The prevention of neural tube defects in post-partum women.

Sir, Periconceptional supplementation with extra folic acid,1 or a multivitamin preparation containing folic acid2,3 reduces the recurrence and occurrence rate of neural tube defect (NTD). Also, the Department of Health’s expert Advisory group recommends that all women should take an extra 0.4 mg folic acid before conception and during the early months of pregnancy. Between September 1994 and May 1995 we investigated the awareness of these recommendations and assessed folate intake in 150 women aged 16–41 years (mean 29.1, SD 5.0) on the post-natal ward at the General Infirmary at Leeds. Median folate intake indicated by the dietary questionnaire was 285 μg/day (IQ range 231-339.5 μg/day), with 13 women consuming less than the RDA of 200 μg/day. Smokers had a mean intake of 235.5 μg/day (IQ 210-312 μg/day), which was significantly lower than that of non-smokers whose mean intake was 295.0 μg/day (IQ 243-357 μg/day, P=0.009 Mann-Whitney). When interviewed, 125 (83%) women were aware of the use of folic acid for the prevention of NTD, 15 (10%) were unaware and 10 (7%) had partial or vague knowledge (e.g. ‘helped baby’, ‘helped conception’). Eighty-two per cent of women were able to name foods that are good sources of folate, but only 33% were able to name foods that had folate added to them. Seventy-four (49% of the total sample) of the 135 who had some knowledge of the importance of folic acid, obtained this knowledge during their present pregnancy. Of the remaining 61, 18 had unplanned pregnancies, leaving 43 who could have taken preconceptional folate. Twenty-nine (19.3% of the total sample) of these women had increased their folate intake before conception, 26 (17.3%) by folate supplements after conception (fair starting between day one and day 28 post-conception, and one started taking folate supplements and three (2%) by increasing their intake of fruit and vegetables. Five mothers had started taking folate supplements after conception (four starting between day one and day 28 post-conception, and one started taking folate supplements when 10 weeks pregnant). Two mothers had increased their dietary intake of folate once pregnancy was confirmed (one by eating more green vegetables and the other by eating fortified cereals). Three had consulted their general practitioners (one at eight weeks), but had not been given folate supplements. Only three women who had complete knowledge and one with partial knowledge of the recommendations and had planned pregnancies had taken no further action. Sources of knowledge for those women aware that folate prevented spina bifida are shown in Table 1. Thus, we confirmed our earlier finding that less than 20% of women take folate supplements before they conceive and are thus protected from an NTD-affected pregnancy.4 Two years after the Department of Health recommended that all women planning to become pregnant should consume additional folate, 59% of women were unaware of the recommendations before starting their pregnancy and 10% were still unaware after they gave birth to their baby. Our findings showed the need for a broadbased education campaign targeting health professionals and all women of reproductive age. The need to increase folate intake before conception should be stressed. JENNIFER WILD CHRISTOPHER J SCHORAH MALCOLM I LEVENE