Preconception and Prenatal Care
Preconception and Prenatal Care
Folic acid use
The percent of women who reported taking folic acid supplements prior to pregnancy was significantly higher in Middlesex-London compared to Ontario and the Peer Group from 2013 to 2016. In 2016, 44.3% of women in Middlesex-London who gave birth reported taking folic acid supplements before getting pregnant compared to 33.5% in Ontario (Fig. 11.1.1).
Women aged 30 to 39 had the highest reported use of folic acid prior to pregnancy from 2013 to 2017 in Middlesex-London. Women in the youngest age group (<20 years) reported the lowest use of folic acid supplements, ranging from just 4.0% to 5.9% of women in that age group who gave birth (Fig. 11.1.2).
Folic acid use among the rural population of Middlesex-London was significantly higher than the urban population from 2013 to 2017. In 2017, 56.2% of women in the rural population reported taking folic acid supplements prior to pregnancy compared to 41.4% in the urban population (Fig. 11.1.3).
The percent of women who reported taking folic acid supplements prior to and during pregnancy (excludes those who only took supplements prior to pregnancy) was also significantly higher in Middlesex-London compared to Ontario and the Peer Group from 2013 to 2016. In 2016, 43.2% of women in Middlesex-London who gave birth reported taking folic acid supplements compared to 31.3% in Ontario (Fig. 11.1.4).
Interpretive notes:
Folic acid, or folate (vitamin B9), is an important nutrient for the growth and development of a fetus.1 It is naturally present in foods such as corn, beans, spinach, peas, broccoli and oranges.2 It is also present in foods that have been fortified with the vitamin, including breakfast cereals, enriched pastas, and white flour.3
Folic acid intake by women prior to pregnancy and up to 12 weeks of pregnancy has been found to help reduce the risk of neural tube defects in the baby.4, 5 Neural tube defects are birth defects of the brain, spine, or spinal cord; they occur when a fetus’ neural tube does not fully close during the early weeks of pregnancy.2 The two most common neural tube defects are spina bifida (when the spine does not close) and anencephaly (when part of the brain and skull are missing).2
On their own, dietary sources of folic acid are not enough to reach the level required to protect against neural tube defects2; as a result, folic acid supplements are recommended for all women of child-bearing age.
First trimester visit
The percent of women in Middlesex-London who had a prenatal care visit with a physician or midwife during the first trimester of pregnancy (up to 12 weeks of gestation) was 96.5% in 2017, compared to 91.3% in Ontario. From 2013 to 2017, the percentages in Middlesex-London increased over time and remained significantly higher than Ontario (Fig. 11.1.5).
The percent of women who had a prenatal care visit during the first trimester of pregnancy was similar among the urban and rural population of Middlesex-London from 2013 to 2017 (not shown).
Early prenatal care can help ensure a healthy pregnancy for both the mother and baby. The World Health Organization recommends that the first prenatal care visit takes place in the first trimester of pregnancy (up to 12 weeks of gestation).6
Prenatal care can be delivered by different healthcare providers, including family doctors, registered midwives, or obstetricians. During the first prenatal care visit, the healthcare provider will assess the health of the mother and fetus, collect blood and urine to screen for any potential conditions or infections, provide any needed health counseling regarding pregnancy, and help to develop a plan for continued prenatal care.
Healthy Growth and Development Guideline, 2018
Ontario Public Health Standards: Requirements for Programs, Services, and Accountability
References:
1. Greenberg JA, Bell SJ, Guan Y, Yu Y-H. Folic Acid Supplementation and Pregnancy: More Than Just Neural Tube Defect Prevention. Rev Obstet Gynecol [Internet]. 2011 [cited 2018 Nov 12];4(2):52-9. Available from: https://www.ncbi.nlm.nih.gov/pmc/PMC3218540/
2. Public Health Agency of Canada. Folic Acid and Neural Tube Defects [Internet]. 2018 [cited 2018 Nov 12]. Available from: https://www.canada.ca/en/public-health/services/pregnancy/folic-acid.html
3. Canadian Food Inspection Agency. Foods to Which Vitamins, Mineral Nutrients and Amino Acids May or Must Be Added [D.03.002, Fdr] [Internet]. 2018 [cited 2018 Nov 12]. Available from: http://www.inspection.gc.ca/food/labelling/food-labelling-for-industry/nutrient-content/reference-information/eng/1389908857542/1389908896254?chap=1
4. Ingrid Goh Y, Bollano E, Einarson TR, Koren G. Prenatal Multivitamin Supplementation and Rates of Congenital Anomalies: A Meta-Analysis. J Obstet Gynaecol Can [Internet]. 2006 [cited 2018 Nov 12];28(8):680-9. Available from: http://www.sciencedirect.com/science/article/pii/S1701216316322277 DOI: https://doi.org/10.1016/S1701-2163(16)32227-7
5. De-Regil LM, Fernandez-Gaxiola AC, Dowswell T, Pena-Rosas JP. Effects and Safety of Periconceptional Folate Supplementation for Preventing Birth Defects. Cochrane Database Syst Rev [Internet]. 2010 [cited 2018 Nov 12];(10):Cd007950. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4160020/ DOI: 10.1002/14651858.CD007950.pub2
6. World Health Organization. WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience [Internet]. World Health Organization, 2016 [cited 2018 Nov 30]. Available from: http://apps.who.int/iris/bitstream/handle/10665/250796/9789241549912-eng.pdf;jsessionid=0FF2CA94792E8B0A2C50C6E1EA7B93D6?sequence=1
Last modified on: January 24, 2019
Jargon Explained
Folic acid use prior to pregnancy
The percentage of women who gave birth (live or still) who reported taking folic acid prior to pregnancy. Includes women who reported any folic acid use prior to pregnancy (including those who continued use during pregnancy).
Folic acid use prior to and during pregnancy
The percentage of women who gave birth (live or still) who reported taking folic acid supplements prior to and during pregnancy. Excludes women who did report any use during pregnancy (i.e., use only reported prior to pregnancy).
Neural tube defect
Birth defects of the brain, spine, or spinal cord. The two most common neural tube defects are spina bifida (when the spine does not close) and anencephaly (when part of the brain and skull are missing).2
Folic acid fortification
The addition of folic acid to food. In Canada, folic acid must be added to enriched pasta, white flour, infant formula, whole egg substitutes, and simulated meat products.3
Attended an antenatal visit with a healthcare provider during the first trimester
The percentage of women who gave birth that attended a prenatal visit with a healthcare provider (e.g., physician, midwife, or obstetrician) during the first trimester of pregnancy (up to 12 weeks of gestation).