A nationwide program for the use of preconceptional folic acid to prevent the development of open neural tube defects. Who is really using folic acid?

A nationwide program directed at stimulating the preconceptional use of folic acid (FA) for the prevention of open neural tube defects has been in effect in Puerto Rico for the last 4 years. To evaluate its effectiveness, 479 questionnaires were distributed among pregnant patients. The average age was 27 (range 14-21), and 64.9% of the pregnancies were unplanned. Preconceptional use of FA was 31.5%, despite 87.7% of patients reporting knowledge about the importance of FA use. Only 35.4% of patients who had knowledge about FA used it prior to conception. Among patients who planned their pregnancies and knew about the importance of FA, 92/168 (54.6%) used it prior to pregnancy. With these dismal results, we believe these campaigns should re-evaluate their educational strategies and consider reduction of unplanned pregnancies as part of their goals.