Determinants of folic acid use in early pregnancy in a multi-ethnic urban population in The Netherlands: The Generation R study
Objective: Recommendations on folic acid use to prevent neural tube defects have been launched in several countries. Adequate folic acid use seems to be low. This study assesses the prevalence of folic acid use and identifies its determinants. Methods: The study was embedded in the Generation R Study Rotterdam, the Netherlands, a population-based prospective cohort study between 2002 and 2006. Complete information of 6940 women was available. Information on folic acid use and potential determinants was obtained by questionnaires and physical examination. Results: Of all women 37% adequately used folic acid during the preconception period. Most important risk factors for inadequate use were unplanned pregnancy (OR 9.5, CI 7.2-12.4, p < 0.001), low educational level (OR 2.5, CI 1.8-3.6, p < 0.001) and non-western ethnicity, (OR 3.5, CI 2.9-4.3, p < 0.001). After stratification for ethnicity, unplanned pregnancy remained the most important risk factor for inadequate use. Other risk factors for inadequate use were younger age, single marital status, smoking, multiparity (all p < 0.001) and alcohol use (p < 0.05). In contrast, previous spontaneous abortion decreased the risk of inadequate folic acid use (p < 0.001). Conclusion: Adequate preconception folic acid supplementation is still too low. Implementation of preconception programs and other public health strategies are strongly needed.