# Folic Acid Supplement Intake Before Pregnancy With and Without Educational Intervention: A Cross-Sectional Study in Japan

## TL;DR

This study in Japan found that education and awareness about folic acid are linked to higher intentions to take supplements before pregnancy.

## Contribution

The study explores how folic acid education and awareness influence pre-pregnancy supplement intentions among graduates in Japan.

## Key findings

- Food and Nutrition majors were more likely to intend to take folic acid supplements.
- Awareness of neural tube defects and access to folic acid information increased supplement intention.
- Prior education about folic acid was positively associated with future supplement use.

## Abstract

Background

Although folic acid supplementation during pregnancy has been recommended for over 20 years, awareness remains insufficient. This study aimed to investigate whether graduates who received folic acid education at a dietitian training school intended to take supplements prior to future pregnancies and to examine the methods of information dissemination.

Methods

This cross-sectional study targeted graduates of the Department of Lifestyle and Culture at Wakayama Shin-Ai Women’s Junior College, Wakayama, Japan. Data were collected via a questionnaire administered through Google Forms (Google LLC, Mountain View, CA, USA). The primary outcome was the intention to take folic acid supplements before pregnancy, and the main exposure was having received folic acid nutrition education during student years. A logistic regression model was used to assess associated factors.

Results

A total of 1,109 graduates (532 from the Life Culture major and 577 from the Food and Nutrition major) were eligible. Forty-eight responses were received, with 47 considered valid (response rate: 4.2%). Among the valid responses, 24 participants (51%) indicated they would take folic acid supplements before future pregnancies, while 23 (49%) reported they would not. A Food and Nutrition major was strongly associated with a higher intention to take folic acid supplements (OR: 17.69, 95% CI: 2.91-343.83). Awareness of neural tube defects (NTDs; OR: 3.81, 95% CI: 1.17-13.49) and access to folic acid-related information (OR: 7.20, 95% CI: 2.07-28.94) were also positively associated with this intention. Furthermore, participants who recalled learning about folic acid during junior college were more likely to intend to take supplements (OR: 6.50, 95% CI: 1.80-28.14).

Conclusions

Having a Food and Nutrition major, awareness of NTDs, access to folic acid information, and prior education about folic acid were positively associated with the intention to take folic acid supplements before pregnancy. However, due to the very low response rate, the multivariate findings were unstable and exploratory. Therefore, interpretation was limited to univariate results. Further prospective cohort studies with larger sample sizes are needed to confirm these associations.