Folic acid awareness influences supplement use before pregnancy

Intending to take folic acid supplements before pregnancy is more common among women with a food and nutrition major in college, awareness of neural tube defects (NTDs), and access to folic acid–related information, according to a recent study published in Cureus.¹

Cell growth is significantly influenced by folic acid. Additionally, folic acid supplement use before pregnancy has been linked to reduced odds of developing NTDs, defined as congenital malformations that occur when the neural tube is unable to properly close. This has led folic acid supplementation to be recommended during pregnancy for more than 20 years.²

“However, awareness of the recommendation to take folic acid to prevent NTDs remains insufficient, particularly among women who have never been pregnant,” wrote investigators.¹

Questionnaire development

Investigators conducted a trial to evaluate factors linked to the intent to take folic acid supplementation in reproductive-aged women prior to pregnancy. A questionnaire was developed by reviewing available literature about folic acid intake during pregnancy. The study authors discussed variables aligned with the purposes of the trial.

Following this process, a research team utilized professional judgement to review and cross-evaluate questionnaire items and terminology. Finally, 10 experts assessed the clarity and content validity of the draft questionnaire.

Graduates from the Department of Life Culture at Wakayama Shin-Ai Women’s Junior College between March 2006 and March 2023 were recruited for the analysis. Folic acid supplement use prior to pregnancy was reported in these patients as the primary outcome.

Major, pregnancy experience, NTD awareness, awareness of the role of folic acid in reducing NTD risk, access to folic acid information, recollection of learning about folic acid during junior college, and sharing information about the necessity of folic acid intake before pregnancy were considered potential predictors of intending to take folic acid before pregnancy.

Findings on folic acid supplementation intent

There were 47 respondents included in the final analysis, 51% of whom intended to take folic acid supplements before pregnancy, while 49% did not. A significant association was reported between graduating with a food and nutrition major and being more likely to intend to take folic acid supplementation before pregnancy, with an OR of 17.69.

Pregnancy experience was linked to an OR of 3.33 for this outcome, indicating a weak or nonsignificant association. ORs of 3.81 and 7.20 were reported for folic acid supplementation before pregnancy in patients with awareness of NTDs and access to folic acid information, respectively, highlighting significant associations.

Additionally, the odds of taking folic acid supplements were increased by learning about folic acid during junior college, with an OR of 6.50. However, investigators noted high uncertainty about the effect of providing others with information about the need to take folic acid supplements before pregnancy.

Implications

These results indicated positive associations for a major in food and nutrition, NTD awareness, educational experiences in junior college, and access to folic acid information with an intention to take folic acid supplements before pregnancy. However, investigators noted the data were limited by a low response rate.

“Further prospective cohort studies with larger sample sizes are necessary to confirm these associations,” wrote investigators.

References

1. Morioka M, Kataoka Y, Taito S. Folic acid supplement intake before pregnancy with and without educational intervention: a cross-sectional study in Japan. Cureus. 2025;17(7):e87959. doi:10.7759/cureus.87959
2. Promoting appropriate information provision regarding folic acid intake to women of childbearing age and others to reduce the risk of neural tube defects. Article in Japanese. Accessed May 25, 2025. https://www.mhlw.go.jp/www1/houdou/1212/h1228-1_18.html