The Dutch `Folic Acid Campaign'±have the goals been achieved? K. M. van der Pal-de Bruin a , H. E. K. de Walle d , W. Jeeninga b , C. de Rover c , M. C. Cornel d , L. T. W. de Jong-van den Berg e , J. Schouten b , R. Brand f and S. E. Buitendijk a a TNO Prevention and Health, Leiden, b GGD Midden-Brabant, Tilburg, c GGD Achterhoek, Doetinchem, d EUROCAT registration, Department of Medical Genetics and e Department of Social Pharmacy and Pharmacoepidemiology, Groninger Institute for Drug Studies (GIDS), University of Groningen, Groningen, and f Department of Medical Statistics, Leiden University, Leiden, The Netherlands. Introduction In the Netherlands, & 260 children annually are born with a neural tube defect are born, including 125 livebirths with spina bifida. 1 Periconceptional folic acid considerably reduces the recurrence as well as the occurrence risk of neural tube defects, 2±4 and since the early nineties many national Public Health Authorities have recommended its use. 5,6 In several of these countries, health education programmes have subse- quently been set up to provide information to women wishing to conceive. 7±9 In accordance with the published advice, these programmes focused primar- ily on use of folic acid-enriched food or of folic acid supplements. In the Netherlands, foods fortified with folic acid are not available because of legal constraints, and so women wishing to conceive have been advised to take orally a supplementary daily dosage of 0.4±0.5 mg folic acid. 10 Two years after the recommendations were issued, a national Folic Acid Campaign was conducted to provide information about the effects of folic acid to women wishing to conceive and to their health-care professionals. Thus, midwives, obstetricians, general practitioners, pharmacists and drug store personnel, for example, were targeted and given information about folic acid through professional associations, publications in national medical journals and a personal letter. In this way, they were provided with educational materials to establish a positive attitude towards advising women to use folic acid. Addition- ally, women wishing to conceive were given informa- tion via a multimedia approach. The aim was to reach at least 70% of women wishing to conceive and that 65% of these women would use it appropriately. 11 These targets were based on results from other health education programmes such as non-smoking cam- paigns for pregnant women. In two regions in the Netherlands (Midden-Brabant and Achterhoek), a local campaign was conducted to support the national campaign in providing informa- tion to the health-care professionals and women wishing to conceive. Further information was given to the local professionals by letter and at general meetings of the local professional association. The # Blackwell Science Ltd. Paediatric and Perinatal Epidemiology 2000, 14, 111±117 Ahed Bhed Ched Dhed Ref marker Fig marker Table mar- ker Ref end Ref start Correspondence: K. M. van der Pal-de Bruin, TNO Prevention and Health, PO Box 2215, 2301 CE Leiden, The Netherlands. E-mail: KM.vanderPal@pg.tno.nl Summary Periconceptional folic acid use considerably reduces the risk of neural tube defects. The aim of this study was to measure the effect of the national and the local `Folic Acid Campaign' on periconceptional folic acid use. Before (1995 survey) and 1 year after the campaign (1996 survey), the awareness and use of folic acid was measured among pregnant women in four regions of the Netherlands. To this end, pregnant women who visited the midwife, general practitioner or obstetrician for the first or second prenatal visit were asked to complete a questionnaire. The results showed that use of folic acid for any period around conception increased from 25.1% in 1995 to 53.5% in 1996. Appropriate use (4 weeks before until 8 weeks after conception) increased from 4.8% in 1995 to 21.0% in 1996. No additional effect of the local Folic Acid Campaign was found (adjusted odds ratio=1.0; 95% confidence interval=0.7, 1.4). It was possible to conclude that folic acid use at the recommended time increased considerably as a result of the national and the local Folic Acid Campaign, but the target (use in 46% of women wishing to conceive) was not achieved. New health education programmes are needed to increase further its use at the appropriate times. 111 Paper 251 Disc