Concordance between periconceptional folic acid supplementation and Canadian Clinical Guidelines

In 2007, the Society of Obstetricians and Gynaecologists of Canada (SOGC) introduced new guidelines on periconceptional folic acid supplementation.

To evaluate the concordance between the SOGC guidelines and actual vitamin/folic acid supplementation, and to identify maternal determinants of concordant folic acid use.MethodsFrom May to July 2010, pregnant women attending the outpatient clinic at CHU Ste-Justine in Montreal were surveyed to assess use of folic acid. Data on socio-demographic factors, lifestyles, family and personal medical history, and periconceptional folic acid supplementation were collected using a self-administrated questionnaire. Concordance between maternal reported intake of folic acid and SOGC guidelines was estimated accounting for pregnancy history, comorbidities, and lifestyles.

A total of 361 eligible women gave informed consent; of these, 97 (27%) had periconceptional folic acid supplementation intake that was concordant with guidelines. Women with no personal history of neural tube defects (NTDs) were the most concordant with guidelines (36%), followed by women with a previous child with NTD (26%), and women with health risk factors for NTDs (18%). Women who smoked and drank alcohol had the lowest concordance with guidelines (4%). Women with planned pregnancies and higher income were more likely to be concordant with guidelines; whereas, smokers, alcohol and recreational drug user and women with health risk for NTDs were less likely to be concordant.

Concordance with clinical guidelines was low, even for women with a history of NTDs. Our findings highlight the need for public health programs to inform women to consume folic acid every day before and during pregnancy.