{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T23:46:31Z","timestamp":1773099991528,"version":"3.50.1"},"reference-count":69,"publisher":"Cambridge University Press (CUP)","issue":"11","license":[{"start":{"date-parts":[[2022,7,25]],"date-time":"2022-07-25T00:00:00Z","timestamp":1658707200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Public Health Nutr."],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S1368980022001574_as1\"><jats:title>Objective:<\/jats:title><jats:p>Neural tube defects (NTD) are potentially preventable by periconceptual folic acid supplementation. Women with obesity are at higher risk of NTD, therefore, are recommended a higher dose of 5 mg folic acid to mitigate this risk. The aim of this study was to evaluate maternal practice of folic acid supplementation amongst the antenatal population in relation to maternal obesity status.<\/jats:p><\/jats:sec><jats:sec id=\"S1368980022001574_as2\"><jats:title>Design:<\/jats:title><jats:p>Prospective observational study.<\/jats:p><\/jats:sec><jats:sec id=\"S1368980022001574_as3\"><jats:title>Setting:<\/jats:title><jats:p>Women \u226418 weeks\u2019 gestation at their first antenatal appointment attending University Maternity Hospital Limerick (Ireland) were recruited. Maternal height and weight were measured. Obesity was defined at a threshold of \u226530\u00b70 kg\/m<jats:sup>2<\/jats:sup> and \u226527\u00b75 kg\/m<jats:sup>2<\/jats:sup> when adjusting for ethnicity. A two-part questionnaire captured maternal characteristics and assessed supplementation compliance, commencement and dosage. Fisher\u2019s exact test for independence analysed differences in variables. A <jats:italic>P<\/jats:italic> value of &lt;0\u00b705 was considered significant.<\/jats:p><\/jats:sec><jats:sec id=\"S1368980022001574_as4\"><jats:title>Participants:<\/jats:title><jats:p>A total of 328 women participated over a duration of 6 weeks.<\/jats:p><\/jats:sec><jats:sec id=\"S1368980022001574_as5\"><jats:title>Results:<\/jats:title><jats:p>Mean gestational age was 12\u00b74 \u00b1 1\u00b74 weeks and mean BMI 26\u00b77 kg\/m<jats:sup>2<\/jats:sup> \u00b1 5\u00b72 kg\/m<jats:sup>2<\/jats:sup>. 23\u00b78 % (<jats:italic>n<\/jats:italic> 78) were classified as obese. 96\u00b75 % (<jats:italic>n<\/jats:italic> 315) were taking folic acid and 95\u00b77 % (<jats:italic>n<\/jats:italic> 314) supplemented daily. 30\u00b72 % (<jats:italic>n<\/jats:italic> 99) commenced supplementation 12 weeks prior to conception. Overall, 57\u00b79 % (<jats:italic>n<\/jats:italic> 190) of women met folic acid supplementation dose requirements. 89\u00b71 % (<jats:italic>n<\/jats:italic> 55) of women with obesity did not. Women with obesity were less likely to meet the higher folic acid supplementation dose requirements (<jats:italic>P =&lt;<\/jats:italic> 0\u00b7001).<\/jats:p><\/jats:sec><jats:sec id=\"S1368980022001574_as6\"><jats:title>Conclusion:<\/jats:title><jats:p>Folic acid supplementation practices within this cohort were suboptimal to prevent their risk of NTD. This study showed inadequate compliance of folic acid supplementation, and inadequate dosage for women with obesity. Increased patient education and awareness are needed within the antenatal period of pregnancy to bring folic acid supplementation practices in line with best practice guidelines.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s1368980022001574","type":"journal-article","created":{"date-parts":[[2022,7,25]],"date-time":"2022-07-25T08:18:08Z","timestamp":1658737088000},"page":"3025-3035","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":8,"title":["An evaluation of adherence to folic acid supplementation in pregnant women during early gestation for the prevention of neural tube defects"],"prefix":"10.1017","volume":"25","author":[{"given":"Anna","family":"Linnell","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niamh","family":"Murphy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jon","family":"Godwin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4996-1430","authenticated-orcid":false,"given":"Alexandra","family":"Cremona","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2022,7,25]]},"reference":[{"key":"S1368980022001574_ref15","doi-asserted-by":"publisher","DOI":"10.1038\/ejcn.2015.131"},{"key":"S1368980022001574_ref34","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2006.01180.x"},{"key":"S1368980022001574_ref30","unstructured":"30. Institute of Obstetricians and Gynaecologists, Royal College of Physicians of Ireland, Clinical Strategy and Programme Directorate et al. (2011) Obesity and Pregnancy Clinical Practice Guideline. Care of Women with Obesity in Pregnancy (Green-top Guideline No. 72) | RCOG (accessed July 2020)."