Delaying mandatory folic acid fortification policy perpetuates health inequalities: results from a retrospective study of postpartum New Zealand women.

Retrospective cross-sectional survey (VAMPS) of postpartum women aged 18+ who delivered a healthy term infant, across New Zealand maternity centers; data collected March 7–April 15, 2011; anonymous self-administered questionnaire; 758 agreed to participate; 723 included after excluding 33 for maternal age or gestational duration; logistic regression used to estimate unadjusted and adjusted odds ratios for adequate folic acid intake from supplements and bread; independent variables included age, parity, ethnicity, education, income, and relationship status; ethical approval by Multi-Region Ethics Committee.

Supplements containing ≥400 mg of folic acid daily or on most days for the periconceptional period (1 month before conception until end of the third month post-conception).

33% of women reported taking folic acid supplements as recommended during the periconceptional period. Modelled mandatory bread fortification at 135 μg folic acid per 100 g bread would deliver 118–150 μg/day for three or more slices per day and increase the proportion with adequate folic acid intake to 59%. Fully adjusted odds for planning pregnancy predicting adequate supplement intake fell from 17.24 to 2.61 (P<0.001) with fortification, and socio-demographic predictors of low intake were substantially attenuated or non-significant. Authors conclude that mandatory bread fortification could reduce health inequalities by increasing access to adequate folic acid intake among groups less likely to supplement, though maximal prevention of neural tube defects is not yet attained; policy implications support fortification as a population-level strategy while monitoring remains important.

Retrospective design with potential recall bias; self-reported supplement and bread intake; possible misreporting and missing brand/dose information; not fully representative of all NZ regions (Northland excluded) and language-limited to English speakers.