Adequacy of prenatal care as a major determinant of folic acid, iron, and vitamin intake during pregnancy Adequação dos cuidados pré-natais como determinante da utilização de ácido fólico, ferro e vitaminas durante a gravidez

This study aimed to quantify the association between adequacy of prenatal care and prevalence of folic acid, iron, and multivitamin intake during pregnancy. Data were obtained on socio-demographics, prenatal care, pregnancy complications, and use of vitamin/mineral supplements for 836 women, using a postpartum interview. Associations with the use of vitamin/mineral supplements were quantified with risk ratios (RR), computed by generalized binomial regression. A high proportion of women reported the use of folic acid (81.9%), iron (55.4%), and multivitamins (76.2%) as supplements during pregnancy. Use of supplements was independently associated with adequacy of prenatal care (adequate vs. inadequate: folic acid, RR = 2.28; 95%CI: 1.58-3.29; iron, RR = 1.99; 95%CI: 1.57-2.52, multivitamins, RR = 1.97; 95%CI: 1.54-2.51). Higher schooling was also associated with increased use of folic acid (RR = 1.42; 95%CI: 1.18-1.70), but not multivitamins (RR = 0.87; 95%CI: 0.77-0.98). Use of folic acid was less prevalent in single women (RR = 0.67; 95%CI: 0.48-0.95) and during unplanned pregnancies (RR = 0.81; 95%CI: 0.71-0.92). Adequacy of prenatal care is a major determinant of vitamin/ mineral intake during pregnancy. Folic Acid; Iron; Vitamins; Prenatal Care; Pregnancy Introduction Obstetric guidelines recommend that all women use folic acid supplements in the periconceptional period to prevent neural tube defects. Prescription of iron for all pregnant women is not a consensus 1,2,3, since dietary intake may be sufficient to maintain recommended levels 4. Supplements should be reserved for women with or at high risk of anemia (women from developing countries, multiparous women, or those with multiple gestations or gestational hemorrhage) 2. The use of other vitamins and mineral supplements is questioned, except for low-income women, those with special diets, or those under treatment with specific drugs 5,6. Previous studies have quantified the use of vitamins and minerals in pregnancy 1,4,7,8,9,10,11, 12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32, 33,34,35,36,37,38, and some have addressed its association with age 11,12,13,30,31,38, ethnicity 8,12,13,30,33, education 11,13,18,30,31,36,38, marital status 11,13,38, parity 11,13,18,31,38, and planning of pregnancy 11,18,32,34,38. However, the effect of prenatal care has often been disregarded 8,11,18,27,29 or has relied on single measures such as the source of care 4,13,26,30,38 or simply attendance at prenatal care visits 12,36. Additionally, the influence of prenatal care vitamin/mineral supplementation and its relationship to sociodemographic factors can be expected to vary from country to country, namely concerning ARTIGO ARTICLE