Folic acid supplement and its influencing factors in pregnant women in Shaanxi province: a cross-sectional study

Objective To examine the prevalence and determinants of folic acid supplement among pregnant women in Shaanxi province and to provide evidences for related interventions.Methods Using stratified multistage random sampling,we selected 32 400 women with pregnancy between 2010 and 2013 from 10 urban districts and 20 counties in Shaanxi province and then conducted a face-to-face survey from August to November 2013 with a self-designed questionnaire on folic acid supplement before and during the pregnancy.Results Of the 29 818 pregnant women with complete data,66.4%(63.4% for rural women and 72.6% for urban women) used folic acid for 3 months before and during the pregnancy.Of the women with maternal folic acid supplement,25.3% had folic acid before the pregnancy and 19.9%,56.8%,and 4.7% took folic acid continuously for 30,31-90,and >180 days,respectively.Among the women surveyed,the facilitating factors for folic acid supplement included having prenatal examination 8 times or more (adjusted odds ratioOR_adj=2.25,95% confidence interval95% CI:2.09-2.43),having the first prenatal examination during early pregnancy (OR_adj=1.91,95% CI:1.78-2.03),having prenatal examination 5 to 8 times (OR_adj=1.68,95% CI:1.57-1.78),with a husband having the education of college and above (OR_adj=1.67,95% CI:1.50-1.87),with the education of college and above (OR_adj=1.52,95% CI:1.36-1.71),having eugenic counseling (OR_adj=1.42,95% CI:1.33-1.51),with the education of senior high school (OR_adj=1.33,95% CI:1.23-1.44),with a husband having the education of senior high school (OR_adj=1.26,95% CI:1.17-1.36),with abnormal obstetrical history (OR_adj=1.22,95% CI:1.10-1.35),and at ages of 30-35 years (OR_adj=1.20,95% CI:1.04-1.20);while the hindering factors were younger than 20 years (OR_adj=0.60,95% CI:0.52-0.70),elder than 35 years (OR_adj=0.89,95% CI:0.80-1.00),with once or more deliveries (OR_adj=0.76,95% CI:0.72-0.81),and being permanent urban resident (OR_adj=0.81,95% CI:0.76-0.86).Conclusion The rate of folic acid supplementation and the rate of adequate folic acid supplementation are lower than the national requirement among pregnant women in Shaanxi province;the results suggested that health management should be strengthened among the pregnant women,particularly among those of young,elder and with multiple delivery history.