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Periconceptional bread intakes indicate New Zealand's proposed mandatory folic acid fortification program may be outdated: results from a postpartum survey.
BMC Pregnancy Childbirth. 2012 Feb 14; 12:8.BP

Abstract

BACKGROUND

In September 2009, a folic acid fortification mandate (135 μg/100 g bread) was to be implemented in New Zealand. However, due to political and manufacturer objection, fortification was deferred until May 2012. Based on estimates of bread consumption derived from a 1997 nationally representative survey, this program was intended to deliver a mean additional intake of 140 μg folic acid/d to women of childbearing age. Little is known about current bread consumption patterns in this target group. The aim of this study was to assess bread consumption among women prior to and during pregnancy with the intent to estimate periconceptional folic acid intakes that would be derived from bread if mandatory fortification were implemented as currently proposed.

METHODS

A retrospective survey of 723 postpartum women in hospitals and birthing centres across New Zealand was conducted using a self-administered questionnaire on bread intake prior to and during pregnancy and maternal socio-demographic and obstetric characteristics.

RESULTS

Median bread intake before conception (2 slices/d) was below that of previous data upon which the current fortification proposal was modeled (3-4 slices/d). If mandatory fortification is implemented as proposed, only 31% (95% CI = 24%-37%) of childbearing-age women would attain an additional folic acid intake of ≥ 140 μg/d, with a mean of 119 μg/d (95% CI = 107 μg/d-130 μg/d). Based on these data, a fortification level of 160 μg/100 g bread is required to achieve the targeted mean of 140 μg folic acid/d. Nonetheless, under the current proposal additional folic acid intakes would be greatest among the least advantaged segments of the target population: Pacific and indigenous Māori ethnic groups; those with increased parity, lower income and education; younger and single mothers; and women with unplanned pregnancies. Subgroups predicted to derive less than adequate folic acid intakes from the proposed policy were women of Asian descent and those with a postgraduate education.

CONCLUSIONS

This study provides insight on the ability of a fortification policy to benefit the groups at highest risk of poor folate intakes in a population. However, bread consumption among the target group of childbearing women appears to have declined since the data used in previous dietary modeling were collected. Thus, it seems prudent to re-model dietary folic acid intakes based on more recent national survey data prior to the implementation of a mandatory folic acid fortification policy.

Authors+Show Affiliations

Department of Human Nutrition, University of Otago, Dunedin, New Zealand.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22333513

Citation

Mallard, Simonette R., et al. "Periconceptional Bread Intakes Indicate New Zealand's Proposed Mandatory Folic Acid Fortification Program May Be Outdated: Results From a Postpartum Survey." BMC Pregnancy and Childbirth, vol. 12, 2012, p. 8.
Mallard SR, Gray AR, Houghton LA. Periconceptional bread intakes indicate New Zealand's proposed mandatory folic acid fortification program may be outdated: results from a postpartum survey. BMC Pregnancy Childbirth. 2012;12:8.
Mallard, S. R., Gray, A. R., & Houghton, L. A. (2012). Periconceptional bread intakes indicate New Zealand's proposed mandatory folic acid fortification program may be outdated: results from a postpartum survey. BMC Pregnancy and Childbirth, 12, 8. https://doi.org/10.1186/1471-2393-12-8
Mallard SR, Gray AR, Houghton LA. Periconceptional Bread Intakes Indicate New Zealand's Proposed Mandatory Folic Acid Fortification Program May Be Outdated: Results From a Postpartum Survey. BMC Pregnancy Childbirth. 2012 Feb 14;12:8. PubMed PMID: 22333513.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Periconceptional bread intakes indicate New Zealand's proposed mandatory folic acid fortification program may be outdated: results from a postpartum survey. AU - Mallard,Simonette R, AU - Gray,Andrew R, AU - Houghton,Lisa A, Y1 - 2012/02/14/ PY - 2011/10/15/received PY - 2012/02/14/accepted PY - 2012/2/16/entrez PY - 2012/2/16/pubmed PY - 2012/5/24/medline SP - 8 EP - 8 JF - BMC pregnancy and childbirth JO - BMC Pregnancy Childbirth VL - 12 N2 - BACKGROUND: In September 2009, a folic acid fortification mandate (135 μg/100 g bread) was to be implemented in New Zealand. However, due to political and manufacturer objection, fortification was deferred until May 2012. Based on estimates of bread consumption derived from a 1997 nationally representative survey, this program was intended to deliver a mean additional intake of 140 μg folic acid/d to women of childbearing age. Little is known about current bread consumption patterns in this target group. The aim of this study was to assess bread consumption among women prior to and during pregnancy with the intent to estimate periconceptional folic acid intakes that would be derived from bread if mandatory fortification were implemented as currently proposed. METHODS: A retrospective survey of 723 postpartum women in hospitals and birthing centres across New Zealand was conducted using a self-administered questionnaire on bread intake prior to and during pregnancy and maternal socio-demographic and obstetric characteristics. RESULTS: Median bread intake before conception (2 slices/d) was below that of previous data upon which the current fortification proposal was modeled (3-4 slices/d). If mandatory fortification is implemented as proposed, only 31% (95% CI = 24%-37%) of childbearing-age women would attain an additional folic acid intake of ≥ 140 μg/d, with a mean of 119 μg/d (95% CI = 107 μg/d-130 μg/d). Based on these data, a fortification level of 160 μg/100 g bread is required to achieve the targeted mean of 140 μg folic acid/d. Nonetheless, under the current proposal additional folic acid intakes would be greatest among the least advantaged segments of the target population: Pacific and indigenous Māori ethnic groups; those with increased parity, lower income and education; younger and single mothers; and women with unplanned pregnancies. Subgroups predicted to derive less than adequate folic acid intakes from the proposed policy were women of Asian descent and those with a postgraduate education. CONCLUSIONS: This study provides insight on the ability of a fortification policy to benefit the groups at highest risk of poor folate intakes in a population. However, bread consumption among the target group of childbearing women appears to have declined since the data used in previous dietary modeling were collected. Thus, it seems prudent to re-model dietary folic acid intakes based on more recent national survey data prior to the implementation of a mandatory folic acid fortification policy. SN - 1471-2393 UR - https://www.unboundmedicine.com/medline/citation/22333513/Periconceptional_bread_intakes_indicate_New_Zealand's_proposed_mandatory_folic_acid_fortification_program_may_be_outdated:_results_from_a_postpartum_survey_ L2 - https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-12-8 DB - PRIME DP - Unbound Medicine ER -