverse pregnancy outcomes with a unique distinction between preconceptional- and prenatal lifestyle behaviours. Methods A secondary analysis took place within a prospective multicentre cohort study in the Netherlands, including 3,684 pregnant women. Baseline characteristics and preconceptional and first trimester lifestyle behaviours were assessed through a self-administered questionnaire in the first trimester. Adverse pregnancy outcomes (hypertensive disorders in pregnancy (HDP), small for gestational age (SGA), gestational diabetes (GDM) and spontaneous preterm birth (sPTB)) were reported by healthcare professionals. Data were collected between 2012 and 2014 and analysed using multivariate logistic regression. Results Women who are overweight, and especially obese, have the highest odds of developing any adverse pregnancy outcome (adjusted odds ratio (aOR) 1.61 (95 % Confidence Interval (CI) 1.31–1.99) and aOR 2.85 (95 %CI 2.20–3.68), respectively), particularly HDP and GDM. Women who prenatally continued smoking attained higher odds for SGA (aOR 1.91 (95 %CI 1.05–1.15)) compared to the reference group, but these odds decreased when women prenatally quit smoking (aOR 1.14 (95 %CI 0.59–2.21)). Women who did not use folic acid supplements tended to have a higher odds of developing adverse pregnancy outcomes (aOR 1.28 (95 %CI 0.97–1.69)), while women who prenatally started folic acid supplements did not (aOR 1.01 (95 %CI 0.82–1.25)). Conclusions Our results indicate that smoking cessation, having a normal body mass index (BMI) and initiating folic acid supplements preconceptionally may decrease the risk of adverse pregnancy outcomes. Therefore, intervening as early as the preconception period could benefit the health of future generations.

Prevention of Neural Tube Defects in Europe: A Public Health Failure

Objective: Thirty years ago it was demonstrated that folic acid taken before pregnancy and in early pregnancy reduced the risk of a neural tube defect (NTD). Despite Public Health Initiatives across Europe recommending that women take 0.4 mg folic acid before becoming pregnant and during the first trimester, the prevalence of NTD pregnancies has not materially decreased in the EU since 1998, in contrast to the dramatic fall observed in the USA. This study aimed to estimate the number of NTD pregnancies that would have been prevented if flour had been fortified with folic acid in Europe from 1998 as it had been in the USA.Design and Setting: The number of NTD pregnancies from 1998 to 2017 that would have been prevented if folic acid fortification had been implemented in the 28 countries who were members of the European Union in 2019 was predicted was predicted using data on NTD prevalence from 35 EUROCAT congenital anomaly registries and literature searches for population serum folate levels and folic acid supplementation.Results: From 1998 to 2017 an estimated 95,213 NTD pregnancies occurred amongst 104 million births in the 28 countries in the EU, a prevalence of 0.92 per 1,000 births. The median serum folate level in Europe over this time period was estimated to be 14.1 μg/L. There is a lack of information about women taking folic acid supplements before becoming pregnant and during the first trimester of pregnancy, with one meta-analysis indicating that around 25% of women did so. An estimated 14,600 NTD pregnancies may have been prevented if the European countries had implemented fortification at the level adopted by the USA in 1998 and 25% of women took folic acid supplements. An estimated 19,500 NTD pregnancies would have been prevented if no women took folic acid supplements.Conclusions: This study suggests that failure to implement mandatory folic acid fortification in the 28 European countries has caused, and continues to cause, neural tube defects to occur in almost 1,000 pregnancies every year.

Folic Acid From Supplements or Fortified Foods Consumed During Pregnancy and/or Lactation and Health Outcomes in Mothers and Their Children: A NESR Systematic Review

Objectives To inform the Dietary Guidelines for Americans, 2020–2025, USDA and HHS identified the following important public health question for the 2020 Dietary Guidelines Advisory Committee to answer with support from USDA's Nutrition Evidence Systematic Review (NESR) team: What is the relationship between folic acid from supplements and/or fortified foods consumed before and during pregnancy and lactation and health outcomes? Methods The Committee developed protocols to describe how they would use NESR's systematic review methodology to examine the evidence. NESR conducted a literature search and dual-screened the results using pre-defined inclusion and exclusion criteria for articles published between 1980 and 2019. NESR extracted data and assessed risk of bias of included studies. The Committee synthesized the evidence, developed conclusion statements, and graded the strength of the evidence underlying the conclusion statements. Results This systematic review included 30 articles, most of which were well-designed RCTs. Observational studies had risk of bias concerns. The study populations did not fully represent the diversity of the U.S. population. Conclusions Strong evidence indicates that folic acid supplements consumed before and/or during pregnancy are positively associated with folate status. Moderate evidence indicates that folic acid supplements consumed during lactation are positively associated with folate status. Limited evidence suggests that folic acid supplements consumed during early pregnancy may have a beneficial effect on reducing the risk of hypertensive disorders during pregnancy among women at high-risk versus no supplementation. Moderate evidence indicates that higher versus lower levels of folic acid supplements consumed during pregnancy does not affect the risk of hypertensive disorders during pregnancy among women at low-risk. Moderate evidence indicates that folic acid supplements consumed during lactation does not influence folate levels in human milk. Insufficient or no evidence was available to examine folic acid and gestational diabetes or child developmental, or folic acid from fortified foods and any outcome. Funding Sources USDA, Food and Nutrition Service, Center for Nutrition Policy and Promotion.

Methylenetetrahydrofolate Reductase Dimer Configuration as a Risk Factor for Maternal Meiosis I-Derived Trisomy 21

<b><i>Background:</i></b> Evidence suggests that the dimer configuration of methylenetetrahydrofolate reductase (MTHFR) enzyme might be destabilized by polymorphisms in monomers at the positions C677T and A1298C. It has been observed that these polymorphisms may lead to stable (CCAA, CCAC, CCCC) and unstable (CTAA, CTAC, TTAA) enzyme dimer configurations. <b><i>Objective:</i></b> The aim of this study was to evaluate the association of the MTHFR enzyme dimer configuration and folate dietary intake with the stage of meiotic nondisjunction in mothers of children with maternally derived trisomy 21. <b><i>Methods:</i></b> A total of 119 mothers of children with maternally derived free trisomy 21 were included in the study. The mean maternal age at the time of the birth of the child with trisomy 21 was 32.3 ± 6.4 (range 16–43) years. All mothers were Caucasian. Parental origin of trisomy 21 and meiotic stage of nondisjunction was determined using short tandem repeat markers spanning from the centromere to the telomere of chromosome 21q. The <i>MTHFR</i> C677T and <i>A1298C</i> polymorphism was evaluated by PCR-RFLP. <b><i>Results:</i></b> Increased frequency of the <i>MTHFR</i> genotype combinations CTAA, CTAC, and TTAA was found in the group of mothers with meiosis I (MI) nondisjunction (<i>p</i> = 0.007). No differences were found between study participants regarding dietary and lifestyles habits. <b><i>Conclusion:</i></b> The risk for MI nondisjunction of chromosome 21 was 4.6-fold higher in cases who had CTAA, CTAC, and TTAA <i>MTHFR</i> genotype combinations and who did not used folic acid supplements in the preconception period.