Issue link: https://maltatoday.uberflip.com/i/1183404
2 maltatoday | SUNDAY • 10 NOVEMBER 2019 NEWS JAMES DEBONO JUST one quarter of Maltese women who delivered a baby as recently as 2015, had reported taking folic acids before preg- nancy – a supplement which significantly reduces neurologi- cal diseases like Spina Bifida. An extensive study of 4,385 women who delivered a baby in 2015 found that just 25% (1,125) reported taking their folic acid, a supplement strongly recom- mended by doctors and gy- naecologists before and during pregnancy. Moreover, only 7% of mothers aged under 25 reported taking folic acids, the study published in the Malta Medical Gazette found. And in an indication of health inequalities, the least likely to have taken folic acids were peo- ple with lower educational levels and migrants from outside the European Union.Mothers are advised to take 400 micrograms of folic acid each day – from be- fore they are pregnant until they are 12 weeks pregnant. Folic acid is a man-made form of a B vitamin called folate, and plays an important role in the production of red blood cells to help a baby's neural tube develop into her brain and spinal cord. Birth defects occur within the first 3-4 weeks of pregnancy, so having folate during those early stages when the baby's brain and spinal cord are developing is im- portant to prevent neural tube abnormalities that can lead to the occurrence of anencephaly and spina bifida. Folate is found naturally in dark green vegeta- bles and citrus fruits but to be effective, folic acids have to be taken in the right dosage before conception. The prevalence of neural tube defects in Malta is 10 for every 10,000 births. Yet according to the Malta Medical Gazette study this rate can be halved if more women take folic acids before conception. To reduce the risk of these diseases a number of countries, including the USA and Canada, have introduced mandatory food fortification of flour with folic acid, to ensure that women are already taking the required amounts of folic acid before and during the early weeks of con- ception. These initiatives have translated into a significant de- crease in neural tube defects in those countries. Women in Malta are routinely asked during the first antenatal clinic visit at hospital whether they have been taking folic acid supplements and whether they started them before pregnancy. However, the authors ac- knowledged that women gener- ally present at the obstetricians' clinics following conception, "at a time too late for prevention of potentially avoidable NTDs." Results showed that women having had a planned pregnancy were the most likely to take folic acid before becoming pregnant. The study showed Gozitan women reported taking signifi- cantly less folic acid before preg- nancy than women residing in other areas. Young women were found to be the least likely to take folic acid supplementation before be- coming pregnant, with only 7% of mothers in Malta aged less than 25 years taking preconcep- tion folic acid. Mothers of African or Euro- pean non-EU origin were asso- ciated with the lowest rates of preconception folic acid intake. "This highlights the possibility of existent health inequalities," the study said, and issues with health promotion messages and recommendations reaching for- eign mothers and mothers of minority ethnic groups. Moreover, a number of family doctors are themselves not fully aware of the benefits and cor- rect timing and dosage of folic acid intake. "Women's knowledge and in- take of folic acid supplements is influenced significantly by health care professionals' ad- vice, namely general practition- ers, obstetricians, paediatricians and pharmacists," the authors said. "General practitioners have an important role in increasing awareness and improving pre- conceptional folic acid intake. It is important that they are aware of this and give appropriate ad- vice to all women of childbear- ing age even when they are at- tending clinics for other reasons. "Unfortunately, it has been documented that a number of family doctors are themselves not fully aware of the benefits and correct timing and dosage of pre-conceptional folic acid intake. Although obstetricians are fully aware and do provide folic acid supplementation ad- vice, women generally present at the obstetricians' clinics fol- lowing conception, at a time too late for prevention of potentially avoidable NTDs." 'Preconception clinics' are considered as the ideal venues that may educate and encourage women to take preconception folic acid supplements. Howev- er, such clinics are not available in Malta. "In the absence of manda- tory food fortification, countries must be innovative and pro-ac- tive in undertaking initiatives to improve women's folic acid up- take with the aim of avoiding po- tentially preventable devastating birth defects as are neural tube defects. This is an area which undisputedly offers great public health potential. It is important to ensure that any initiatives undertaken reach all maternal categories including the more vulnerable women," the doctors said, calling for more research in determining women's views of what encourages or stops them from having better preconcep- tion care. The study was authored by doctors Miriam Gatt and Marika Borg, researcher Elaine Grech Mercieca and Prof Nev- ille Calleja. Percentage of women who took folic acid before pregnancy Went to university 35.5% Other post-sec educ. 26.6% Stopped at secondary 17.2% Aged under 25 7% 25-35 29% Over 35 27.8% From western region 35.8% From northern region 30.2% From south-east region 29.8% From north harbour 23% From Gozo 21.9% From south harbour 18.4% Maltese-born 28.2% Other EU country 20.7% Other European country 19.8% Africa & Middle East 4.3% A number of family doctors are themselves not fully aware of the benefits and correct timing and dosage of pre-conceptional folic acid intake Women shun vitamin that helps prevent birth defects