Dos Santos Sueny P Lima, Yuncker Raegan, Chertok Ilana R A, Haile Zelalem T
Graduate College, Ohio University, Athens, Ohio, USA.
Center for Nutrition and Health Impact, Omaha, Nebraska, USA.
Glob Health Epidemiol Genom. 2025 Jun 12;2025:4427791. doi: 10.1155/ghe3/4427791. eCollection 2025.
Folic acid supplementation during pregnancy is essential for preventing neural tube defects and other congenital anomalies. Despite global recommendations, supplementation remains suboptimal in many low- and middle-income countries, including Guatemala, where disparities persist across regions and populations. To investigate the association between the quality of antenatal care and folic acid supplementation among pregnant women in Guatemala. This cross-sectional study used data from the 2014-2015 Encuesta Nacional de Salud Materno Infantil (ENSMI), part of the Demographic and Health Survey (DHS). A total of 9523 women aged 15-49 with children under two years were included. Folic acid supplementation was assessed through self-reported responses to survey questions. Multilevel logistic regression examined the association between antenatal care quality and folic acid supplementation, accounting for individual, household, and community-level factors. Overall, 15.4% of women reported not taking folic acid during pregnancy. Lower folic acid supplementation was most notable among women who received no or inadequate antenatal care, indigenous women, and those living in socioeconomically disadvantaged communities. Women without antenatal care had 97% lower odds of folic acid supplementation compared with those with adequate care (OR = 0.03, 95% CI: 0.02-0.04, and < 0.001), while intermediate care was associated with 41% lower odds (OR = 0.59, 95% CI: 0.47-0.74, and < 0.001). Indigenous women had 26% lower odds of supplementation (OR = 0.74, 95% CI: 0.63-0.86, and < 0.001), and women in communities with high levels of no media exposure had 33% lower odds of folic acid supplementation (OR = 0.67 and 95% CI: 0.53-0.84). Quality antenatal care plays a critical role in improving maternal nutrition behaviors. These findings underscore the need for targeted interventions, such as culturally tailored education, mass media campaigns, and improved access to antenatal careto increase folic acid supplementation among pregnant women in Guatemala.
孕期补充叶酸对于预防神经管缺陷和其他先天性异常至关重要。尽管有全球建议，但在包括危地马拉在内的许多低收入和中等收入国家，补充情况仍不理想，该国不同地区和人群之间的差距依然存在。为了调查危地马拉孕妇的产前护理质量与叶酸补充之间的关联。这项横断面研究使用了2014 - 2015年全国母婴健康调查（ENSMI）的数据，该调查是人口与健康调查（DHS）的一部分。总共纳入了9523名年龄在15 - 49岁且有两岁以下子女的妇女。通过对调查问卷问题的自我报告回答来评估叶酸补充情况。多水平逻辑回归分析了产前护理质量与叶酸补充之间的关联，同时考虑了个人、家庭和社区层面的因素。总体而言，15.4%的妇女报告在孕期未服用叶酸。在未接受或接受不足产前护理的妇女、土著妇女以及生活在社会经济弱势社区的妇女中，叶酸补充率较低的情况最为明显。与接受充分护理的妇女相比，未接受产前护理的妇女补充叶酸的几率低97%（比值比[OR] = 0.03，95%置信区间[CI]：0.02 - 0.04，P < 0.001），而接受中等护理的妇女补充叶酸的几率低41%（OR = 0.59，95% CI：0.47 - 0.74，P < 0.001）。土著妇女补充叶酸的几率低26%（OR = 0.74，95% CI：0.63 - 0.86，P < 0.001），并且在没有媒体曝光率高的社区中的妇女补充叶酸的几率低33%（OR = 0.67，95% CI：0.53 - 0.84）。高质量的产前护理在改善孕产妇营养行为方面起着关键作用。这些发现强调了有针对性干预措施的必要性，例如文化适应性教育、大众媒体宣传活动以及改善产前护理的可及性，以提高危地马拉孕妇的叶酸补充率。
