{"id":"https://openalex.org/W7214548653","doi":"https://doi.org/10.64898/2026.09.25.26363991","title":"Timing matters: when do primiparous and multiparous pregnant women initiate folic acid supplementation, and who initiates it too late?","display_name":"Timing matters: when do primiparous and multiparous pregnant women initiate folic acid supplementation, and who initiates it too late?","publication_year":2026,"publication_date":"2026-09-27","ids":{"openalex":"https://openalex.org/W7214548653","doi":"https://doi.org/10.64898/2026.09.25.26363991"},"language":"en","primary_location":{"id":"doi:10.64898/2026.09.25.26363991","doi":"https://doi.org/10.64898/2026.09.25.26363991","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.09.25.26363991","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/27/2026.09.25.26363991.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"volume":null,"type":"preprint","is_traditional":true,"indexed_in":["crossref"],"open_access":{"is_oa":true,"oa_status":"green","oa_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/27/2026.09.25.26363991.full.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5060547626","display_name":"Utibe S Ebong","orcid":"https://orcid.org/0000-0001-8981-3988","observed_orcids":["https://orcid.org/0000-0001-8981-3988"]},"institutions":[{"id":"https://openalex.org/I138801177","display_name":"University of Ulster","ror":"https://ror.org/01yp9g959","country_code":"GB","type":"education","lineage":["https://openalex.org/I138801177"]},{"id":"https://openalex.org/I4405260289","display_name":"Ulster University, Derry-Londonderry Campus","ror":"https://ror.org/03hab3x36","country_code":"GB","type":"education","lineage":["https://openalex.org/I138801177","https://openalex.org/I4405260289"]}],"countries":["GB"],"is_corresponding":false,"raw_author_name":"Utibe S. Ebong","raw_affiliation_strings":["School of Medicine, Faculty of Life and Health Sciences, Ulster University"],"raw_orcid":"https://orcid.org/0000-0001-8981-3988","affiliations":[{"raw_affiliation_string":"School of Medicine, Faculty of Life and Health Sciences, Ulster University","institution_ids":["https://openalex.org/I138801177","https://openalex.org/I4405260289"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5011948654","display_name":"Joanne Emma Given","orcid":"https://orcid.org/0000-0003-4921-1944","observed_orcids":["https://orcid.org/0000-0003-4921-1944"]},"institutions":[{"id":"https://openalex.org/I138801177","display_name":"University of Ulster","ror":"https://ror.org/01yp9g959","country_code":"GB","type":"education","lineage":["https://openalex.org/I138801177"]},{"id":"https://openalex.org/I4405260289","display_name":"Ulster University, Derry-Londonderry Campus","ror":"https://ror.org/03hab3x36","country_code":"GB","type":"education","lineage":["https://openalex.org/I138801177","https://openalex.org/I4405260289"]}],"countries":["GB"],"is_corresponding":false,"raw_author_name":"Joanne E. Given","raw_affiliation_strings":["Institute of Nursing and Health Research, Faculty of Life and Health Sciences, Ulster University"],"raw_orcid":"https://orcid.org/0000-0003-4921-1944","affiliations":[{"raw_affiliation_string":"Institute of Nursing and Health Research, Faculty of Life and Health Sciences, Ulster University","institution_ids":["https://openalex.org/I138801177","https://openalex.org/I4405260289"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5112806722","display_name":"Frank Casey","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I138801177","display_name":"University of Ulster","ror":"https://ror.org/01yp9g959","country_code":"GB","type":"education","lineage":["https://openalex.org/I138801177"]},{"id":"https://openalex.org/I4405260289","display_name":"Ulster University, Derry-Londonderry Campus","ror":"https://ror.org/03hab3x36","country_code":"GB","type":"education","lineage":["https://openalex.org/I138801177","https://openalex.org/I4405260289"]}],"countries":["GB"],"is_corresponding":false,"raw_author_name":"Frank A. Casey","raw_affiliation_strings":["School of Medicine, Faculty of Life and Health Sciences, Ulster University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"School of Medicine, Faculty of Life and Health Sciences, Ulster University","institution_ids":["https://openalex.org/I138801177","https://openalex.org/I4405260289"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5011696603","display_name":"Maria A. Loane","orcid":"https://orcid.org/0000-0002-1206-3637","observed_orcids":["https://orcid.org/0000-0002-1206-3637"]},"institutions":[{"id":"https://openalex.org/I138801177","display_name":"University of