Healthcare Providers and Folic Acid

Results of a 2002 survey assessing obstetric-gynecology and family practice

physicians’ awareness and practices regarding folic acid

Results from Gallup Survey

• 2004 women

• January/February 2002

Things Women Reported Might Encourage them to Take a Multivitamin Daily

March of Dimes Folic Acid Survey, 2002

3

3

3

4

4

4

11

34

0 10 20 30 40

I f pregnant

Someone to remind me

More info about benefits

Remembered to take

Needed vitamins

Feeling run down

Change in health

Advised by a health care provider

Percentage of women ages 18-45who do not take vitamins daiily

Results from Physician Survey

• 362 OB/GYN’s

• 249 FP’s

• June/July 2002

Perceived Nutrient Requirements forNon-Pregnant Woman of Childbearing Age

Q. 10 “How much [of nutrient] should a typical non-pregnant woman of childbearing age consume daily?” Note: Correct RDA responses are outlined.

Asterisked (*) categories include a small number of verbatim responses thatwere close to, but different from, the pre-coded categories listed in the chart.

Folic acid 600+ mcg* 400 mcg 260 mcg <=140 mcg* DK/R-OB/G 28% 55% 4% 7% 6%-FP 36% 35% 6% 11% 12%

Calcium 2000 mg* 1200 mg 1000 mg <=800 mg* DK/R-OB/G 5% 45% 35% 12% 3%-FP 16% 42% 31% 8% 2%

Iron 18+ mg* 15 mg 10 mg <=5 mg* DK/R-OB/G 38% 14% 17% 10% 22%-FP 31% 20% 21% 8% 21%

14%

4%

16%

57%

9%

3%

4%

46%

40%

8%

0% 10% 20% 30% 40% 50% 60% 70%

DK/Not sure

"5 milligrams"

"4 milligrams"

"1 milligram"

"400 micrograms"OB/GYNFP

Perceived Recommended PreconceptionalFolic Acid Dose for NTD Patients

Q. 21 “To the best of your knowledge, what is the recommended preconceptional daily dose of folic acid for women who have had a pregnancy affected by NTD?”

Perceived Benefits of Folic Acid

Q. 14 “Please tell me whether each statement is true or false, or ifyou are not sure.” Note: Correct responses are outlined.

OB/G FP OB/G FP OB/G FP

Prevent some birth defects 98% 96% 0% 0% 2% 3%

Prevent some cardiovascular events 56% 70% 12% 8% 33% 23%

Prevent osteoarthritis 7% 8% 35% 50% 58% 42%

Decrease risk of Alzheimer's 20% 32% 24% 32% 55% 36%

Lower risk of colorectal cancer 35% 37% 19% 27% 47% 36%

Decreases homocysteine levels 51% 70% 8% 5% 40% 25%

Most grain products in US are fortified with folic acid

58% 56% 20% 18% 22% 26%

Because grain supply is fortified with folic acid, women of childbearing age do not need folic acid supplements

8% 5% 82% 82% 11% 13%

True False Not Sure

Optimal Time for Starting Folic Acid

2%

2%

2%

8%

85%

0%

1%

4%

3%

91%

0% 20% 40% 60% 80% 100%

DK/Not sure

Other: post-conception

Other: pre-conception

By 8th week ofpregnancy

At least a monthbefore conception

OB/GYNFP

Q. 18 “When should women begin to take folic acid,to prevent neural tube defects?”

Preconceptional Care• On average, those physicians who

provide any prenatal care see 20% (FPs: 21%) of all their prenatal patients for a preconceptional care visit prior to their pregnancy.

Q. 8 “Thinking about all of the women you see for prenatal care, whatpercentage did you see for a preconceptional care visit prior to their pregnancy?”

3%

46%

43%

8%

5%

28%

58%

9%

0% 10% 20% 30% 40% 50% 60% 70%

"DK/Not sure"

"About 25%"

"About 50%"

"About 75%"OB/GYNFP

Perceived Percentage of Unintended Pregnancies

Q. 19 “To the best of your knowledge, about what percentage of all pregnanciesin the US are unintended?” Correct response (“about 50%”) is outlined.

When Do Physicians Recommend Multivitamins/Folic Acid?

Q. 15 “In your practice, do you always, usually, occasionally, or neverrecommend multivitamins or folic acid supplementation:…?”

