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Patterns and predictors of folic acid supplement use among pregnant women: the Norwegian Mother and Child Cohort Study^1,2,3

¹ From the Section for Epidemiology and Medical Statistics, Department of Public Health and Primary Health Care (RMN, SEV, and HKG), and the LOCUS for Homocysteine and Related Vitamins and the Section for Pharmacology, Institute of Medicine (PMU), University of Bergen, Bergen, Norway; the Medical Birth Registry, Norwegian Institute of Public Health, Bergen, Norway (SEV); and the Divisions of Epidemiology (HKG and PM) and Environmental Health (HMM and MH), Norwegian Institute of Public Health, Oslo, Norway

Background: Patterns and predictors of maternal folic acid supplement use have not been examined in large prospective studies of pregnant women.

Objective: We examined the patterns and predictors of maternal folic acid supplement use from 2 mo before pregnancy through the eighth month of pregnancy.

Design: Data from 22 500 women in the Norwegian Mother and Child Cohort Study with deliveries recorded in 2000–2003 were analyzed.

Results: Folic acid supplement use increased from 11.8% at 2 mo before pregnancy to 46.9% at gestational month 3, but decreased to 26.0% at gestational month 8. Of 16 116 women (71.6%) who had taken folic acid supplements at some time before or during pregnancy, 72.4% had started use after becoming pregnant. Ten percent of the women had used supplements regularly from 1 mo before pregnancy throughout the first trimester. These women more frequently reported higher maternal and paternal education, planned pregnancies, infertility treatments, or chronic diseases. They were also more likely to be older, married, and nonsmokers and to have higher income and lower parity.

Conclusions: Most women started folic acid supplementation too late with respect to the prevention of neural tube defects. More effective intervention programs to improve periconceptional intakes of folic acid are needed and should consider both demographic and socioeconomic factors.

Key Words: Predictors • pregnancy • folic acid • supplements • neural tube defects • cohort study

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