Ulster","ror":"https://ror.org/01yp9g959","country_code":"GB","type":"education","lineage":["https://openalex.org/I138801177"]},{"id":"https://openalex.org/I4405260289","display_name":"Ulster University, Derry-Londonderry Campus","ror":"https://ror.org/03hab3x36","country_code":"GB","type":"education","lineage":["https://openalex.org/I138801177","https://openalex.org/I4405260289"]}],"countries":["GB"],"is_corresponding":false,"raw_author_name":"Maria Loane","raw_affiliation_strings":["Institute of Nursing and Health Research, Faculty of Life and Health Sciences, Ulster University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Institute of Nursing and Health Research, Faculty of Life and Health Sciences, Ulster University","institution_ids":["https://openalex.org/I138801177","https://openalex.org/I4405260289"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5019449110","display_name":"Helen M. Dolk","orcid":"https://orcid.org/0000-0001-6639-5904","observed_orcids":["https://orcid.org/0000-0001-6639-5904"]},"institutions":[{"id":"https://openalex.org/I138801177","display_name":"University of Ulster","ror":"https://ror.org/01yp9g959","country_code":"GB","type":"education","lineage":["https://openalex.org/I138801177"]},{"id":"https://openalex.org/I4405260289","display_name":"Ulster University, Derry-Londonderry Campus","ror":"https://ror.org/03hab3x36","country_code":"GB","type":"education","lineage":["https://openalex.org/I138801177","https://openalex.org/I4405260289"]}],"countries":["GB"],"is_corresponding":true,"raw_author_name":"Helen Dolk","raw_affiliation_strings":["School of Medicine, Faculty of Life and Health Sciences, Ulster University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"School of Medicine, Faculty of Life and Health Sciences, Ulster University","institution_ids":["https://openalex.org/I138801177","https://openalex.org/I4405260289"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":2,"corresponding_author_ids":["https://openalex.org/A5019449110"],"corresponding_institution_ids":["https://openalex.org/I138801177","https://openalex.org/I4405260289"],"apc_list":null,"apc_paid":null,"fwci":null,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":null,"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10499","display_name":"Folate and B Vitamins Research","score":0.951200008392334,"subfield":{"id":"https://openalex.org/subfields/2916","display_name":"Nutrition and Dietetics"},"field":{"id":"https://openalex.org/fields/29","display_name":"Nursing"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10499","display_name":"Folate and B Vitamins Research","score":0.951200008392334,"subfield":{"id":"https://openalex.org/subfields/2916","display_name":"Nutrition and Dietetics"},"field":{"id":"https://openalex.org/fields/29","display_name":"Nursing"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T12741","display_name":"Maternal and Neonatal Healthcare","score":0.022700000554323196,"subfield":{"id":"https://openalex.org/subfields/2735","display_name":"Pediatrics, Perinatology and Child Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11964","display_name":"Pregnancy and Medication Impact","score":0.008100000210106373,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/folic-acid-supplementation","display_name":"folic acid supplementation","score":0.996999979019165},{"id":"https://openalex.org/keywords/periconceptional-supplementation","display_name":"periconceptional supplementation","score":0.75},{"id":"https://openalex.org/keywords/neural-tube-defects","display_name":"neural tube defects","score":0.8550000190734863},{"id":"https://openalex.org/keywords/parity","display_name":"parity","score":0.8119999766349792},{"id":"https://openalex.org/keywords/primiparous-women","display_name":"primiparous women","score":0.8989999890327454},{"id":"https://openalex.org/keywords/unintended-pregnancy","display_name":"unintended pregnancy","score":0.8569999933242798},{"id":"https://openalex.org/keywords/pregnancy-planning","display_name":"pregnancy planning","score":0.9470000267028809},{"id":"https://openalex.org/keywords/maternal-deprivation","display_name":"maternal deprivation","score":0.47699999809265137},{"id":"https://openalex.org/keywords/folate-intake","display_name":"folate intake","score":0.8220000267028809},{"id":"https://openalex.org/keywords/miscarriage","display_name":"miscarriage","score":0.5899999737739563},{"id":"https://openalex.org/keywords/infertility-treatment","display_name":"infertility treatment","score":0.9580000042915344},{"id":"https://openalex.org/keywords/pregnancy-recognition","display_name":"pregnancy