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RESEARCH ARTICLE (Open Access)
Contents Vol 15(4)

Inequities in pre-pregnancy folic acid use in Central and South Auckland: secondary analysis from a postpartum contraception survey

Esther Tutty https://orcid.org/0000-0001-6997-6077 1 * , Jordon Wimsett https://orcid.org/0000-0002-4465-3949 2 3 , Charlotte Oyston https://orcid.org/0000-0002-1762-7905 1 2 , Sue Tutty https://orcid.org/0000-0001-6905-7556 4 , Matire Harwood https://orcid.org/0000-0003-1240-5139 5 , Emelia Legget https://orcid.org/0000-0003-1164-5261 6 , Lynn Sadler https://orcid.org/0000-0003-0681-6652 2 3
+ Author Affiliations
- Author Affiliations

1 Department of Obstetrics and Gynaecology, Te Whatu Ora Counties Manukau Health, Auckland, New Zealand.

2 Department of Obstetrics and Gynaecology, Waipapa Taumata Rau University of Auckland; Auckland, New Zealand.

3 Department of Women’s Health, Te Whatu Ora Te Toka Tumai, Auckland, New Zealand.

4 Department of General Practice, Te Whatu Ora Counties Manukau Health, Auckland, New Zealand.

5 Department on General Practice, Waipapa Taumata Rau University of Auckland; Auckland, New Zealand.

6 Otago Medical School, University of Otago Christchurch, New Zealand.

* Correspondence to: Esther.Tutty@middlemore.co.nz

Handling Editor: Tim Stokes

Journal of Primary Health Care 15(4) 308-315 https://doi.org/10.1071/HC23103
Submitted: 2 September 2023  Accepted: 10 November 2023  Published: 7 December 2023

© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Introduction

In Aotearoa New Zealand (NZ), there is inequity in rates of neural tube defects (NTDs). Among Maaori, NTD occur in 4.58/10 000 live births, and for Pacific peoples, it is 4.09/10 000 live births; this is compared to 2.81/10 000 live births for non-Maaori, non-Pacific peoples.

Aim

To describe self-reported pre-pregnancy folic acid supplementation and to determine the association between pregnancy intendedness, ethnicity, parity, maternal age, care provider and pre-pregnancy folic acid supplementation.

Methods

Secondary analysis of postpartum survey data collected at Te Whatu Ora Te Toka Tumai and Counties Manukau birthing facilities in 2020 was conducted. Descriptive analyses explored pregnancy intendedness and self-reported folic acid use by demographic variables. Multivariable logistic regression explored independent associations between demographic variables and folic acid use among intended pregnancies.

Results

In total, 398 participants completed the survey. The response rate was (140/149) 94% at Counties Manukau and (258/315) 82% at Te Toka Tumai. Pre-pregnancy supplementation was reported by 182 of 398 participants (46%). Use was higher among those who intended their pregnancy (151/262, 58%) compared to those who were ‘pregnancy ambivalent’ (9/33, 27%) or did not intend to become pregnant (22/103, 21%). Factors independently associated with supplementation among intended pregnancies included: ‘Other ethnicity’ (European, Middle Eastern, Latin American, African) compared to Maaori (aOR 5.3 (95% CI 1.3, 21.8)), age ≥30 years compared to <30 years (aOR 2.1 (1.0, 4.1)), and private obstetrician compared to midwifery care (aOR 4.2 (1.6, 10.9)).

Discussion

Low rates of pre-pregnancy folic acid supplementation exist in Auckland with significant ethnic disparity. Mandatory fortification of non-organic wheat is important, but supplementation is still recommended to maximally reduce risk.

Keywords: congenital anomaly, equity, folate, folic acid, fortification, neural tube defects, pre-pregnancy supplementation, prevention.

References

1  The Health Benefits and Risks of Folic Acid Fortification of Food Auckland New Zealand. 2018. Available at https://www.royalsociety.org.nz/assets/Uploads/The-health-benefits-and-risks-of-folic-acid-fortification-of-food.pdf

2  De‐Regil LM, Peña‐Rosas JP, Fernández‐Gaxiola AC, et al. Effects and safety of periconceptional oral folate supplementation for preventing birth defects. Cochrane Database Syst Rev [12] 2015; CD007950.
| Crossref | Google Scholar |

3  Xu W, Yi L, Deng C, et al. Maternal periconceptional folic acid supplementation reduced risks of non‐syndromic oral clefts in offspring. Sci Rep 2021; 11: 12316.
| Crossref | Google Scholar |

