Folate intakes and awareness of folate to prevent neural tube defects: A survey of women living in Vancouver, Canada

Objective To estimate folate intake and knowledge in women of childbearing age, in relation to risk of neural tube defects. Subjects/setting One hundred forty-eight women (aged 18 to 45 years) in the Vancouver area of British Columbia, Canada. Design Using an interviewer-administered survey, we examined women for folate knowledge and the relation of folate knowledge to intake in a random sample. Contribution of folate from food, fortified grain products, and supplements was assessed by validated semiquantitative food frequency questionnaire. Statistical analyses performed Descriptive statistics, t tests, chi(2), Pearson correlation analysis. Results Mean daily folate intake from food, fortified foods, and supplementation was 812 +/- 710 Dietary Folate Equivalents (DFE)/day. Fortification of bread and grain products contributed 104 +/- 68 mug synthetic folic acid (SFA)/day (equal to 174 +/- 114 DFE), and supplements contributed 205 +/- 388 mug SFA/day. Although 86% of women met the Estimated Average Requirement (320 DFE/day) for folate, only 26% met the recommendation (400 mug SFA/day) for women capable of becoming pregnant. Most (95%) of the women had heard of folate, but only 25% knew that it could prevent birth defects. One-fourth of the women had good or very good knowledge of folate-rich foods. However, folate knowledge was not related to its intake. The most common sources of folate information were magazines/newspapers, doctors, and television/ radio. Lack of awareness of the importance of folate was the most common reason given for choosing not to use folic acid supplements before pregnancy. However, 78% of the women indicated that, with knowledge of the benefits of folate, they would use supplemental folic acid daily to reduce the risk of birth defects. Applications/conclusions Educational strategies are required to increase folate awareness among women and to promote the benefits of periconceptional folic acid supplementation. Targeting physicians to educate women on the importance of folate could be a potentially successful route.