Knowledge and practice by Canadian family physicians regarding periconceptional folic acid supplementation for the prevention of neural tube defects

Neural tube defects (NTDs) are among the most common serious congenital malformations. Periconceptional folic acid supplementation (PFAS) has been shown to prevent 50% to 90% of NTDs. Previous studies demonstrated that the majority of women are not aware of the value of PFAS. However, the awareness and actual pattern of delivery of this information by primary care physicians has not been examined. METHODS: The current level of awareness regarding PFAS was investigated by interviewing 36 family physicians who contacted the Motherisk Program (a provincially funded multidisciplinary team that provides counselling for pregnant women or those planning pregnancy and their health care providers) by telephone and by analyzing responses of a randomly selected group of 35 primary care practitioners to a similar questionnaire. RESULTS: As many as 40% of primary care doctors did not mention PFAS during the discussion with women of childbearing age or with those who were planning pregnancy. Furthermore, only 14% of the participating physicians had adequate knowledge of the appropriate timing and dosage of folate supplementation. This figure can be extrapolated to indicate that at least 86% of women are not being counselled by their primary care physicians to supplement with sufficient folic acid periconceptionally. CONCLUSIONS: Most family physicians surveyed did not counsel women planning pregnancy regarding appropriate PFAS and hence did not help prevent NTDs. This situation, unless changed, will not help decrease rates of NTDs and may expose practitioners to medicolegal risks.