Purpose Neural tube defects (NTD) occur in 1/1000 pregnancies. Women with a prior NTD-affected pregnancy (pNTD) have a 3-4% recurrence risk, over a 10-fold increase from baseline. Although 4 milligrams/day of preconceptional folic acid (FA) decreases the recurrence risk by 70%, data suggest that these high risk women do not take adequate supplementation. This study aimed to determine if New Mexican women with pNTD know the current FA recommendations and to identify barriers that prevent these women from consuming the recommended dose of FA.
Methods Study was performed from Sept 2003 to Feb 2004 at the University of New Mexico Hospital (UNMH) and affiliated institutions. The subject population (n=23) was composed of women with a pNTD who delivered between 1999 and 2004 in New Mexico. Baseline knowledge and usage was established by a comparison population (n=98) of women without an NTD-affected pregnancy, recruited during their post partum visit at UNMH. Each participant completed a perception survey, which inquired about knowledge of FA recommendations, prevention of NTDs, and current FA intake. The importance of barriers such as healthcare provider advice, FA pill formulations, and financial issues were assessed. Study format is an A/B design and examines baseline (A) verses pNTD group (B) utilizing inferential statistics for data analysis.
Results Knowledge of FA among the pNTD group was 100% while that of baseline population was 59.0%. Baseline population daily intake of FA was 51.0%. Of pNTD women who were able to become pregnant (n=17); 64.7% reported taking high dose FA, although only 13.6% could write down the correct dose. In the pNTD group, 58.9% were actually planning a future pregnancy. Of these women, 70% were taking FA but only 30% continuously. Barriers identified to FA intake were the need to take multiple FA pills per day (31.8%) and lack of healthcare provider recommendations (22.7%).
Conclusions Women with pNTD were well informed about the role of FA in prevention of NTDs and reported a greater intake of FA compared to baseline. Barriers to FA consumption appear to be the lack of 4mg dose FA pills, lack healthcare provider recommendations, and lack of knowledge of the FA dose and regimens for NTD recurrence prevention. This study suggests that NM women require more specific education about FA dosing and effective recommendations and they expect their healthcare providers to relay this information to them.
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