Knowledge of periconceptional folic acid for the prevention of neural tube defects - The missing links

Background: Periconceptional folic acid supplementation is effective in preventing primary and secondary neural tube defects (NTDs) and other congenital defects. However, debate exists regarding the effectiveness of public and physician education on patient knowledge and compliance. Objective: To examine the level of knowledge about the usefulness of periconceptional folic acid supplementation in a sample of patients from primary care practices. Design: Cross-sectional survey. A confidential, anonymous questionnaire was completed by patients before physician encounters. A maximum of 20 consecutive female patients from each of 3 age groups (16-24, 25-32, and 33-40 years) were recruited from each primary care practice. Settings: Twenty-two Canadian teaching practices affiliated with the Northeastern Ontario Primary Care Research Group. Outcome: Women's knowledge of periconceptional folic acid supplementation for the prevention of NTDs. Results: Of 1125 eligible female patients between the ages of 16 and 40 years visiting their family physician in 1996, 1124 (99.9%) completed the questionnaire. General awareness of NTDs was high (62.7%); however, knowledge that these defects were preventable was lower (22.5%). Only 7.8% of the women made the association between folic acid intake and NTDs. The specific knowledge that NTDs could be prevented with folic acid supplementation before conception was identified by 1.8% of the sample. Pregnant participants were at least twice as likely to be informed about the link. Interpractice variability existed with respect to knowledge of folic acid supplementation. Conclusion: Knowledge of periconceptional folic acid supplementation for the prevention of NTDs was low in this sample and is likely to be reflected in missed opportunities to prevent an important class of congenital malformations.