Folic Acid Supplementation in Chinese Peri-conceptional Population: Results from the SPCC Study

Objective: To determine the prevalence and determinants of folic acid (FA) supplementation in Chinese couples planning for pregnancy and in women during early pregnancy.

Methods: This was a cross-sectional study based on the Shanghai PreConception Cohort (SPCC) study. Data on FA supplementation and socio-demographic features were collected using questionnaires. Couples visiting clinics for pre-pregnancy examination and pregnant women at < 14 gestational weeks were recruited in Shanghai, China, between March 2016 and September 2018.

Results: Among the pregnancy planners, 42.4% (4,710/11,099) women and 17.1% (1,377/8,045) men used FA supplements, while 93.4% (14,585/15,615) of the pregnant women used FA supplements. FA supplement use was higher in female pregnancy planners who were older ( RR: 1.13, 95% CI: 1.08-1.18), had higher education ( RR: 1.71, 95% CI: 1.53-1.92), and were residing in urban districts ( RR: 1.06, 95% CI: 1.01-1.11) of FA supplementation; female pregnancy planners with alcohol consumption ( RR: 0.95, 95% CI: 0.90-0.99) had lower odds of FA supplementation. In early pregnancy, women with higher educational level ( RR: 1.04, 95% CI: 1.03-1.06), who underwent pre-pregnancy examination ( RR: 1.02, 95% CI: 1.01-1.03) had higher odds of using an FA supplement; older aged ( RR: 0.99, 95% CI: 0.98-0.99), and multigravida ( RR: 0.97, 95% CI: 0.96-0.98) had lower odds of FA supplementation.

Conclusion: Although the majority of pregnant women took FA supplements, more than half of the women planning for pregnancy did not. Urgent strategies are needed to improve pre-conception FA supplementation.