WEDNESDAY, Sept. 5, 2001 (HealthDayNews) -- Less than a third of women of childbearing age are taking a daily multivitamin containing folic acid, and doctors are not advising them to do so, a new national survey shows.
The survey, commissioned by the March of Dimes, shows a 5 percent drop in women using folic acid last year. Three in four women said their doctors did not discuss the importance of taking the supplement, the survey says.
A daily dose of folic acid, a member of the vitamin B family, can slash the risk of neural tube birth defects (NTDs) by up to 70 percent, research has shown. The neural tube is the part of the unborn fetus that develops into the brain and spinal cord. Despite increasing awareness of folic acid's importance in preventing birth defects, daily use of the supplement has not increased since 1995.
"The good news is that awareness [of the benefits of folic acid] has increased to 79 percent since 1995 among women ages 18 to 45," says Janis Biermann, director of the March of Dimes National Folic Acid Campaign. "But in order to have an effect on neural tube defects, you have to take folic acid once a day, at least one month before you become pregnant. And only 7 percent knew about the need for the supplement before pregnancy, compared to 2 percent in 1995. So it's only a modest increase."
The March of Dimes has been conducting an annual survey on folic acid awareness and vitamin-taking behavior since 1995 to track the effectiveness of public education campaigns urging women to take the supplement daily.
"The U.S. Public Health Agency came out with a recommendation in 1992 that all women should take 400 micrograms of folic acid. And then in 1998, the recommendation came out from the Institute of Medicine that women had to take 400 micrograms of synthetic folic acid," Biermann says. "So originally it was in food, and then the recommendation changed to include a supplement. So we initiated our formal campaign on folic acid in 1999, based on these recommendations."
Folic acid, also known as folate, is found in some enriched foods and vitamin pills. Research has shown that women who have enough of the vitamin in their bodies before pregnancy reduce the risk birth defects in the baby's brain (anencephaly) or spine (spina bifida).
The March of Dimes says an estimated 2,500 babies are born each year with NTDs, and many pregnancies result in miscarriage or stillbirth. The most common NTD is spina bifida, a leading cause of childhood paralysis. Anencephaly is a fatal condition in which a baby is born with an underdeveloped brain and skull.
This year's survey of 2,001 women shows that 29 percent of those aged 18 to 45 take a daily multivitamin, down from 34 percent in 2000. For women who were not pregnant at the time of the survey, 27 percent report taking a multivitamin containing folic acid every day, a decrease from 32 percent reported in 2000. About one in five women know that folic acid prevents birth defects.
Biermann says, "One possible reason women are not taking folic acid was uncovered in our survey. Seventy-six percent of the women reported that their doctors did not discuss the importance of folic acid. We know that this is important because, unprompted, 20 percent of the women in our survey said that hearing the supplement was important from their health-care provider would cause them to be more likely to do so."
"We find that [doctors not advising their patients about folic acid] surprising," Biermann says. "Doctors and health-care providers may be missing their only chance to prevent birth defects. NTDs only affect 2,500 live births, so it may not be on the health-care providers' radar screen. And they only have limited time with any one patient, so they have to prioritize their message. But to us, it's a lost opportunity."
"I think the blame may be able to be placed with a lot of different people," says Dr. Ted Ganiats, a professor of family and preventive medicine at the University of California at San Diego and a spokesman for the American Academy of Family Physicians. "It takes a fair amount of time for a majority of doctors to change their practice in the face of new evidence. That is not just limited to folate but to a wide range of medical interventions."
"But the patient has some responsibility here, too," he says. "The patient has been told and either didn't remember, or they are told and they don't realize the doctor has said, 'Take these vitamins -- take folate.'"
Doctors should make sure that women get enough folate, but Ganiats says, "You have to remember the doctor has a lot of messages during an appointment and a short time to deliver them."
What To Do
Green, leafy vegetables are a good source of folic acid. Many breads and cereals also contain it.
For more on the recommendation to take folic acid and how to get it, see the National Center for Birth Defects and Developmental Disabilities or the March of Dimes.