recognition","score":0.49300000071525574}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.8389000296592712},{"id":"https://openalex.org/C2779234561","wikidata":"https://www.wikidata.org/wiki/Q11995","display_name":"Pregnancy","level":2,"score":0.7961999773979187},{"id":"https://openalex.org/C151956035","wikidata":"https://www.wikidata.org/wiki/Q1132755","display_name":"Logistic regression","level":2,"score":0.6743999719619751},{"id":"https://openalex.org/C143095724","wikidata":"https://www.wikidata.org/wiki/Q515895","display_name":"Odds","level":3,"score":0.5691999793052673},{"id":"https://openalex.org/C131872663","wikidata":"https://www.wikidata.org/wiki/Q5284418","display_name":"Obstetrics","level":1,"score":0.5565999746322632},{"id":"https://openalex.org/C156957248","wikidata":"https://www.wikidata.org/wiki/Q1862216","display_name":"Odds ratio","level":2,"score":0.5525000095367432},{"id":"https://openalex.org/C2992130864","wikidata":"https://www.wikidata.org/wiki/Q127060","display_name":"Folic acid","level":2,"score":0.5371000170707703},{"id":"https://openalex.org/C518429986","wikidata":"https://www.wikidata.org/wiki/Q964401","display_name":"Fertility","level":3,"score":0.5076000094413757},{"id":"https://openalex.org/C27415008","wikidata":"https://www.wikidata.org/wiki/Q7256382","display_name":"Psychological intervention","level":2,"score":0.4429999887943268},{"id":"https://openalex.org/C2776035688","wikidata":"https://www.wikidata.org/wiki/Q1606558","display_name":"Affect (linguistics)","level":2,"score":0.4027999937534332},{"id":"https://openalex.org/C121752807","wikidata":"https://www.wikidata.org/wiki/Q1981388","display_name":"Reproductive health","level":3,"score":0.3991999924182892},{"id":"https://openalex.org/C138816342","wikidata":"https://www.wikidata.org/wiki/Q189603","display_name":"Public health","level":2,"score":0.38749998807907104},{"id":"https://openalex.org/C46973012","wikidata":"https://www.wikidata.org/wiki/Q28627","display_name":"Gestation","level":3,"score":0.38339999318122864},{"id":"https://openalex.org/C2777003008","wikidata":"https://www.wikidata.org/wiki/Q548213","display_name":"Neural tube defect","level":4,"score":0.36469998955726624},{"id":"https://openalex.org/C2779076696","wikidata":"https://www.wikidata.org/wiki/Q1280670","display_name":"Family planning","level":4,"score":0.3228999972343445},{"id":"https://openalex.org/C2908647359","wikidata":"https://www.wikidata.org/wiki/Q2625603","display_name":"Population","level":2,"score":0.3131999969482422},{"id":"https://openalex.org/C188816634","wikidata":"https://www.wikidata.org/wiki/Q2113324","display_name":"Prospective cohort study","level":2,"score":0.30399999022483826},{"id":"https://openalex.org/C29456083","wikidata":"https://www.wikidata.org/wiki/Q1221899","display_name":"Gynecology","level":1,"score":0.30250000953674316},{"id":"https://openalex.org/C42407357","wikidata":"https://www.wikidata.org/wiki/Q521","display_name":"Physiology","level":1,"score":0.29649999737739563},{"id":"https://openalex.org/C2780594696","wikidata":"https://www.wikidata.org/wiki/Q1127402","display_name":"Neural tube","level":3,"score":0.29159998893737793},{"id":"https://openalex.org/C2909565028","wikidata":"https://www.wikidata.org/wiki/Q2915477","display_name":"Folic acid supplementation","level":3,"score":0.28439998626708984},{"id":"https://openalex.org/C2776534028","wikidata":"https://www.wikidata.org/wiki/Q1141363","display_name":"Medicaid","level":3,"score":0.28360000252723694},{"id":"https://openalex.org/C44249647","wikidata":"https://www.wikidata.org/wiki/Q208498","display_name":"Confidence interval","level":2,"score":0.26750001311302185},{"id":"https://openalex.org/C142052008","wikidata":"https://www.wikidata.org/wiki/Q954027","display_name":"Cross-sectional study","level":2,"score":0.2529999911785126}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.64898/2026.09.25.26363991","doi":"https://doi.org/10.64898/2026.09.25.26363991","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.09.25.26363991","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/27/2026.09.25.26363991.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"}],"best_oa_location":{"id":"doi:10.64898/2026.09.25.26363991","doi":"https://doi.org/10.64898/2026.09.25.26363991","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.09.25.26363991","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/27/2026.09.25.26363991.