Taking a folic acid pill a day - a simple measure to prevent severe birth defects - is under-promoted in the media, under-recommended by health care providers and underused by women of childbearing age, according to a new review of studies.
Less than one-fourth of women who are aware of the importance of folic acid take supplements daily in accordance with public health guidelines, said Corina Mihaela Chivu, lead author of the systematic review, which appears in the March/April issue of the American Journal of Health Promotion.
Chivu and co-authors reviewed 31 studies conducted between 1992 and 2005 designed to increase awareness, knowledge and consumption of folic acid before and during pregnancy. The studies used television, Internet, brochures, counseling, posters, newspapers and magazines to provide information about folic acid to women. The data encompassed some 23,000 women ages 15 to 49, Chivu said.
Overall, researchers found that receiving information increased awareness and knowledge: 60 percent of women were aware of the role of folic acid before the interventions while 72 percent were afterward. However, knowledge did not necessarily translate to action: 14 percent took folic acid before the intervention; only 23 percent started taking it afterward.
What will help the message sink in?
The role of the mass media and health professionals is crucial, said Chivu, a physician who was with the National Institute for Research and Development in Health, in Bucharest, Romania when the review took place.
“For the last six months in the U.S., no advertisement about folic acid in pregnancy has appeared on TV,” Chivu said. “Instead, ads promoting expensive and ineffective drugs appear daily.”
Chivu, now with the Centre for Public Health Research at Brunel University in London, was surprised to learn that “interventions within national campaigns didn't persuade health professionals about the importance of counseling women on folic acid.”
A study in the Netherlands showed 25 percent of health professionals never advised women about folic acid, she added.
Similarly, a March of Dimes Gallup Survey in 2007 revealed that of those aware of folic acid, only one-third had heard about it from a health provider. However, this represents an increase from 1995, when only 13 percent heard about the supplement from a health provider. Another 31 percent read about folic acid in magazines and 23 percent received the news from radio or television.
Folic acid, a form of vitamin B, occurs in green plants, fresh fruit, liver and yeast. U.S. Public Health Service guidelines call for women of childbearing age to take 400 micrograms of folic acid daily. Health officials say women should take folic acid for two months before pregnancy and during the first three months of pregnancy.