EDITORIAL COMMENT: We accepted this paper for publication because it presents useful information concerning folate intake in a community and the impact a health promotion project can have in changing folate supplementation in women before 20 weeks gestation. This study did not attempt to evaluate whether or not the health promotion project increased prepregnancy supplementation of folate by dietary intake or specific prescription of folic acid. However, the takeaway message seems to be that even in the final phase of the study, 85% of the 72 women investigated were not taking folic acid supplements before pregnancy. This finding is in keeping with data reported from other centres. Because pregnancy is not planned in about 40% of instances (reference 11 of this paper), and since the neural tube closes by the end of the 6th week from the last menstrual period, it seems that the incontestable conclusion from the data presented and discussed in this paper, is that a policy of folate fortification of food as recommended by the National Health and Medical Research Council of Australia, should be implemented.
Summary: We assessed the use of folic acid supplements and changes in serum and red cell folate levels in pregnancy over the course of a healui promotion project in Western Australia by 4 cross-sectional studies of women attending a public antenatal outpatient clinic in 1992 (before the launch of the health promotion project), 1993, 1994, and 1995. A short questionnaire was completed and blood taken for estimation of serum and red cell folate. There was an increase in the proportion of women taking folic acid supplements in the first trimester (51.9% in the final phase) and before pregnancy (15% in the final phase of the study), and no change in the proportion taking other vitamin supplements. Serum and red cell folate levels increased significantly over the study period in both women taking and not taking folic acid supplements. The proportion of women who had seen the pamphlet used in die health promotion project rose to 35.4% in die third phase, and fell to 27.8% in the final phase. Coincident with the health promotion project, there was an increase in folate status in early pregnancy. However, most women were not taking folic acid supplements before they became pregnant and, hence, may not have had sufficient folate at the time of normal neural tube closure.