4  Feng Y, Wang S, Chen R, Tong X, Wu Z, Mo X. Maternal folic acid supplementation and the risk of congenital heart defects in offspring: a meta‐analysis of epidemiological observational studies. Sci Rep 2015; 5: 8506.
| Crossref | Google Scholar | PubMed |

5  Greene NDE, Copp AJ. Neural tube defects. Annu Rev Neurosci 2014; 37: 221-42.
| Crossref | Google Scholar | PubMed |

6  Folic acid, iodine and vitamin D: Manatu Hauora. Available at https://www.health.govt.nz/your-health/pregnancy-and-kids/pregnancy/helpful-advice-during-pregnancy/folic-acid-iodine-and-vitamin-d [Accessed 15 October 2023].

7  Wimsett J, Sadler L, Tutty S, et al. Pregnancy planning and barriers to accessing postnatal contraception in New Zealand. Contraception 2022; 112: 100-4.
| Crossref | Google Scholar |

8  Verrall A. Folic acid fortification to protect tamariki beehive.org.nz. New Zealand Government; 2021. Available at https://www.beehive.govt.nz/release/folic-acid-fortification-protect-tamariki#:~:text=The%20Government%20is%20taking%20action,This%20is%20about%20protecting%20babies

9  Monitoring the health impacts of mandatory folic acid and iodine fortification. Canberra: Australian Institute of Health and Welfare; 2016. https://www.aihw.gov.au/reports/food-nutrition/monitoring-health-impacts-of-mandatory-folic-acid/summary

10  Folate and Folic Acid: Te Whatu Ora. 2022. Available at https://www.tewhatuora.govt.nz/for-the-health-sector/health-sector-guidance/folate-and-folic-acid

11  Mallard SR, Houghton LA. Folate knowledge and consumer behaviour among pregnant New Zealand women prior to the potential introduction of mandatory fortification. Asia Pac J Clin Nutr 2012; 21(3): 440-9.
| Google Scholar | PubMed |

12  Wimsett J, Legget E, Roberts H, et al. Factors associated with postpartum contraceptive planning in New Zealand. Contraception 2023; 118: 109898.
| Crossref | Google Scholar | PubMed |

13  Ministry of Health. HISO 10001:2017 Ethnicity data protocols. Wellington: Ministry of Health; 2017.

14  Kalafatelia E, Fryer K. Awareness and Knowledge of Folate and Folic Acid. A survey of New Zealand women of child-bearing age. Wellington: Ministry of Agriculture and Forestry; 2011.

15  Hauora: Report on Stage One of the Health Services and Outcomes Kaupapa Inquiry. Wellington: Waitangi Tribunal; 2019. https://forms.justice.govt.nz/search/Documents/WT/wt_DOC_195476216/Hauora%202023%20W.pdf

16  Morton SM, Grant CC, Atatoa Carr PE. Too many left at risk by current folic acid supplementation use: evidence from Growing Up in New Zealand. Aust N Z J Public Health 2013; 37(2): 190-1.
| Crossref | Google Scholar | PubMed |

17  Dawson P, Auvray B, Jaye C, et al. Social determinants and inequitable maternal and perinatal outcomes in Aotearoa New Zealand. Womens Health (Lond) 2022; 18: 17455065221075913.
| Crossref | Google Scholar | PubMed |

18  Rolnick SJ, Pawloski PA, Hedblom BD, et al. Patient characteristics associated with medication adherence. Clin Med Res 2013; 11(2): 54-65.
| Crossref | Google Scholar | PubMed |

19  Camier A, Kadawathagedara M, Lioret S, et al. Social inequalities in prenatal folic acid supplementation: results from the ELFE cohort. Nutrients 2019; 11(5):.
| Crossref | Google Scholar | PubMed |

20  Svendsen MT, Bak CK, Sørensen K, et al. Associations of health literacy with socioeconomic position, health risk behavior, and health status: a large national population-based survey among Danish adults. BMC Public Health 2020; 20(1): 565.
| Crossref | Google Scholar | PubMed |

21  Report on Maternity web tool: Te Whatu Ora. 2023. Available at https://tewhatuora.shinyapps.io/report-on-maternity-web-tool/

22  Arroll N, Sadler L, Stone P, et al. Can we improve the prevention and detection of congenital abnormalities? An audit of early pregnancy care in New Zealand. N Z Med J 2013; 126(1380): 46-56.
| Google Scholar | PubMed |