Folic acid use among pregnant women in Canada
Results from the Canadian Maternity Experiences Survey
Introduction
Since 1998, the Government of Canada has required that folic acid be added to all white flour, enriched pasta, and cornmeal products sold in Canada. Since then, there has been a significant decline in the rates of neural tube defects (NTDs) in Canada. As it is hard to get enough folic acid from diet alone, the Public Health Agency of Canada recommends that all women who could become pregnant should take a multivitamin containing 0.4 mg of folic acid every day. Higher amounts are recommended for some women whose risk for NTDs is higher. Although the benefit of folic acid in preventing NTDs is well known, not all women take supplements during the 3 months before conception, and during the first 3 months of pregnancy (periconceptional period).
Summary
- Overall, 77.6% of women knew that taking folic acid before conception could help protect their baby from NTDs.
- Over half (57.7%) of women reported taking a multivitamin containing folic acid or a folic acid supplement before they became pregnant.
- Most (89.4%) women reported taking folic acid (multivitamin or supplement) during the first 3 months of pregnancy.
- Half (49.2%) of all women took folic acid according to the recommended guidelines (daily supplementation in periconceptional period).
- Where they live had an impact on whether women reported knowing about the benefits of using folic acid before pregnancy. (See Figure 1)
- Older women and those with higher levels of education and income were more likely to know about the benefits of folic acid and to take supplements before and after conception.
- Women who had an unplanned pregnancy were less likely to supplement with folic acid, compared to women who had a planned pregnancy.
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Organization: Public Health Agency of Canada
Figure 1: Depending on where they live, Canadian women’s understanding of the need to take folic acid varies
Description - Figure 1
Figure 1: Distribution of folic acid knowledge in Canada
| Province/territory | Percent of women reporting they understood the need to take folic acid |
|---|---|
| Nunavut | <50% |
| Northwest Territories | 50.0-69.9% |
| Alberta, Saskatchewan, Manitoba, Ontario, Quebec, New Brunswick | 70.0-79.9% |
| British Columbia, Newfoundland and Labrador, Prince Edward Island, Yukon, Nova Scotia | >80% |
Although half of women were using folic acid according to the national recommendations, survey results also showed that differences existed based on social factors like education and economic status, as well as age and planning for pregnancy. (See Figure 2).
Identification of women whose use of folic acid is low, may allow for educational or other interventions to increase knowledge of the importance of folic acid in pregnancy and increase its use to help achieve healthy pregnancy outcomes.
Figure 2: Percentage of women who used folic acid supplements before pregnancy, based on four factors
Figure 2a: Percentage of women who used folic acid supplements before pregnancy based on highest level of education attained
Description - Figure 2a
Figure 2a: Percentage of women who used folic acid supplements before pregnancy based on highest level of education attained
| Highest level of education attained | Percent who used folic acid |
|---|---|
| Less than high school | <30% |
| High school + some post secondary education | Approximately 40% |
| Post-secondary diploma or certificate | Approximately 65% |
| University degree | Approximately 75% |
Figure 2b: Percentage of women who used folic acid supplements before pregnancy based on low income cut off
Description - Figure 2b
Figure 2b: Percentage of women who used folic acid supplements before pregnancy based on low income cut off
| Low income cut off score | Percent who used folic acid |
|---|---|
| At or below low income cut off score | Approximately 35% |
| Above low income cut off score | Approximately 65% |
Figure 2c: Percentage of women who used folic acid supplements before pregnancy based on pregnancy status
Description - Figure 2c
Figure 2c: Percentage of women who used folic acid supplements before pregnancy based on pregnancy status
| Pregnancy status | Percent who used folic acid |
|---|---|
| Planned pregnancy | Approximately 68% |
| Unplanned pregnancy | Approximately 30% |
Figure 2d: Percentage of women who used folic acid supplements before pregnancy based on different age groups
Description - Figure 2d
Figure 2d: Percentage of women who used folic acid supplements before pregnancy based on different age groups
| Age group | Percent who used folic acid |
|---|---|
| 15-19 years | Approximately 18% |
| 20-24 years | Approximately 30% |
| 25-29 years | Approximately 50% |
| 30-34 years | Approximately 60% |
| 35-39 years | Approximately 60% |
| 40-44 years | Approximately 55% |
| 45-49 years | Approximately 90% |
More information
Details about the MES, such as the questionnaire, data tables, and teaching slides are available here: The Canadian Maternity Experiences Survey
To learn more about positive choices to help ensure a healthy pregnancy, please see the Guide to a Healthy Pregnancy. Available from: Guide to a Healthy Pregnancy
For more information on why all women who could become pregnant should be taking Folic Acid, please visit folic acid
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