Pre-conceptional folic acid supplement use according to maternal country of birth.
BACKGROUND
Supplementation with folic acid tablets in the pre-conceptional period reduces the risk of neural tube defects (NTD). In Canada, the risk of NTD may differ across certain ethnic groups. It is not known whether pre-conceptional folic acid supplement use varies according to a woman's country of birth or her duration of residency in Canada.


METHODS
We included 6349 Canadian women who gave birth between January 2005 and December 2006, and who had participated in the nationally representative Maternity Experiences Survey. Reported use of a supplement containing folic acid in the three months prior to conception was evaluated in association with maternal place of birth, categorized by nine regions of the world. Odds ratios (OR) were adjusted for maternal age, gravidity, income, education level, gestational age at first prenatal care visit, and number of years living in Canada.


RESULTS
Relative to a rate of 61% among Canadian-born mothers, the adjusted OR for pre-conceptional use of supplements containing folic acid was significantly lower among those who emigrated from the Caribbean and Latin America (OR 0.46; 95% confidence interval [CI] 0.31-0.70), Northern Africa and the Middle East (OR 0.33; 95% CI 0.20-0.57), and China and the South Pacific (OR 0.55; 95% CI 0.40-0.78).


CONCLUSIONS
Certain groups of women who are immigrants to Canada take pre-conceptional folic acid supplements at rates much lower than Canadian-born women. Interventions aimed at increasing folic acid use might focus on these women, perhaps around their time of arrival in Canada.
Han
Alice
A
Faculty of Medicine, University of Toronto, Toronto ON.
Rotermann
Michelle
M
Health Information and Research Division, Statistics Canada, Ottawa ON.
Fuller-Thomson
Esme
E
Faculty of Social Work, and Department of Family and Community Medicine, University of Toronto, Toronto ON.
Ray
Joel G
JG
Faculty of Medicine, University of Toronto, Toronto ON; Department of Obstetrics and Gynaecology, St. Michael's Hospital, University of Toronto, Toronto ON; Department of Health Policy Management and Evaluation, St. Michael's Hospital, University of Toronto, Toronto ON.
D000328:Adult; D003430:Cross-Sectional Studies; D019587:Dietary Supplements; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use*; D015438:Health Behavior / Q000208:ethnology*; D006801:Humans; D016742:Preconception Care; D014803:Vitamin B Complex / Q000627:therapeutic use*
D014803:Vitamin B Complex; D005492:Folic Acid