Folic acid for the prevention of neural tube defects.

Although the prevalence of preconception folic acid supplementation in Europe has increased after many years of delivered recommendations, many women still do not follow the recommendations and many start supplementation too late. In this context, the total prevalence of neural tube defects in Europe has not declined markedly over the years. In Italy, our experience shows the difficulty of increasing preconception supplementation with only recommendations as well as women’s access to services before conception for preconception care. This difficulty occurs in spite of the fact that in Italy, the official recommendations were launched in April 2004 and that the use of folic acid to prevent neural tube defects has been free of charge since 2005 with a physician’s prescription. In accordance, cross-sectional data collected in 2012 for 2189 women from 7 maternity clinics located in 6 Italian regions indicated that preconception folic acid supplement use in many women is low (23.5% of participants).2 Furthermore, to contribute to strategies for the implementation of preconception care and the increase of preconception folic acid use, a qualitative study among Italian women of childbearing age and health care professionals was conducted. The results indicated the presence of many barriers and a lack of awareness of preconception health relating to women, health care professionals, and policies.3 These results, together with the presence of inadequate level of red blood cell folate and fruit and vegetable consumption in women of childbearing age,4 make it urgent to design integrated intervention programs to improve the preconception folic acid supplement use even in Italy, traditionally the country cradle of Mediterranean diet.