Uncovering the hidden hunger in translational research for periconceptional folic acid awareness among health care providers.

Background: Although healthcare providers (HCPs) know folic acid (FA), many are unaware of its various fetal-maternal-offspring beneficial effects.

Methods: A cross-sectional study (September 2024) was conducted among HCPs using a pretested interviewer-based questionnaire. The total knowledge score was 30. The awareness score was good, average, and low for total scores >20, 11-20, and ≤10, respectively.

Results: Out of 300 participants, 96 were excluded because of incomplete responses to the questions marked for outcome assessment. The participants were medical officers (42/206; 20.38%), nursing staff (108/206; 52.42%), and multipurpose/auxiliary nurse midwives/Accredited Social Health Activist workers (56/206; 27.18%). The mean age of participants was 24.0 ± 5.0 years (ranged 21-42 years). Rural and urban HCPs were 27.18% (56/206) and 72.81% (150/206), respectively. The HCPs who previously underwent educational training were 50.97% (105/206). Awareness of beneficial effects of FA in fetal protection from congenital anomalies: 35.9% (74/206) participants knew that FA supplements prevent neural tube defects (NTDs), but only 6.3% (13/206) and 14.5% (29/206) correctly responded for the prevention of anencephaly and neonatal anaemia. 87.86% (181/206) of participants were unaware of other beneficial fetal effects (prevention of septal heart defects, facial cleft, prevention of preterm delivery, and an increase in fetus weight). (a) Awareness about FA benefits in the prevention of maternal complications: 95.1% (196/206) participants were aware of FA's role in preventing pregnancy anemia, but they were not aware of its preventive role in pre-eclampsia, stillbirth, low-birth-weight/very-low-birth-weight babies, abortion, and macrosomia: (b) Awareness about neonatal/infant benefits of periconceptional FA: 5.8% (12/206) knew the beneficial effects of FA on mental development, and 4.9% (10/206) prevention of anemia in infancy. (c) Awareness about high-risk factors that can affect fetuses from NTDs: The response was correct about parents having NTDs (60/206; 29%), drug intake of periconceptional intake of valproic acid and carbamazepine (63.9%; 131/206), and serum FA deficiency (70.9%, 146/206). 9.7% (20/206) were aware that possible cause of NTD can be genetic factors, and 78.6% (162/206) were aware that NTDs can be sporadic. Maternal hyperthermia, maternal diabetes, and obesity were identified as risk factors for NTDs in 1.2% (2/206), 4.9% (10/206) and 6.7% (20/206) HCPs. 125/206 (60.68%) know about the correct dosage and duration of FA in the normal periconceptional period, but awareness of dosage (16/206; 7.76%) and duration (12/206; 5.8%) in high-risk pregnancy was not good. 24.8% (51/206) knew that increasing the demand for FA in pregnancy can only be achieved with FA supplementation. Total mean awareness scores (± standard deviation) were good (23 ± 0.63), intermediate (18 ± 0.22), and low (9 ± 0.26) in 19.90% (41/206), 31.55% (65/206), and 48.5% (100/206) HCWs. HCPs having good knowledge scores were not statistically different by their designation (P = 0.130), age distribution (P = 0.819), rural or urban service area (P = 0.653), experience of service in medical field (P = 0.973), and marital status (P = 0.754). HCPs with good knowledge scores were statistically different regarding their education status (P = 0.049), having their children (P < 0.00001), and FA awareness sessions attended in the past (P = 0.018).

Conclusions: Wide-spectrum FA benefit awareness among HCPs and adolescent women might increase compliance with periconceptional consumption of FA. The government should prioritize implementing updated content in the various curriculum and media to fill the knowledge gap among HCPs.