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","score":0.9922999739646912,"display_name":"Good health and well-being"}],"study_designs":[{"id":"https://openalex.org/study-designs/observational-study","display_name":"Observational Study"}],"awards":[],"funders":[{"id":"https://openalex.org/F4320316531","display_name":"Department for the Economy","ror":"https://ror.org/0161w0r98"},{"id":"https://openalex.org/F4320320859","display_name":"Ulster University","ror":"https://ror.org/01yp9g959"},{"id":"https://openalex.org/F4320325690","display_name":"Northern Ireland Chest Heart and Stroke","ror":null}],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7214548653.pdf","grobid_xml":"https://content.openalex.org/works/W7214548653.grobid-xml"},"referenced_works_count":27,"referenced_works":["https://openalex.org/W2025424582","https://openalex.org/W2030272400","https://openalex.org/W2122027802","https://openalex.org/W2133308027","https://openalex.org/W2136608905","https://openalex.org/W2143135457","https://openalex.org/W2241353431","https://openalex.org/W2418287122","https://openalex.org/W2492233097","https://openalex.org/W2576536258","https://openalex.org/W2791559304","https://openalex.org/W2800419398","https://openalex.org/W2803996268","https://openalex.org/W2806334835","https://openalex.org/W2940041856","https://openalex.org/W3008014911","https://openalex.org/W3026944070","https://openalex.org/W3138917719","https://openalex.org/W3158397412","https://openalex.org/W3180220530","https://openalex.org/W3184356679","https://openalex.org/W3199026927","https://openalex.org/W4385442153","https://openalex.org/W4387642853","https://openalex.org/W4389615377","https://openalex.org/W4396494820","https://openalex.org/W7160048535"],"related_works":["https://openalex.org/W1966136508","https://openalex.org/W2528975169","https://openalex.org/W6990527089","https://openalex.org/W1864680902","https://openalex.org/W7160048535","https://openalex.org/W2151685114","https://openalex.org/W4321367768","https://openalex.org/W3212286243","https://openalex.org/W2073115389","https://openalex.org/W1748891490"],"abstract_inverted_index":{"ABSTRACT":[0],"Background":[1],"Women":[2],"are":[3,24,206],"recommended":[4],"to":[5,12,30,74,222,231,235,246],"take":[6],"folic":[7],"acid":[8],"supplements":[9],"(FAS)":[10],"periconceptionally":[11],"prevent":[13,223],"neural":[14,224],"tube":[15,225],"defects,":[16],"but":[17,218],"the":[18,41,59,178],"low":[19,135],"levels":[20],"of":[21,43,54,84,103,110,152,166,215],"FAS":[22,44,85,106,155,188,208,216],"uptake":[23],"poorly":[25],"understood.":[26],"This":[27,212],"study":[28],"aimed":[29],"determine":[31],"how":[32],"parity,":[33],"pregnancy":[34,124,147,159,198,210],"planning":[35],"and":[36,76,96,132,145,200,238,242],"other":[37],"maternal":[38],"factors":[39],"affect":[40],"timing":[42],"initiation.":[45,189],"Method":[46],"We":[47],"used":[48],"data":[49],"from":[50,58],"a":[51,134],"representative":[52],"sample":[53],"966":[55],"pregnant":[56],"women":[57,104,153,174,195,201],"Northern":[60],"Ireland":[61],"Baby":[62],"Hearts":[63],"study.":[64],"Questionnaire":[65],"responses":[66],"on":[67],"health":[68,180,228],"behaviours,":[69],"including":[70,164],"FAS,":[71,241],"were":[72,113,140],"linked":[73],"maternity":[75],"area-based":[77],"deprivation":[78,131],"data.":[79],"Logistic":[80],"regression":[81,90],"assessed":[82,91],"determinants":[83],"initiation":[86,94,112],"preconception.":[87,107],"Time-varying":[88],"Cox":[89],"associations":[92],"between":[93],"postconception":[95],"pregnancy-related":[97],"milestones.":[98],"Results":[99],"Forty-one":[100],"per":[101,150],"cent":[102,151],"initiated":[105,154],"Lower":[108],"odds":[109,139],"preconception":[111],"associated":[114,141],"with":[115,142,175,196],"multiparity":[116],"(adjusted":[117,125],"OR":[118,126],"0.47":[119],"(0.32":[120],"\u2013":[121,129],"0.68)),":[122],"unplanned":[123,176],"0.08":[127],"(0.05":[128],"0.13)),":[130],"consuming":[133],"folate":[136],"diet.":[137],"Higher":[138],"fertility":[143],"treatment":[144],"previous":[146,197],"loss.":[148],"Forty-seven":[149],"postconception,":[156],"mainly":[157],"after":[158,209],"recognition":[160],"(median":[161,183],"5":[162],"weeks),":[163],"34.1%":[165],"those":[167],"who":[168,202],"planned":[169,203],"their":[170,204],"pregnancy.":[171],"For":[172],"primiparous":[173],"pregnancies,":[177,205],"first":[179],"service":[181],"contact":[182],"7":[184],"weeks)":[185],"further":[186],"increased":[187],"Conclusion":[190],"Many":[191],"women,":[192],"even":[193],"multiparous":[194,247],"experience":[199],"initiating":[207],"recognition.":[211],"shows":[213],"awareness":[214,234],"benefits,":[217],"is":[219],"too":[220],"late":[221],"defects.":[226],"Public":[227],"interventions":[229],"need":[230],"go":[232],"beyond":[233],"address":[236],"motivation":[237],"opportunity":[239],"for":[240],"pay":[243],"more":[244],"attention":[245],"women.":[248]},"counts_by_year":[],"updated_date":"2026-11-08T12:12:28.789561","created_date":"2026-09-28T00:00:00"}