OB/G FP OB/G FP OB/G FP OB/G FP

Among patients who express interest in becoming pregnant

89% 78% 9% 16% 2% 4% 0% 2%

At annual GYN exams with non-pregnant women

27% 21% 34% 34% 32% 41% 8% 4%

At other types of visits by non-pregnant women, regardless of the reason for the visit

13% 9% 27% 22% 50% 60% 9% 9%

Always Usually Occasionally Never

Patient-Initiated Inquiries

• Almost all respondents (80% of OB/GYNs and 92% of FPs) report that less than one-quarter of their patients bring up the issue of folic acid on their own.

Issues Addressed at Annual Well-Woman Exam

Q. 7 “Which issues do you always, usually, occasionally, or never address at an annual well-woman exam with a woman of reproductive age, that is, under age 45?”

OB/G FP OB/G FP OB/G FP OB/G FP

Annual Pap tests 96% 83% 3% 13% 1% 4% 0% 0%Breast self-exam 83% 78% 14% 19% 3% 3% 0% 0%Birth control 70% 43% 24% 34% 7% 21% 0% 2%Smoking 69% 72% 21% 21% 9% 7% 1% 0%Mammograms 69% 68% 20% 19% 9% 12% 1% 1%STD prevention 49% 37% 32% 27% 19% 38% 0% 3%Weight control (diet/exercise) 37% 49% 39% 31% 23% 20% 0% 0%Alcohol use 37% 37% 25% 28% 35% 33% 3% 2%Calcium supplements 37% 33% 36% 35% 24% 30% 3% 2%Folic acid supplements 29% 15% 32% 26% 37% 54% 2% 5%Multivitamins 24% 16% 33% 30% 39% 48% 3% 7%Iron supplements 13% 9% 22% 24% 62% 63% 3% 4%

Always Usually Occasionally Never

Reasons Physicians Don’t Always Recommend Folic Acid or Multivitamins

• Both OB/GYNs and FPs cite lack of knowledge (~40%) and lack of time (30%) as the primary reasons that some physicians may not address folic acid with all women of childbearing age.

– Physicians note a need for more knowledge or information about folic acid, nutrition, and unintended pregnancy.

Preferred Information Sources Each physician identified up to two types of medical

information resources that would be effective at reaching him/her with information about folic acid.

Medical journals are the most popular information source, attracting the attention of two-thirds of the OB/GYNs and FPs.

Much smaller segments express a preference for obtaining information through medical associations or medical conferences (10%-12% each), the Internet (6%-7%), or any other modality.

Q. 22 “What sources of medical information would be most effectiveat reaching you with information about folic acid?”

Resources Needed for Patients Physicians were asked to identify up to two types of

resources he/she would like to have to promote folic acid intake among patients.

Tangible printed materials were the most popular request. 57% of OB/GYNs and 66% of FPs requested patient

brochures. Additional resources requested include posters and

charts, articles, Spanish and other non-English-language publications, and handouts or literature for patients.

Q. 23 “What resources would you like to have to promote preconceptional

folic acid intake in your female patients of reproductive age?”

Summary: Understanding of Folic Acid

While physicians universally understand the role of

folic acid in preventing some birth defects, only one-

half are aware of the RDA for a typical non-pregnant

woman of child-bearing age (that is, one with no other

conditions or risk factors that would warrant

additional folic acid).

Summary: Timing of Folic Acid

Although physicians understand the need for women to take folic acid prior to becoming pregnant, in practice they seldom take the initiative to recommend folic acid except

after conception.

Many are not aware of the high percentage of unintended pregnancies.

Only one-fifth initiate preconceptional care visits.

Summary: Prevention or Well-Woman Care

Folic acid supplementation (including multivitamins) is low among many competing

priorities for physicians during the provision of preventive or well-woman care.

Both lack of information and lack of time during a busy exam schedule are major factors that prevent

physicians from addressing folic acid with their patients.

Summary: Folic Acid After NTD Event

Opportunities are being missed to prevent recurrence of NTD-affected pregnancies due to

physicians’ lack of awareness of the recommended peri-conceptional dose, and their limited initiative in

promoting folic acid preconceptionally.

Summary: Information and Communications

Three-quarters of physicians recall seeing information on folic acid from a variety of sources; they prefer to

obtain information about folic acid through their professional journals.

Two-thirds of physicians prefer printed handouts to communicate with patients about folic acid.