Pregnancy Health: Community-Wide Campaigns to Promote the Use of Folic Acid Supplements
Findings and Recommendations
The Community Preventive Services Task Force (CPSTF) 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.
The full CPSTF Finding and Rationale Statement and supporting documents for Pregnancy Health: Community-Wide Campaigns to Promote the Use of Folic Acid Supplements are available in The Community Guide Collection on CDC Stacks.
Intervention
Community-wide campaigns disseminate coordinated educational and motivational messages and materials to women of childbearing age or intending to become pregnant regarding the use of supplements containing folic acid. If a woman has enough folic acid in her body before pregnancy, it can reduce the risk of neural tube birth defects (NTD).
Educational content can be delivered through:
- Mass media messages and articles
- Community activities and promotions
- Distribution of small media (posters, flyers, brochures)
The U.S. Public Health Service recommends all women of childbearing age consume 400 micrograms (0.4 milligrams) of folic acid daily to reduce the risk of neural tube birth defects (CDC). The U.S. Preventive Services Task Force recommends women of childbearing age take a daily supplement containing 400-800 micrograms (0.4-0.8 milligrams) of folic acid (USPSTF).
About The Systematic Review
The CPSTF finding is based on evidence from a systematic review of 24 studies. The review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to preventing birth defects.
Study Characteristics
- Overall body of evidence represents women of childbearing age (18–45) with varying levels of education and socioeconomic status
- Interventions delivered in urban, rural, and suburban settings
- Studies conducted in Australia (3 studies), Israel (2 studies), Norway (2 studies), the Netherlands (3 studies), Germany (1 study), the United Kingdom (England and Ireland; 4 studies), Denmark (1 study), France (1 study), Mexico (1 study), and the United States (5 studies); one study used registry information from 17 European Union countries (not including the UK)
Summary of Results
Twenty-four studies 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)
- Findings from individual studies were inconsistent and the effect measured across studies does not indicate substantial changes in NTD rates
- Two studies showing greatest reduction were potentially confounded by ongoing national fortification programs and additional NTD recurrence prevention programs
Summary of Economic Evidence
An economic review of this intervention was not conducted.
Applicability
Findings from this review should be applicable to women of childbearing age in high-income countries.
Evidence Gaps
- What is the impact of community-wide interventions in communities with low rates of supplement use?
- Is there a ceiling limit for these behavior changes?
- How does program effectiveness vary among different populations such as women with lower SES, younger women (aged 18–24 years), and African American and Hispanic women?
Implementation Considerations and Resources
Consideration should be given to accessibility as not all women will have money to purchase daily supplements.
Crosswalks
Healthy People 2030 includes the following objectives related to this CPSTF recommendation.