Pregnancy Intentions and Folic Acid Supplementation Exemplars: Findings from the Central Pennsylvania Women's Health Study

Abstract

One Healthy People 2010 objective is that 80% of women in the United States start a pregnancy with optimal levels of folic acid. This often requires women to use folic acid supplements preconceptionally to get adequate levels. Efforts to achieve the objective have resulted in a suboptimal floor effect at less than 50% of women. We advance a framework based on exemplification theory, identifying supplementation as an additive action in which two role models exemplify folic acid supplementation among women of reproductive age able to become pregnant (n = 1,258). The women were participants in Phase I of the Central Pennsylvania Women's Health Study (CePAWHS). One exemplar identified represents the positive habits aligned with supplementers considering a pregnancy sometime in their future, while the other resides in the exemplification of positive habits aligned with supplementers not considering a pregnancy sometime in their future but still able to become pregnant. Among women not considering a future pregnancy, daily green salad consumption, weekly fish consumption, having had a health care visit in the past year, and having had any ob/gyn visit in the past 2 years resulted in increased odds of folic acid supplement use in a multivariable model. In the same model, an increase in age resulted in increased odds of folic acid supplement use. Among women considering a future pregnancy, not smoking cigarettes, having higher levels of psychosocial stress, and having higher levels of interaction social support resulted in increased odds of folic acid supplement use in a multivariable model. In the same model, those who have had a health care visit in the past year, as well as those who have received pregnancy planning counseling, were also more likely to use a folic acid supplement. Implications for strategic communication are considered.

This project is funded, in part, under grant number 4100020719 with the Pennsylvania Department of Health. The department specifically disclaims responsibility for any analyses, interpretations, or conclusions.

Notes

∗Using data on household income and household composition, a variable was created to indicate whether the respondent's poverty status was nonpoor, poor (below the federal poverty level), or near poor (below 200%. of the federal poverty threshold).

∗p < .05.

∗∗p < .001.

∗p < .05.

∗∗p < .001.

∗p < .05.