Folic Acid Training

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FOLIC ACID AWARENESS AND USE BY WOMEN IN
CALIFORNIA (1997-2002) Suzanne Haydu MPH, RD,
Gretchen Caspary PhD, Shabbir Ahmad PhD, Joyce
Weston BSN, MSHA
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What is Folic Acid?

• B vitamin
• Involved in DNA synthesis
• Role during pregnancy
• Prevent certain birth defects of the brain and
  spine called neural tube defects (NTDs)
• Supports growth of the placenta and fetus
• Necessary for overall good health

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Neural Tube Development
Source Folicacid.net.
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Three Forms of Neural Tube Defects
Spina bifida
Encephalocele
Anecephaly
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Who is at risk for NTDs?

• Infants born to all women capable of becoming
  pregnant
• 95 of NTDs occur in women with no family history
  of NTDs
• There are some known risk factors

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Folic Acid vs. Folate

• The natural form of folic acid found in foods is
  called folate.
• Folic acid is the form found in vitamins and
  fortified foods.
• Folic acid is better absorbed by the body than
  folate.
• Once absorbed by your body, folic acid is
  converted into folate.

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California Recommendations

• Women consume 400 mcg of folic acid daily by
• Taking a multivitamin with 400 mcg of folic acid
  or eating cereal with 400 mcg per serving, and
• Eat a diet of fruits and vegetables rich in
  folate in addition to foods fortified with folic
  acid
• Read your food labels for folic acid content

http//www.mch.dhs.ca.gov/documents/pdf/eng-folicp
amp.pdf
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Folic Acid Education in California
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Before and During Pregnancy, You Need Folate
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Folic Acid, Every Woman, Every Day
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Guidelines for Care,California Diabetes and
Pregnancy Program (Sweet Success)
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Steps to Take, Guidelines for Comprehensive
Perinatal Services Program
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Nutrition and Physical Activity Guidelines for
Adolescents
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Your Future Together
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Womens Knowledge of Folic Acid (March of Dimes
Survey, 2003)
Source March of Dimes.
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Top Reasons Why Women Do Not Take a Multivitamin
Daily(March of Dimes Survey, 2003)
Source March of Dimes.
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California Womens Health Survey

• Began 1997
• Random sample
• On-going monthly telephone survey
• Over 4,000 completions per year
• English and Spanish

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What Did We Want to Know?

• What is the level of awareness and consumption of
  folic acid among California women of childbearing
  age?
• Do rates of awareness and consumption differ by
  age and race/ethnicity?

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Folic Acid Intake

• Steady at 55 from 1999 to 2001, 50 in 2002.  
• Predictors for not taking folic acid (2002)
• younger age group (18-24)
• less than a high school education,
• non-white racial/ethnic group,
• HHI
• and no health insurance

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Folic Acid Intake (cont.)

• 90 of pregnant women,57 of those trying to get
  pregnant
• Latinas were consistently less likely
• Just over 1/3 of Latinas reported taking folic
  acid (compared to 50 of non-Latinas)

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Would knowing that some cereals had 100 of the
daily amount of folic acid in one serving
increase your likelihood of purchasing the
cereal?

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Conclusions

• Latina women consistently have lower knowledge
  and use of folic acid
• Latina women cite physicians as the source of
  folic acid information

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Conclusions (cont.)

• Young women (18-24) are at risk
• A decline in folic acid intake in 2002 was
  substantively large and statistically
  significant, and suggests an overall lowered
  awareness of the importance of folic acid

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Public Health Implication

• In order to increase folic acid awareness and
  periconceptional folic acid use, physicians
  should be encouraged to recommend use of folic
  acid for all female patients of childbearing age,
  especially young women, Latina women, and women
  of lower socioeconomic status.