},{"key":"S1368980022001574_ref60","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-789X.2008.00511.x"},{"key":"S1368980022001574_ref55","first-page":"211","article-title":"Maternal obesity and pre-pregnancy folic acid supplementation","volume":"6","author":"Farah","year":"2013","journal-title":"Eur J Obes"},{"key":"S1368980022001574_ref14","first-page":"763","article-title":"A genetic defect in 5, 10 methylenetetrahydrofolate reductase in neural tube defects","volume":"88","author":"Whitehead","year":"1995","journal-title":"Q J Med"},{"key":"S1368980022001574_ref7","first-page":"2","article-title":"Folic acid and human reproduction\u2014ten important issues for clinicians","volume":"8","author":"Dunlap","year":"2011","journal-title":"J Exp Clin Assist Reprod"},{"key":"S1368980022001574_ref61","doi-asserted-by":"publisher","DOI":"10.1136\/jech.51.3.246"},{"key":"S1368980022001574_ref11","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199212243272602"},{"key":"S1368980022001574_ref46","doi-asserted-by":"publisher","DOI":"10.1136\/jech.55.11.841"},{"key":"S1368980022001574_ref52","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/152.9.823"},{"key":"S1368980022001574_ref3","volume-title":"Pediatric Rehabilitation","author":"Molnar","year":"1999"},{"key":"S1368980022001574_ref43","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/der078"},{"key":"S1368980022001574_ref50","doi-asserted-by":"publisher","DOI":"10.1017\/S1368980008002346"},{"key":"S1368980022001574_ref16","unstructured":"16. WHO (2015) Guideline: Optimal Serum and Red Blood Cell Folate Concentrations in Women of Reproductive Age for Prevention of Neural Tube Defects. Guideline: optimal serum and red blood cell folate concentrations in women of reproductive age for prevention of neural tube defects (who.int) (accessed July 2020)."},{"key":"S1368980022001574_ref33","doi-asserted-by":"publisher","DOI":"10.1016\/j.siny.2009.09.006"},{"key":"S1368980022001574_ref47","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2019.05.003"},{"key":"S1368980022001574_ref5","doi-asserted-by":"publisher","DOI":"10.1093\/pubmed\/fdv019"},{"key":"S1368980022001574_ref28","doi-asserted-by":"publisher","DOI":"10.3109\/01443615.2011.581316"},{"key":"S1368980022001574_ref22","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.111.026633"},{"key":"S1368980022001574_ref26","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2018.10.001"},{"key":"S1368980022001574_ref31","doi-asserted-by":"publisher","DOI":"10.3109\/00016341003801706"},{"key":"S1368980022001574_ref12","doi-asserted-by":"publisher","DOI":"10.1093\/pubmed\/fdu016"},{"key":"S1368980022001574_ref29","doi-asserted-by":"publisher","DOI":"10.1001\/jama.288.14.1723"},{"key":"S1368980022001574_ref51","first-page":"224A","article-title":"Primiparous women\u2019s reported preconception and first trimester folic acid use","volume":"60","author":"Brooke","year":"2001","journal-title":"Proc Nutr Soc"},{"key":"S1368980022001574_ref40","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1996.03530380031027"},{"key":"S1368980022001574_ref42","unstructured":"42. 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CMACE & RCOG (2010) Management of Women with Obesity in Pregnancy. 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Institute of Obstetricians and Gynaecologists, Royal College of Physicians of Ireland, Clinical Strategy and Programme Directorate et al. (2019) Nutrition during Pregnancy, Clinical Practice Guideline. https:\/\/www.rcpi.ie\/news\/publications\/author\/institute-of-obstetricians-and-gynaecologists\/ (accessed July 2020)."},{"key":"S1368980022001574_ref66","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/nqab035"},{"key":"S1368980022001574_ref53","doi-asserted-by":"publisher","DOI":"10.1783\/147118910791749380"},{"key":"S1368980022001574_ref2","unstructured":"2. FSAI (2016) Report of the Scientific Committee of the Food Safety Authority of Ireland. Update Report on Folic Acid and the Prevention of Birth Defects in Ireland. Resources and Publications | The Food Safety Authority of Ireland (fsai.ie) (accessed July 2020)."},{"key":"S1368980022001574_ref59","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ijo.0801375"},{"key":"S1368980022001574_ref56","first-page":"1029","article-title":"Body mass index and serum folate in childbearing age women","volume":"19","author":"Mojtabi","year":"2004","journal-title":"Nutr Epidemiol"},{"key":"S1368980022001574_ref13","doi-asserted-by":"publisher","DOI":"10.1017\/S1368980015000555"},{"key":"S1368980022001574_ref25","volume-title":"FA Supplementation during Pregnancy for Maternal Health and Pregnancy Outcomes (Review)","author":"Lassi","year":"2013"},{"key":"S1368980022001574_ref20","first-page":"59","article-title":"Scientific opinion on dietary reference values for folate","volume":"12","year":"2014","journal-title":"EFSA J"},{"key":"S1368980022001574_ref68","unstructured":"68. Central Statistics Office. 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