Folate Status in Pregnant Women: Current Situation on the Island of Ireland

Project start date: 1 June 2015
Project status: Completed
Project type: Nutrition
Discipline: Nutrition surveillance
Author/s: Prof Michael Turner, UCD
Collaborator/s: Dr Dan McCartney, DIT, Prof Anne Molloy, Trinity College Dublin, Dr Mary Rose Sweeney, Dublin City University, Prof Jayne Woodside and Dr Alyson Hunter, Queen’s University of Belfast, Prof Louise Kenny and Dr Mairead Kiely, Cork Women’s Clinic, Prof Richard Layte, Trinity College Dublin, Dr Bob McDonnell, Health Services Executive

Research objective

To measure biomarkers of folate status in a cohort of 1,000 women from the island of Ireland, sampling during the first ante-natal visit (14-18 weeks gestation).
To relate this data to WHO guidance
To explore the relationship between folate status and maternal adiposity (excess fat)
To assess folic acid supplementation practices and determine compliance with folic acid supplementation recommendations in Ireland.

Outputs

Research report

Title: The folate status of pregnant women: the current position
Publication date: 1 December 2017
Summary: An analysis of the folate status of pregnant women to inform policy and practice relating to folic acid.
Findings:
- One-third of a sample of women in early pregnancy in the ROI had RBC folate measures that were lower than the amount recommended by the WHO to prevent NTDs. 1% of the women were found to be deficient.
- 19.5% of the women were deficient in vitamin B12 relative to the WHO guidance.
- There was no difference in mean folate or B12 levels of women in the “overweight” or “class I obesity” BMI categories when compared with women in the “healthy weight” BMI category.
- Women in the “class II obesity” and “class III obesity” categories had statistically significantly lower serum folate and lower plasma B12 levels than women with a healthy weight BMI.
- 98% of the women reported that they took folic acid after they became pregnant.
- Only 24.9% of the women who took folic acid took it for more than 12 weeks before conception as recommended.
- Statistical analysis showed that the women who planned their pregnancy and the women for whom it was their first pregnancy were most likely to take folic acid before pregnancy.
- The family doctor, family members and friends were the main sources of advice for those who women who took folic acid both pre-conceptionally and post-conceptionally and for those who took folic acid only after becoming pregnant.
- 92% of the women who reported taking folic acid at any point during their pregnancy said that they were taking folic acid “for a healthy baby” when asked to select reasons from a range of possible answers.
- Among those who did not supplement their diet with folic acid before conception, the main reason reported was that the woman did not expect to get pregnant (76.4%).
- 35% of women who did not supplement pre-conceptionally reported that they did not know that they needed to take folic acid before becoming pregnant.
- Women who started to take folic acid supplements more than 4 weeks before their LMP were more likely to have an optimal RBC folate then those who only started when their pregnancy test showed positive.
- Only 39.5% of women who started folic acid 8 weeks or more after their LMP had an optimal RBC folate.
- Only 2.6% of the women achieved the WHO RDA of folate for pregnancy of 600μg per day from dietary intake, with the majority coming from naturally occurring folate in food.
Recommendations:
- Folate and vitamin B12 measurements in pregnant women should be monitored regularly as a public health issue.
- Supplementation practices before conception should also be monitored on an ongoing basis.
- Supplementation policy needs to address the issue of unplanned pregnancy more clearly, to support women taking folic acid supplements before a pregnancy.
- The results from this study should be used to inform discussions on food fortification policy.
- An ongoing public health campaign involving both the traditional communication channels and web-based media about the importance of folic acid supplementation is needed to inform the behaviour of women who may become pregnant whether intended or not.
- Primary care healthcare professionals should be supported to effectively communicate the folic acid message to the women in their care.
You can download the reports below.

The folate status of pregnant women in the Republic of Ireland [PDF]

The folate status of pregnant women in Northern Ireland [PDF]

Other outputs

Peer reviewed articles

Cawley, S., Mullaney, L., McKeating, A., Farren, M., McCartney, D. and Turner, M.J., 2016. Knowledge about folic acid supplementation in women presenting for antenatal care. European Journal of Clinical Nutrition, 70(11), pp.1285-1290.

Turner M. J. 2018. Neural Tube Defects and Folic Acid Food Fortification in Europe. American journal of public health, 108(5), 601–602. https://doi.org/10.2105/AJPH.2018.304389

Research