Preventing Birth Defects: Community-Wide Campaigns to Promote the Use of Folic Acid Supplements

If a woman has enough folic acid in her body before she is pregnant, it can reduce the risk of a pregnancy affected by neural tube birth defects (NTD). Community-wide campaigns to promote the use of folic acid supplements are designed to disseminate information to women of childbearing age or intending to become pregnant, regarding the use of supplements containing folic acid. These campaigns involve the dissemination of coordinated educational and motivational messages and materials within the community. Educational content can be delivered through:

• Mass media messages and articles
• Community activities and promotions
• Distribution of small media (posters, flyers, brochures, etc.)

The U.S. Public Health Service recommends that all women of childbearing age consume 400 micrograms (0.4 milligrams) of folic acid each day in order to reduce the risk of a pregnancy affected by a neural tube birth defect (CDC) . The U.S. Preventive Services Task Force recommends that women of childbearing age take a daily supplement containing 400-800 micrograms (0.4-0.8 milligrams) of folic acid (USPSTF) .

Summary of Task Force Findings & Recommendations

The Community Preventive Services Task Force recommends community-wide education campaigns to promote the use of folic acid supplements among women of childbearing age on the basis of sufficient evidence that these approaches are effective in increasing the number of these women who consume folic acid supplements.

Task Force Finding & Rationale Statement

Results of the Systematic Review

The twenty-four studies that qualified for the review assessed several outcomes.

• Folic acid consumption among women of childbearing age:
  • Median increase of 5.9% (interquartile interval [IQI] 2.5% to 20.5%; 16 studies)
  • Studies with lowest baseline consumption rates generally reported the largest effect size.
• Prevalence rates of neural tube defects (NTD):
  • Median reduction of 4% (IQI: –33.9% to 8.5%; 8 studies)
  • The two studies that showed the greatest reduction were potentially confounded by ongoing national fortification programs and by additional NTD recurrence prevention programs focused on increasing the use of folic acid before and during pregnancy.
  • Findings from individual studies were inconsistent and the effect measured across studies does not indicate substantial changes in NTD rates.
• The overall body of evidence represents women of childbearing age (18–45) with varying levels of education and social economic status.
• The intervention was delivered in urban, rural, and suburban settings in various international communities with high-income economies.

These results are based on a systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic reviews, other research, and public health practice and policy related to the prevention of birth defects.

---



Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Preventing birth defects: community-wide campaigns to promote the use of folic acid supplements. www.thecommunityguide.org/birthdefects/community.html. Last updated: MM/DD/YYYY.

Review completed: June 2004