Use of high doses of folic acid supplements in pregnant women in Spain: an INMA cohort study.
OBJECTIVES
We examined the use of low (<400 μg/day, including no use) and high folic acid supplement (FAS) dosages (≥1000 μg/day) among pregnant women in Spain, and explored factors associated with the use of these non-recommended dosages.


DESIGN
Population-based cohort study.


SETTING
Spain.


PARTICIPANTS
We analysed data from 2332 pregnant women of the INMA study, a prospective mother-child cohort study in Spain.


MAIN OUTCOME MEASURES
We assessed usual dietary folate and the use of FAS from preconception to the 3rd month (first period) and from the 4th to the 7th month (second period), using a validated food frequency questionnaire. We used multinomial logistic regression to estimate relative risk ratios (RRRs).


RESULTS
Over a half of the women used low dosages of FAS in the first and second period while 29% and 17% took high dosages of FAS, respectively. In the first period, tobacco smoking (RRR=1.63), alcohol intake (RRR=1.40), multiparous (RRR=1.44), unplanned pregnancy (RRR=4.20) and previous spontaneous abortion (RRR=0.58, lower use of high FAS dosages among those with previous abortions) were significantly associated with low FAS dosages. Alcohol consumption (RRR=1.42), unplanned pregnancy (RRR=2.66) and previous spontaneous abortion (RRR=0.68) were associated with high dosage use. In the second period, only tobacco smoking was significantly associated with high FAS dosage use (RRR=0.67).


CONCLUSIONS
A high proportion of pregnant women did not reach the recommended dosages of FAS in periconception and a considerable proportion also used FAS dosages ≥1000 μg/day. Action should be planned by the Health Care System and health professionals to improve the appropriate periconceptional use of FAS, taking into consideration the associated factors.
['Navarrete-Muñoz|Eva María|EM|', 'Valera-Gran|Desirée|D|', 'García de la Hera|Manoli|M|', 'Gimenez-Monzo|Daniel|D|', 'Morales|Eva|E|', 'Julvez|Jordi|J|', 'Riaño|Isolina|I|', 'Tardón|Adonina|A|', 'Ibarluzea|Jesus|J|', 'Santa-Marina|Loreto|L|', 'Murcia|Mario|M|', 'Rebagliato|Marisa|M|', 'Vioque|Jesus|J|', '|||']
D000022:Abortion, Spontaneous D000293:Adolescent D000328:Adult D000428:Alcohol Drinking D019587:Dietary Supplements D005260:Female D005492:Folic Acid D006801:Humans D016015:Logistic Models D039382:Maternal Nutritional Physiological Phenomena D016017:Odds Ratio D010298:Parity D011247:Pregnancy D049168:Pregnancy, Unplanned D011295:Prenatal Care D011446:Prospective Studies D012907:Smoking D013030:Spain D055815:Young Adult
NUTRITION & DIETETICS PUBLIC HEALTH