Folic acid supplementation among pregnant women in southern Brazil: prevalence and factors associated

Linhares, Angélica Ozório; Cesar, Juraci Almeida

doi:10.1590/1413-81232017222.06302016

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Sumário

ARTICLE • Ciênc. saúde colet. 22 (2) • Feb 2017 • https://doi.org/10.1590/1413-81232017222.06302016 copy

Folic acid supplementation among pregnant women in southern Brazil: prevalence and factors associated

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To identify the prevalence and factors associated with the use of folic acid supplementation in pregnancy.

Methods

A cross-sectional population based study, in Rio Grande, RS. In 2013, all pregnant women and had children with birth weight less than 500 grams or at least 20 weeks of gestation were included in the study. They investigated demographic characteristics, socioeconomic, reproductive life and assistance to prenatal care. We conducted multivariate analysis with Poisson regression, considering a hierarchical model and p < 0.05 for the association.

Results

2,685 mothers were interviewed. Prevalence of folic acid use during pregnancy was 54.2%. Factors associated with the use of folic acid were: women with white skin color, living with a partner, higher schooling and family income, being primiparous, they planned their pregnancies, have six or more prenatal consultations and have started prenatal care in the first trimester of pregnancy.

Conclusions

The low prevalence of folic acid use in this study is worrisome, especially among mothers color black skin, less educated and poorer, then with the greatest potential to have complications during pregnancy. To implement more effective campaigns, targeting, especially for women with lower socioeconomic status is necessary.

Folic acid; Pregnancy; Prenatal; Supplementation

Variable	N	Percentage
Maternal age (years)
13–19	464	17.3%
20–24	707	26.3%
25–29	648	24.1%
≥ 30	866	32.3%
Self-referred skin color
Black	312	11.6%
Brown/mixed	597	22.2%
White	1,776	66.2%
Living with a partner	2,303	85.8%
Maternal schooling (years)
0–4	162	6.0%
5–8	902	33.6%
9–11	1,201	44.8%
≥ 12	420	15.6%
Household income in quartiles
First (lower)	680	25.3%
Second	693	25.8%
Third	641	23.9%
Fourth (upper)	671	25.0%
Number of children
None	1,273	47.4%
One	795	29.6%
Two or more	619	23.0%
Planned pregnancy	1,008	37.5%
Number of prenatal visits
1–3	111	4.2%
4–5	261	10.0%
6 or more	2,244	85.8%
Trimester of prenatal care initiation
First	2.056	78.6%
Second	511	19.5%
Third	48	1.8%
Care setting
Public	1,351	51.6%
Private	1,265	48.4%
Folic acid supplementation during pregnancy	1,458	54.2%
Total	2,685	100%

Level	Variable	Folic acid supplementation	Prevalence rate (95% CI)

			Crude analysis	Adjusted analysis
1	Maternal age (years)
	13–19	46.3%	p < 0.001^** 1.00	p = 0.29^** 1.00
	20–24	49.7%	1.07 (0.95–1.21)	0.90 (0.78–1.02)
	25–29	58.2%	1.26 (1.12–1.41)	0.97 (0.86–1.10)
	≥ 30	59.4%	1.28 (1.14–1.43)	0.97 (0.86–1.10)
	Self-referred skin color
	Black	41.7%	p < 0.001^* 1.00	p = 0.03^* 1.00
	Brown/mixed	50.1%	1.20 (1.03–1.40)	1.15 (0.99–1.34)
	White	57.9%	1.39 (1.21–1.59)	1.20 (1.04–1.38)
	Living with a partner
	No	38.2%	p < 0.001^* 1.00	p < 0.001^* 1.00
	Yes	56.9%	1.49 (1.30–1.70)	1.30 (1.14–1.49)
	Maternal schooling (years)
	0–4	29.0%	p < 0.001^** 1.00	p < 0.001^** 1.00
	5–8	42.2%	1.45 (1.12–1.86)	1.44 (1.12–1.86)
	9–11	59.8%	2.06 (1.61–2.63)	1.91 (1.49–2.44)
	≥ 12	74.5%	2.57 (2.01–3.29)	2.17 (1.69–2.81)
	Household income in quartiles
	First (lower)	41.5%	p < 0.001^** 1.00	p = 0.001^** 1.00
	Second	50.1%	1.21 (1.07–1.36)	1.08 (0.97–1.22)
	Third	55.1%	1.33 (1.19–1.49)	1.11 (0.98–1.24)
	Fourth (upper)	70.8%	1.71 (1.54–1.89)	1.25 (1.11–1.40)
2	Primiparous
	No	46.5%	p < 0.001^* 1.00	p < 0.001^* 1.00
	Yes	62.9%	1.35 (1.26–1.45)	1.27 (1.18–1.36)
	Planned pregnancy
	No	45.2%	p < 0.001^* 1.00	p < 0.001^* 1.00
	Yes	69.4%	1.54 (1.44–1.64)	1.33 (1.24–1.42)
3	Number of prenatal care visits
	1–3	9.9%	p < 0.001^** 1.00	p < 0.001^** 1.00
	4–5	15.7%	1.49 (1.00–2.21)	1.25 (0.85–1.85)
	6 or more	50.9%	2.78 (1.95–3.97)	1.69 (1.18–2.42)
	Trimester of prenatal care initiation
	First	62.7%	p < 0.001^*	p < 0.001^*
	Second or third	30.2%	2.07 (1.82–2.36) 1.0	1.50 (1.31–1.72) 1.0
	Care setting
	Public	49.4%	p < 0.001^* 1.00	p = 0.004^* 1.00
	Private	62.5%	1.26 (1.18–1.35)	0.89 (0.82–0.96)

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E-mail: cienciasaudecoletiva@fiocruz.br

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[1] Collaborations

AO Linhares was involved in the fieldwork, helped in the data entry, conducted the literature review and data analysis, and prepared the manuscript. JA Cesar designed the original research project, supervised the collection and entry of data, helped in the data analysis, critically reviewed the entire manuscript, and approved its final version.