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Pregnancy Health: Community-Wide Campaigns to Promote the Use of Folic Acid Supplements

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What the CPSTF Found

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.

Context

There is no information for this section.

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement pdf icon [PDF - 565 kB].

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.

Summary of Economic Evidence

A systematic review of economic evidence has not been conducted.

Applicability

Findings from this review should be applicable to women of childbearing age in high-income countries.

Evidence Gaps

Each Community Preventive Services Task Force (CPSTF) review identifies critical evidence gaps—areas where information is lacking. Evidence gaps can exist whether or not a recommendation is made. In cases when the CPSTF finds insufficient evidence to determine whether an intervention strategy works, evidence gaps encourage researchers and program evaluators to conduct more effectiveness studies. When the CPSTF recommends an intervention, evidence gaps highlight missing information that would help users determine if the intervention could meet their particular needs. For example, evidence may be needed to determine where the intervention will work, with which populations, how much it will cost to implement, whether it will provide adequate return on investment, or how users should structure or deliver the intervention to ensure effectiveness. Finally, evidence may be missing for outcomes different from those on which the CPSTF recommendation is based.

Identified Evidence Gaps

Future research should aim to address the following questions.

  • 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.

Study Characteristics

  • 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.
  • Studies were 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 countries in the European Union (not including the UK).

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