title: Use of high doses of folic acid supplements in pregnant women in Spain: an INMA cohort study.
abstract: OBJECTIVE
  We examined the use of low (<400 μg/day, including no use) and high folic acid supplement (FAS) dosages (≥1000 μg/day) among pregnant women in Spain, and explored factors associated with the use of these non-recommended dosages.
  
  
  METHODS
  Population-based cohort study.
  
  
  METHODS
  Spain.
  
  
  METHODS
  We analysed data from 2332 pregnant women of the INMA study, a prospective mother-child cohort study in Spain.
  
  
  METHODS
  We assessed usual dietary folate and the use of FAS from preconception to the 3rd month (first period) and from the 4th to the 7th month (second period), using a validated food frequency questionnaire. We used multinomial logistic regression to estimate relative risk ratios (RRRs).
  
  
  RESULTS
  Over a half of the women used low dosages of FAS in the first and second period while 29% and 17% took high dosages of FAS, respectively. In the first period, tobacco smoking (RRR=1.63), alcohol intake (RRR=1.40), multiparous (RRR=1.44), unplanned pregnancy (RRR=4.20) and previous spontaneous abortion (RRR=0.58, lower use of high FAS dosages among those with previous abortions) were significantly associated with low FAS dosages. Alcohol consumption (RRR=1.42), unplanned pregnancy (RRR=2.66) and previous spontaneous abortion (RRR=0.68) were associated with high dosage use. In the second period, only tobacco smoking was significantly associated with high FAS dosage use (RRR=0.67).
  
  
  CONCLUSIONS
  A high proportion of pregnant women did not reach the recommended dosages of FAS in periconception and a considerable proportion also used FAS dosages ≥1000 μg/day. Action should be planned by the Health Care System and health professionals to improve the appropriate periconceptional use of FAS, taking into consideration the associated factors.
authors.affiliation: Departamento Salud Pública, Universidad Miguel Hernández, San Juan de Alicante, Spain CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.
authors.forename: Eva María
authors.initials: EM
authors.lastname: Navarrete-Muñoz
authors.affiliation: Departamento Salud Pública, Universidad Miguel Hernández, San Juan de Alicante, Spain.
authors.forename: Desirée
authors.initials: D
authors.lastname: Valera-Gran
authors.affiliation: Departamento Salud Pública, Universidad Miguel Hernández, San Juan de Alicante, Spain CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.
authors.forename: Manoli
authors.initials: M
authors.lastname: García de la Hera
authors.affiliation: Departamento Salud Pública, Universidad Miguel Hernández, San Juan de Alicante, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Gimenez-Monzo
authors.affiliation: CIBER de Epidemiología y Salud Pública (CIBERESP), Spain Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Morales
authors.affiliation: CIBER de Epidemiología y Salud Pública (CIBERESP), Spain Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Julvez
authors.affiliation: CIBER de Epidemiología y Salud Pública (CIBERESP), Spain Servicio de Pediatria, Hospital San Agustin-Aviles, Asturias, Spain.
authors.forename: Isolina
authors.initials: I
authors.lastname: Riaño
authors.affiliation: CIBER de Epidemiología y Salud Pública (CIBERESP), Spain Universidad de Oviedo, Asturias, Spain.
authors.forename: Adonina
authors.initials: A
authors.lastname: Tardón
authors.affiliation: CIBER de Epidemiología y Salud Pública (CIBERESP), Spain Subdirección de Salud Pública y Adicciones de Gipuzkoa, San Sebastian, Spain Instituto de Investigación Sanitaria BIODONOSTIA, San Sebastián, Spain.
authors.forename: Jesus
authors.initials: J
authors.lastname: Ibarluzea
authors.affiliation: CIBER de Epidemiología y Salud Pública (CIBERESP), Spain Subdirección de Salud Pública y Adicciones de Gipuzkoa, San Sebastian, Spain Instituto de Investigación Sanitaria BIODONOSTIA, San Sebastián, Spain.
authors.forename: Loreto
authors.initials: L
authors.lastname: Santa-Marina
authors.affiliation: CIBER de Epidemiología y Salud Pública (CIBERESP), Spain Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO/CSISP), Public Health, Valencia, Spain.
authors.forename: Mario
authors.initials: M
authors.lastname: Murcia
authors.affiliation: CIBER de Epidemiología y Salud Pública (CIBERESP), Spain Departamento de Medicina, Universitat Jaume I, Castellón de la Olana, Spain.
authors.forename: Marisa
authors.initials: M
authors.lastname: Rebagliato
authors.affiliation: Departamento Salud Pública, Universidad Miguel Hernández, San Juan de Alicante, Spain CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.
authors.forename: Jesus
authors.initials: J
authors.lastname: Vioque
mesh_terms: D000022:Abortion, Spontaneous; D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking; D019587:Dietary Supplements; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage*; D006801:Humans; D016015:Logistic Models; D039382:Maternal Nutritional Physiological Phenomena; D016017:Odds Ratio; D010298:Parity; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D011295:Prenatal Care / Q000592:standards*; D011446:Prospective Studies; D012907:Smoking; D013030:Spain; D055815:Young Adult
chemical_list: D005492:Folic Acid
keywords: NUTRITION & DIETETICS; PUBLIC HEALTH