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Preventing neural tube defects. Survey of preconceptional use of folic acid.

OBJECTIVE
To determine the proportion of women who take daily folic acid supplements in the month before conception and to identify factors associated with supplement use.


DESIGN
Cross-sectional survey by self-administered questionnaire.


SETTING
Tertiary care teaching hospital in Hamilton, Ont.


PARTICIPANTS
Four hundred eighty-four (43%) of 1132 women who delivered normal babies between November 1997 and March 1998.


MAIN OUTCOME MEASURES
Reports of daily vitamin supplement use in the month before pregnancy and after pregnancy, and having heard or read about the need to take folic acid before pregnancy; sources of information about folic acid; factors associated with preconceptional vitamin use.


RESULTS
Thirty-four percent of respondents reported taking vitamins before conception (use ranged from 21% for those with unplanned pregnancies to 40% for those with planned pregnancies); 80% after conception. Of all respondents, 63% were aware of the need for preconceptional folic acid. Key information sources were family doctors and the mass media: the media were more important before conception, doctors after. Being older (30 years or more), having post-secondary education, and having a planned pregnancy were associated with knowing about the benefits of folic acid; knowledge, regular exercise, perceived good health, and planned pregnancy were associated with preconceptional use of vitamins.


CONCLUSIONS
Even in this sample of well educated, English-speaking women, only one third took vitamin supplements before conception, which indicates that current educational efforts do not reach most women early enough. A coordinated, multi-pronged strategy that targets and involves physicians and capitalizes on opportunities to work with schools, public health outlets, and the media is needed.