{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T05:40:00Z","timestamp":1777959600504,"version":"3.51.4"},"reference-count":43,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2015,10,23]]},"published-print":{"date-parts":[[2015,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>We examined the use of low (&lt;400\u2005\u03bcg\/day, including no use) and high folic acid supplement (FAS) dosages (\u22651000\u2005\u03bcg\/day) among pregnant women in Spain, and explored factors associated with the use of these non-recommended dosages.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Population-based cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Spain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>We analysed data from 2332 pregnant women of the INMA study, a prospective mother-child cohort study in Spain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>We assessed usual dietary folate and the use of FAS from preconception to the 3rd month (first period) and from the 4th to the 7th month (second period), using a validated food frequency questionnaire. We used multinomial logistic regression to estimate relative risk ratios (RRRs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Over a half of the women used low dosages of FAS in the first and second period while 29% and 17% took high dosages of FAS, respectively. In the first period, tobacco smoking (RRR=1.63), alcohol intake (RRR=1.40), multiparous (RRR=1.44), unplanned pregnancy (RRR=4.20) and previous spontaneous abortion (RRR=0.58, lower use of high FAS dosages among those with previous abortions) were significantly associated with low FAS dosages. Alcohol consumption (RRR=1.42), unplanned pregnancy (RRR=2.66) and previous spontaneous abortion (RRR=0.68) were associated with high dosage use. In the second period, only tobacco smoking was significantly associated with high FAS dosage use (RRR=0.67).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A high proportion of pregnant women did not reach the recommended dosages of FAS in periconception and a considerable proportion also used FAS dosages \u22651000\u2005\u03bcg\/day. Action should be planned by the Health Care System and health professionals to improve the appropriate periconceptional use of FAS, taking into consideration the associated factors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2015-009202","type":"journal-article","created":{"date-parts":[[2015,11,25]],"date-time":"2015-11-25T01:41:14Z","timestamp":1448415674000},"page":"e009202","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":20,"title":["Use of high doses of folic acid supplements in pregnant women in Spain: an INMA cohort study"],"prefix":"10.1136","volume":"5","author":[{"given":"Eva Mar\u00eda","family":"Navarrete-Mu\u00f1oz","sequence":"first","affiliation":[{"name":"Departamento Salud P\u00fablica, Universidad Miguel Hern\u00e1ndez, San Juan de Alicante, Spain"},{"name":"CIBER de Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP), 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