�鶹ֱ��app

Approximately one in four women in Canada are unaware of the benefits of taking folic acid before and during pregnancy to prevent certain birth defects – a percentage that has not improved in more than a decade.

In , researchers at Sinai Health and the University of Toronto analyzed data from the Canadian Community Health Survey conducted by Statistics Canada in 2017 and 2018.

“We compare this data to the last national study on prevalence of folic acid supplementation awareness in 2006–2007, which utilized data from the Canadian Maternity Experiences Survey,” says Vrati Mehra, a fourth-year medical student in �鶹ֱ��app’s Temerty Faculty of Medicine.

“We see almost no change in awareness levels from then till now. The numbers have essentially remained the same.”

Mehra is lead author of the paper along with Ellen Greenblatt, John Snelgrove and Claire Jones – all clinicians in the department of obstetrics and gynaecology at Mount Sinai Hospital and faculty members in the department of obstetrics and gynaecology in �鶹ֱ��app’s Temerty Faculty of Medicine. Professor Hala Tamim from York University also contributed to the study.

“Vrati had worked on a previous project of ours, a prenatal program design that involved interviewing pregnant participants,” says Jones, who is also the program director for gynecologic reproductive endocrinology and infertility residency at �鶹ֱ��app.

“Hearing many admit they did not know about supplementing with folic acid inspired her to look further into it – a good example of how anecdotal evidence can suggest fruitful research paths.”

In the early 1990s, researchers showed that folic acid could prevent open neural tube defects. The neural tube is formed in the third and fourth weeks of pregnancy and develops into the nervous system: the spinal cord and brain. Defects lead to higher incidence of miscarriages, or debilitating conditions such as spina bifida or anencephaly at birth.

“Although we typically get enough folic acid for daily functioning, the requirement increases significantly during pregnancy to support the development of a growing baby,” says Mehra. “So, in the early 2000s, the government mandated that companies fortify pasta, breads, cereal and other grain foods with folic acid.”

The folic acid fortification came with targeted public ad campaigns that successfully raised awareness levels among Canadian females from between 25 and 50 per cent in the early 2000s to between 70 and 75 per cent in 2007.

“However, since then, the public campaigns have become more passive,” says Mehra. “Posters by the Public Health Agency of Canada are available online for those seeking information about folic acid. However, to my knowledge, there are no active campaigns targeting people who might be completely unaware of its importance.”

The study also found that certain socioeconomic patterns had persisted over the decade. People who were younger were more likely to be unaware of folic acid, as were people with lower income or less education. Landed immigrants were three times more likely to be unaware, on average. 

Some of the disparities may be explained by how health information circulates, says Mehra.

“People get info from their family doctors, or from a public campaign poster in a health-care provider’s office. Those who only see a doctor after finding out that they are pregnant, or don’t have regular follow-up, have fewer chances to learn about folic acid,” she says. 

“We are currently experiencing a crisis of family doctors in the country. The shortage makes me worry about what may happen to awareness levels in the coming years.”

Possible solutions include incorporating information about folic acid’s benefits before and during pregnancy to the high school sexual health curriculum, which already covers content on contraception and pregnancy. The addition would emphasize the importance of folic acid for pregnant individuals and advise those planning to become pregnant to begin taking supplements at least three months prior to conception and during their pregnancy.

The researchers say it may also be beneficial to target newcomers to Canada.  

“I was once an immigrant,” says Mehra. “I remember accompanying my parents to the ServiceOntario Centre to get our health cards. Including a simple line in multiple languages about folic acid, either in the paperwork or displayed on posters, could help.

“We also visited other public spaces like libraries and community centres, which are ideal for informative posters.

“A collective effort from the government, health-care providers, the education system and the immigration system would make a big difference.”