# Awareness and Use of Folic Acid Among Pregnant Women in Western Ukraine: A Pilot Study

## TL;DR

A pilot study in western Ukraine finds low preconception folic acid use among pregnant women, highlighting missed opportunities to prevent neural tube defects.

## Contribution

The study identifies key behavioral and counseling factors influencing folic acid supplementation practices in Ukraine.

## Key findings

- Only 25.3% of pregnant women used folic acid before conception, despite 80.0% starting after pregnancy recognition.
- Preconception counseling, planned pregnancy, and prior supplementation were strongly associated with preconception folic acid use.
- Low awareness of folic acid recommendations and neural tube defect prevention was observed, with no link to supplementation behavior.

## Abstract

Public health relevance—How does this work relate to a public health issue?
This pilot study addresses an important public health concern in Ukraine: persistently high rates of neural tube defects (NTDs), which remain among the highest in Europe.It identifies a substantial gap between recommended and actual folic acid (FA) use, with low preconception supplementation (25.3%) compared to high post-conception initiation (80.0%), reflecting missed opportunities for effective NTD prevention.

This pilot study addresses an important public health concern in Ukraine: persistently high rates of neural tube defects (NTDs), which remain among the highest in Europe.

It identifies a substantial gap between recommended and actual folic acid (FA) use, with low preconception supplementation (25.3%) compared to high post-conception initiation (80.0%), reflecting missed opportunities for effective NTD prevention.

Public health significance—Why is this work of significance to public health?
Based on cross-sectional data, the study provides preliminary evidence on determinants of FA supplementation, demonstrating that preconception counseling, pregnancy planning, and prior supplementation behavior strongly influence preconception intake.The findings show that knowledge alone does not translate into preventive behavior, suggesting limitations in current NTD prevention strategies in Ukraine.

Based on cross-sectional data, the study provides preliminary evidence on determinants of FA supplementation, demonstrating that preconception counseling, pregnancy planning, and prior supplementation behavior strongly influence preconception intake.

The findings show that knowledge alone does not translate into preventive behavior, suggesting limitations in current NTD prevention strategies in Ukraine.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?
Results support strengthening preconception counseling and promoting folic acid supplementation among women of reproductive age.Implementation of national food fortification policies with folic acid and conduction of larger, population-based studies to develop evidence-based prevention strategies in Ukraine are recommended.

Results support strengthening preconception counseling and promoting folic acid supplementation among women of reproductive age.

Implementation of national food fortification policies with folic acid and conduction of larger, population-based studies to develop evidence-based prevention strategies in Ukraine are recommended.

Objective: Neural tube defects remain a significant global health concern. This pilot study assessed folic acid (FA) knowledge and supplementation practices among pregnant women in Ukraine. Methods: A cross-sectional survey was conducted among 95 pregnant women who completed a 22-item self-administered questionnaire assessing FA awareness and socio-demographic characteristics. Results: Although 76.8% of participants reported planned pregnancies, only 25.3% used FA before conception, while 80.0% initiated supplementation after pregnancy recognition (p < 0.05). In bivariate logistic regression analysis, preconception counseling (OR = 7.7, 95% CI: 2.37–24.85), planned pregnancy (OR = 9.7, 95% CI: 1.22–76.25), previous FA supplementation (OR = 3.11, 95% CI: 1.20–8.33), and increasing maternal age (OR = 1.09 per year, 95% CI: 1.00–1.19) were significantly associated with preconception FA use. Sociodemographic factors were not significant predictors. For FA use during pregnancy, only previous supplementation remained significant (OR = 4.10, 95% CI: 1.10–14.29). Awareness of recommended FA use before (35.8%) and during pregnancy (48.4%) and knowledge of neural tube defect prevention (20.0%) were low and not associated with supplementation behavior. Conclusions: A substantial gap exists between recommended and actual FA use, particularly before conception. Strengthening preconception counseling may improve timely supplementation.