title: Why do Canadian women fail to achieve optimal pre-conceptional folic acid supplementation? An observational study.
abstract: OBJECTIVE
  To determine the factors that put Canadian women at risk for not supplementing with folic acid (FA) in the three months before conception, as recommended for the prevention of infant neural tube defects.
  
  
  METHODS
  This study used data from the Canadian Maternity Experiences Survey. We used Poisson regression analysis with a robust variance to determine which factors were associated with women not supplementing with FA in the three months prior to pregnancy as compared with women who did supplement.
  
  
  RESULTS
  Of the 6421 women surveyed, 57.7% were supplementing with FA pre-conceptionally. The risk factors associated with a lack of FA supplementation pre-conceptionally were maternal age <19 (prevalence ratio [PR] = 0.50; 95% CI 0.36 to 0.69) or 20 to 24 (PR = 0.75; 95% CI 0.67 to 0.84); education below high school level (PR = 0.73; 95% CI 0.61 to 0.87), at high school level (PR = 0.77; 95% CI 0.71 to 0.83), or at post-secondary level other than university (PR = 0.93; 95% CI 0.88 to 0.97); being at or below the low-income cut-off (PR = 0.74; 95% CI 0.67 to 0.81); smoking before pregnancy (PR = 0.79; 95% CI 0.73 to 0.86); being non-fluent in the language of the health care provider (PR = 0.66; 95% CI 0.49 to 0.88); being obese (BMI ≥ 30) (PR = 0.91; 95% CI 0.85 to 0.98); being unemployed (PR = 0.94; 95% CI 0.89 to 1.00); and being born outside of Canada (PR = 0.79; 95% CI 0.74 to 0.84).
  
  
  CONCLUSIONS
  Young maternal age, low education, low income, smoking, language barriers, obesity, unemployment, and being born outside Canada are risk factors for suboptimal or lack of FA supplementation pre-conceptionally.
authors.affiliation: Clinical Epidemiology Unit, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa ON; Faculty of Medicine, Queen's University, Kingston ON.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Miller
authors.affiliation: Clinical Epidemiology Unit, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa ON.
authors.forename: Ning
authors.initials: N
authors.lastname: Liu
authors.affiliation: Clinical Epidemiology Unit, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa ON; Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, University of Ottawa, Ottawa ON.
authors.forename: Shi Wu
authors.initials: SW
authors.lastname: Wen
authors.affiliation: Clinical Epidemiology Unit, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa ON; Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, University of Ottawa, Ottawa ON; Ontario Perinatal Surveillance System, Ottawa ON.
authors.forename: Mark
authors.initials: M
authors.lastname: Walker
mesh_terms: D000293:Adolescent; D000328:Adult; D002170:Canada; D003430:Cross-Sectional Studies; D019587:Dietary Supplements; D004522:Educational Status; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage*; D006801:Humans; D008423:Maternal Age; D009436:Neural Tube Defects / Q000517:prevention & control; D009765:Obesity; D011203:Poverty; D016742:Preconception Care / Q000706:statistics & numerical data; D011247:Pregnancy; D012307:Risk Factors
chemical_list: D005492:Folic Acid