BACKGROUND: Folic acid use before and during pregnancy prevents neural tube defects. Since 1995, six surveys have been carried out among pregnant women to measure their knowledge and use of folic acid. The results of the most recent survey in 2009 will be discussed and compared with earlier surveys.: METHODS: Pregnant women in the Northern Netherlands were asked to fill out a questionnaire when visiting their midwife or gynecologist.: RESULTS: Of the 515 participating women, 87.0% knew of folic acid before they became pregnant. Of all respondents, 51.6% reported to have used folic acid during the entire recommended period. Multivariate analysis showed that planned pregnancy (odds ratio [OR], 7.1; 95% confidence interval [CI], 2.4–20.7), smoking (OR, 0.2; 95% CI, 0.1–0.7), folic acid use during a former pregnancy (OR, 22.6; 95% CI, 5.5–92.8) and the number of previous children (per child OR, 0.5; 95% CI, 0.3–0.9) were predicting factors for the recommended use of folic acid; 89.9% of women were sufficiently knowledgeable to start to use folic acid before pregnancy.: CONCLUSIONS: The knowledge about folic acid has declined over recent years, and the use during the recommended period did not improve since the survey of 2005. Based on this survey, there is still room for improvement in the knowledge and actual use of folic acid before pregnancy. Attention to these aspects should focus on younger, low-educated women and should include information about family planning and contraceptives. Birth Defects Research (Part A) 2012. © 2012 Wiley Periodicals, Inc.
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