Last update - 00:00 13/11/2006
Less educated women unlikely to take folic acid during pregnancy
By Relly Sa'ar, Haaretz Correspondent
Taking folic acid prior to conception and in the early stages of pregnancy reduces the number of babies born with serious birth defects by as much as 30 percent. However, there are large socioeconomic gaps in women's knowledge and awareness regarding the importance of folic acid - Vitamin B9 - to a healthy pregnancy.
College-educated women take the vital nutritional supplement 3.5 times more than women who have not completed high school do.
Folic acid is vital to fetal development in the early weeks of pregnancy. A lack of it causes serious birth defects: malformations of the skull (anencelaphy) and incomplete closure of the spinal cord including protruding nerves (spina bifida), which can cause paralysis and even death. These defects can be diagnosed during pregnancy; however Health Ministry professionals say "there are sectors of the population for whom terminating pregnancy is not possible for reasons of faith."
To reduce the number of babies born with these severe defects, six years ago, the Health Ministry launched an awareness campaign about women starting to take folic acid three months before conception and during pregnancy. The neural tube, the precursor of the central nervous system, which comprises the brain and spinal cord, and the rest of the fetal organs, develop in the first two months of pregnancy, largely before many women know they are pregnant or of the importance of their folic acid levels before they conceive.
Health Ministry research examined two aspects of the use of folic acid. Dr. Yona Amitai, head of the ministry's department for mother, child and adolescent health, examined the ramifications of consuming the vitamin on reducing birth defects before the inception of the awareness campaign, and during the program. The second aspect involved surveys of 1,860 women in 2000 - before the campaign, and in the years 2002 and 2005, to assess the efficiency of the campaign.
According to ministry figures for 1999-2000, Jewish mothers had an average 12 babies with severe birth defects for every 10,000 live births. Four years later, that number fell 31 percent to an average of eight. Among Arabs and Druze, the rate of birth defects fell by about 25 percent during the years of the ministry's awareness campaign from an average 22 such births for every 10,000 live births to 17. The number of non-Jewish babies born with severe birth defects of the brain and spinal cord stems from genetic causes, mostly due to interfamily marriage.
To examine the efficiency of the ministry's recommendations regarding consumption of folic acid, the research conducted three surveys at well-baby clinics among 1,860 pregnant women or mothers of newborns. The women who participated in the surveys were asked if they regularly took folic acid supplements before the start of their pregnancies and during the pregnancy, according to Health Ministry recommendations, as well as regarding their knowledge regarding the timing of taking the supplement. In the last survey, conducted one year ago, it became clear that there is a large gap between women's knowledge regarding the necessity of the vitamin to the proper development of the fetus (81 percent) and consumption in practice both before and during pregnancy (34 percent). However, even if only a third of women surveyed last year took the vitamin regularly, five years after inception of the ministry's campaign, Amitai saw it as a success. According to him, "In 2000, 5 percent of women took folic acid, and 18 percent knew of its importance to fetal development. In 2002, 78 percent of women were aware of its importance and 31 percent took it." Ministry figures indicate that knowledge of the importance of folic acid and its consumption can be attributed not only to the effectiveness of the awareness campaign, but also largely to the mother's education. College-educated mothers are better able to use the Internet and understand printed text than women who have not attended college. In the last survey, 97 percent of college-educated mothers knew when it was important to take folic acid, compared to 46 percent of those who had not completed high school. While about half the women with bachelor's degrees took folic acid before and during pregnancy, only 14 percent of those who had dropped out before getting high school diplomas took the vitamin in keeping with ministry recommendations.