Systematic review of interventions to increase periconceptional awareness, knowledge and consumption of folic acid supplements

Background: While many women at reproductive age worldwide are aware of the folic acid role in neural tube defects prevention during pregnancy, their compliance with recommendations remains low. Objective: We conducted a systematic review of studies designed to increase awareness of, knowledge about and consumption of folic acid supplements before and during pregnancy. Methods: Studies were identified from Cochrane Library, Medline, the references of primary studies and reviews. Of 337 published articles thirty one retrieved included two randomised controlled trials, one quasi-experimental interrupted time series study, three follow up studies, one case-control study, and twenty four before-and-after studies. They focussed on women aged 15-49 years and/or health professionals, evaluating women's awareness, knowledge or consumption of folic acid and/or health professionals' knowledge about and counseling on folic acid pre and post intervention. Because of heterogeneity a narrative synthesis was performed describing the direction and the size of effects. Results: Interventions were carried out in the United States, Australia and Europe between 1992 and 2002. Overall, the women's awareness increased from 60% to 72%, the knowledge from 22% to 49% and the consumption from 14% to 23%. The interventions on women and/or health professionals used printed and audio-visual media or other channels of communication. All campaign strategies used more than one channel but lacked the use of social marketing tools. Conclusion: The interventions have limited impact on uptake of folic acid supplements before and during pregnancy. Improved marketing techniques are needed to enhance the implementation of safe and cost-effective folic acid supplementation.