Chinese survey finds gap between folic acid awareness and supplementation adherence

A mixed-methods study published in BMC Public Health examined folic acid knowledge and supplementation practices among women of childbearing age in mainland China. From June to September 2024, researchers administered an online questionnaire to a convenience sample of 5,741 women aged 18–49 years and conducted semi-structured interviews with 18 pregnant women. The study assessed knowledge, supplementation behavior, and associations between knowledge scores and adherence.

Although 5,490 respondents (95.6%) knew that folic acid prevents neural tube defects, 3,594 (62.6%) knew the correct timing and 2,949 (51.4%) knew the recommended daily dose. Among 4,470 women with pregnancy or pregnancy-planning experience, 3,858 (86.3%) had obtained folic acid and 3,708 (83.0%) had taken it, but only 1,281 (28.7%) adhered to the full regimen. Higher knowledge scores were associated with adherence (adjusted odds ratio 1.493; 95% CI 1.43–1.56).

Integrated survey and interview findings suggested that gaps in timing and dosage knowledge, insufficiently individualized information, and brief provider counseling may contribute to suboptimal supplementation. The authors recommend specific preconception guidance on when, how much, and how long to take folic acid. Convenience sampling and self-reported behaviors limit generalizability and introduce potential reporting bias; the observational findings do not establish that improving knowledge causes better adherence.