Degree Name

Master of Science - Research


Faculty of Health and Behavioural Sciences


To reduce risk of Neural Tube Defects (NTDs) and iodine deficiency in pregnancy, recommendations for supplementation with folic acid and iodine have been introduced to complement the mandatory fortification programs in Australia. However, many studies conducted before the introduction of the folic acid and iodine mandatory fortification programs indicated that folic acid and iodine knowledge and the need for these supplements was poor among pregnant women. Health care providers, including pharmacists, can have important roles regarding advice given to women about the importance of these nutrients in pregnancy.

Aims: The study aimed to identify the knowledge, attitudes and practices of pregnant women regarding folic acid and iodine supplementation. A second aim was to assess whether pharmacists have sufficient knowledge about these nutrients to provide appropriate advice to pregnant women about supplement use, and to identify which brands of pregnancy nutritional supplements contain the National Health Medical Research Council recommended amounts of iodine and folic acid.

Methods: A cross sectional survey of pregnant women residing in the Illawarra region of New South Wales, Australia was undertaken between October 2012 and February 2013. Information regarding folate and iodine knowledge and attitudes and supplement use among pregnant women was collected. Additionally, a sample of pharmacists from community pharmacies in the Illawarra region was surveyed to assess their knowledge regarding folic acid and iodine supplementation. Finally, an online audit of pregnancy supplements in Australia was undertaken to collect information regarding the availability of folic acid and iodine supplements.

Results: A total of 152 pregnant women responded to the survey. Most (81.6%) used supplements during their pregnancy; 67.7% took supplement brands which contained both folic acid and iodine in varying dosages. Also, 36% of them started taking supplements before their pregnancy. The supplement use was significantly higher among pregnant women who were in the highest household income category. Although 75.6 % of pregnant women understood that NTDs is the health problem associated with inadequate intake of folic acid, only 39.5% of them knew the health problems associated with inadequate iodine intakes. Half of the pregnant women had limited awareness about good sources of folic acid and iodine. Educated women from higher socio-economic backgrounds had better knowledge about the importance of folic acid and iodine in pregnancy. A total of 41 pharmacists responded to the survey. It was found that most pharmacists have adequate knowledge and understanding about the role of folic acid in preventing NTDs in pregnant women, 73% of them knew that iodine deficiency during pregnancy could result in neurocognitive deficits in the baby and 27% knew the NHMRC recommendation for the 150 microgram daily dose of iodine during pregnancy.

Conclusion: Additional to poor practices regarding folic acid and iodine supplementation, prior to and during pregnancy, limited knowledge and understanding of women about the need for folic acid and iodine supplementation during pregnancy is still a major public health concern in Australia. Pharmacists had good knowledge and understanding about folic acid supplementation during pregnancy, but had deficits in iodine knowledge. This group may be valuable, yet under-utilised sources of nutrition education for pregnant women seeking advice at the point of sale.



Unless otherwise indicated, the views expressed in this thesis are those of the author and do not necessarily represent the views of the University of Wollongong.