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The role of education and migration background in explaining differences in folic acid supplementation intake in pregnancy: Results from a German birth cohort study

  • Objective: Official German recommendations advise women to start taking folic acid supplementation (FAS) before conception and continue during the first pregnancy trimester to lower the risk of birth defects. Women from lower socioeconomic background and ethnic minorities tend to be less likely to take FAS in other European countries. As little is known about the determinants of FAS in Germany, we aimed to investigate the association between FAS and formal education and migration background, adjusting for demographic factors. Design: We used data (2013-2016) on nutrition and socioeconomic and migration background from the baseline questionnaire of the BaBi cohort study. We performed multivariate regressions and mediation analyses. Setting: Bielefeld, Germany. Participants: 947 women (pregnant or who had given birth in the past two months). Results: 16.7% of the participants (158/947) didn't use FAS. Migration-related variables (e.g. language, length of stay) were not associated with FAS in the adjusted models. FAS wasObjective: Official German recommendations advise women to start taking folic acid supplementation (FAS) before conception and continue during the first pregnancy trimester to lower the risk of birth defects. Women from lower socioeconomic background and ethnic minorities tend to be less likely to take FAS in other European countries. As little is known about the determinants of FAS in Germany, we aimed to investigate the association between FAS and formal education and migration background, adjusting for demographic factors. Design: We used data (2013-2016) on nutrition and socioeconomic and migration background from the baseline questionnaire of the BaBi cohort study. We performed multivariate regressions and mediation analyses. Setting: Bielefeld, Germany. Participants: 947 women (pregnant or who had given birth in the past two months). Results: 16.7% of the participants (158/947) didn't use FAS. Migration-related variables (e.g. language, length of stay) were not associated with FAS in the adjusted models. FAS was lower in women with lower level of formal education and in unplanned pregnancies. Reasons given by women for not taking FAS were unplanned pregnancy and lack of knowledge of FAS. Conclusions: Health practitioners may be inclined to see migrant women as an inherently at-risk group for failed intake of FAS. However, it is primarily women who did not plan their pregnancy, and women of lower formal education level, who are at risk. Different public health strategies to counter low supplementation rates should be supported, those addressing the social determinants of health (i.e. education) and those more focussed on family planning.show moreshow less

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Author: Céline Miani, Angelique Ludwig, Ina-Merle Doyle, Jürgen Breckenkamp, Chantal Höller-Holtrichter, Jacob SpallekORCiDGND, Oliver RazumGND
URL:https://pubmed.ncbi.nlm.nih.gov/34420537/
DOI:https://doi.org/10.1017/S1368980021003621
ISSN:1475-2727
Title of the source (English):Public Health Nutrition
Document Type:Scientific journal article peer-reviewed
Language:English
Year of publication:2021
Tag:Folic acid supplementation; Germany; birth cohort; education; migration; pregnancy
First Page:1
Last Page:24
Faculty/Chair:Fakultät 4 Humanwissenschaften (bis 2023 Soziale Arbeit, Gesundheit und Musik) / FG Gesundheitswissenschaften
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