Article Text

Download PDFPDF

Use of high doses of folic acid supplements in pregnant women in Spain: an INMA cohort study
  1. Eva María Navarrete-Muñoz1,2,
  2. Desirée Valera-Gran1,
  3. Manoli García de la Hera1,2,
  4. Daniel Gimenez-Monzo1,
  5. Eva Morales2,3,
  6. Jordi Julvez2,3,
  7. Isolina Riaño2,4,
  8. Adonina Tardón2,5,
  9. Jesus Ibarluzea2,6,7,
  10. Loreto Santa-Marina2,6,7,
  11. Mario Murcia2,8,
  12. Marisa Rebagliato2,9,
  13. Jesus Vioque1,2
  14. on behalf of the INMA Project
  1. 1Departamento Salud Pública, Universidad Miguel Hernández, San Juan de Alicante, Spain
  2. 2CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
  3. 3Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
  4. 4Servicio de Pediatria, Hospital San Agustin-Aviles, Asturias, Spain
  5. 5Universidad de Oviedo, Asturias, Spain
  6. 6Subdirección de Salud Pública y Adicciones de Gipuzkoa, San Sebastian, Spain
  7. 7Instituto de Investigación Sanitaria BIODONOSTIA, San Sebastián, Spain
  8. 8Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO/CSISP), Public Health, Valencia, Spain
  9. 9Departamento de Medicina, Universitat Jaume I, Castellón de la Olana, Spain
  1. Correspondence to Professor Jesús Vioque López; vioque{at}


Objectives We examined the use of low (<400 μg/day, including no use) and high folic acid supplement (FAS) dosages (≥1000 μg/day) among pregnant women in Spain, and explored factors associated with the use of these non-recommended dosages.

Design Population-based cohort study.

Setting Spain.

Participants We analysed data from 2332 pregnant women of the INMA study, a prospective mother-child cohort study in Spain.

Main outcome measures We assessed usual dietary folate and the use of FAS from preconception to the 3rd month (first period) and from the 4th to the 7th month (second period), using a validated food frequency questionnaire. We used multinomial logistic regression to estimate relative risk ratios (RRRs).

Results Over a half of the women used low dosages of FAS in the first and second period while 29% and 17% took high dosages of FAS, respectively. In the first period, tobacco smoking (RRR=1.63), alcohol intake (RRR=1.40), multiparous (RRR=1.44), unplanned pregnancy (RRR=4.20) and previous spontaneous abortion (RRR=0.58, lower use of high FAS dosages among those with previous abortions) were significantly associated with low FAS dosages. Alcohol consumption (RRR=1.42), unplanned pregnancy (RRR=2.66) and previous spontaneous abortion (RRR=0.68) were associated with high dosage use. In the second period, only tobacco smoking was significantly associated with high FAS dosage use (RRR=0.67).

Conclusions A high proportion of pregnant women did not reach the recommended dosages of FAS in periconception and a considerable proportion also used FAS dosages ≥1000 μg/day. Action should be planned by the Health Care System and health professionals to improve the appropriate periconceptional use of FAS, taking into consideration the associated factors.


This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.