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Dr. Prakash Paudel

Written By Dr. Prakash Paudel

Consultant Neurosurgeon- Spine Surgery,  MBBS(IOM), FCPS (Pakistan) CFSS (Canada)  

In the realm of women’s health, the significance of periconceptional folic acid supplementation (FAS) cannot be overstated. This crucial aspect of maternal care holds the potential to avert neural tube defects (NTDs), the most prevalent congenital birth defects affecting newborns at Maternity Hospital, Kathmandu, Nepal. As explored in a comprehensive cross-sectional study by P. Paudel, et al, the pursuit of awareness among Nepalese women of childbearing age becomes a paramount concern.

Folic acid deficiency during conception is intrinsically linked to NTDs, encompassing structural anomalies like spina bifida, encephalocoele, and anencephaly. The latter, characterized by the absence of a major portion of the brain, is incompatible with life. However, timely treatment allows 80–90% of infants with spina bifida to survive, albeit with varying degrees of disability. While the global incidence of NTDs is estimated at 1.4–2 per 1000 births, this figure could be up to four-fold higher in low-income settings, emphasizing the pressing need for preventive measures (Cherian et al., 2005; Gupta, 2000; Nawapun and Phupong, 2007; Ren et al., 2006).

FAS, involving the supplementation of folic acid from one month before pregnancy until 12 weeks into gestation, emerges as a proven strategy to reduce both the occurrence and recurrence of NTDs. However, the timing of awareness is critical, as women typically become cognizant of their pregnancy three weeks after conception. By this point, initiating folic acid supplementation might be too late to forestall NTDs effectively (Sadler, 1998). Therefore, the confluence of planned pregnancies and maternal awareness emerges as pivotal factors in the prevention of NTDs through FAS.

The study conducted in Nepal by the author and the group at Kathmandu Model Hospital in 2011 sought to gauge the awareness levels among women aged 15 to 45 regarding FAS. Shockingly, only 40% of the participants had heard about FAS, with a mere 16.3% recognizing the impact of folate on fetal health and a staggeringly low 5.0% knowing about the necessity of pre-pregnancy supplementation. The correlation between awareness and education level was stark, emphasizing the need for targeted education initiatives (Paudel et al., 2012).

Comparisons with studies from other settings revealed a disconcerting reality. The level of awareness observed in Kathmandu was notably lower than that in higher-income countries like Thailand, Canada, and the USA. Factors contributing to this disparity include the generally low education levels among Nepalese women, potential gaps in counseling by health professionals, and the absence of a nationwide health education campaign on periconceptional FAS in Nepal.

The study’s findings underscore the urgent need for health education initiatives within Kathmandu to raise awareness of periconceptional FAS. In particular, targeting younger women and integrating FAS information into school-level education could prove instrumental in equipping women with the knowledge needed for timely supplementation. Additionally, efforts should be directed towards obtaining NTD prevalence figures for Kathmandu and other regions in Nepal to further underscore the critical role of periconceptional FAS in preventing congenital birth defects.

In conclusion, the low level of awareness regarding periconceptional FAS among women in Kathmandu signals a public health concern that demands immediate attention. The implications of NTDs on maternal and child health, coupled with the proven efficacy of FAS in prevention, necessitate robust awareness campaigns and educational interventions. As we delve into the intricacies of women’s health, ensuring that every woman is informed and empowered to make decisions that positively impact the health of future generations becomes an imperative mission for healthcare professionals, policymakers, and society at large.


  • Paudel, P., Wing, K., & Silpakar, S. K. (2012). Awareness of periconceptional folic acid supplementation among Nepalese women of childbearing age: a cross-sectional study. Preventive Medicine, 55(6), 511–513. doi:10.1016/j.ypmed.2012.09.001
  • Blencowe, H., Cousens, S., Modell, B., & Lawn, J. (2010). Folic acid to reduce neonatal mortality from neural tube disorders. International Journal of Epidemiology, 39(i110–i121). doi:10.1093/ije/dyq028
  • Canfield, M. A., Przybyla, S. M., Case, A. P., Ramadhani, T., Suarez, L., & Dyer, J. (2006). Folic acid awareness and supplementation among Texas women of childbearing age. Preventive Medicine, 43(1), 27–30. doi:10.1016/j.ypmed.2006.02.017
  • Cherian, A., Seena, S., Bullock, R. K., & Antony, A. C. (2005). Incidence of neural tube defects in the least-developed area of India: a population-based study. The Lancet, 366(9492), 930–931. doi:10.1016/S0140-6736(05)67251-2
  • Czeizel, A. (1993). Prevention of congenital abnormalities by periconceptional multivitamin supplementation. BMJ, 306(6881), 1645–1648. doi:10.1136/bmj.306.6881.1645
  • Czeizel, A. E., & Dudás, I. (1992). Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation. New England Journal of Medicine, 327(26), 1832–1835. doi:10.1056/NEJM199212243272602
  • De-Regil, L. M., F.-G. A., Dowswell, T., & Peña-Rosas, J. P. (2010). Effects and safety of periconceptional folate supplementation for preventing birth defects. Cochrane Database of Systematic Reviews, 10(10). doi:10.1002/14651858.CD007950.pub2
  • French, M. R., Barr, S. I., & Levy-Milne, R. (2003). Folate intakes and awareness of folate to prevent neural tube defects: a survey of women living in Vancouver, Canada. Journal of the American Dietetic Association, 103(2), 181–185. doi:10.1053/jada.2003.50016
  • Gupta, P. (2000). Awareness regarding the use of folic acid for the prevention of congenital neural tube defects. National Medical Journal of India, 13(6), 304–306.