Trends, disparities, and socioeconomic inequalities in periconceptional folic acid supplementation in China: a nationwide survey analysis.

2026-05-26
BMC pregnancy and childbirth 26(1)
- Jing Dong
- Xiangyang Gao
- Shuyan Shi
- Ying Yang
- Jihong Xu
- Ya Zhang
- Qiaomei Wang
- Haiping Shen
- Yiping Zhang
- Donghai Yan
- Zuoqi Peng
- Yuan He
- Xu Ma

PubMed: 42192535
DOI: 10.1186/s12884-026-09015-2

Study Design

Type: Observational
Population: over 11 million reproductive-aged couples between 2012 and 2019
Methods: used data from a nationwide survey, Modified Poisson regression models

Background

Periconceptional folic acid supplementation (FAS) is known to reduce the risk of adverse pregnancy outcomes, but limited evidence exists on its national coverage and socioeconomic disparities in China.

Methods

This study used data from a nationwide survey of over 11 million reproductive-aged couples between 2012 and 2019 to examine patterns, trends, and inequalities in overall and adequate FAS use. Modified Poisson regression models were used to estimate the associations between parental separate and joint SES indicators and periconceptional FAS use. Socioeconomic inequalities were quantified using the Erreygers Concentration Index based on maternal education.

Results

Overall FAS use increased from 2012 to 2019 to reach 92.6% (95% CI 89.8%-95.5%) in urban and 92.1% (95% CI 90.4%-93.8%) in rural areas. Despite this increase, adequate adherence remained suboptimal at 64.8% (95% CI 59.9%-69.6%) for urban and 66.0% (95% CI 61.2%-70.8%) for rural participants. Lower maternal SES was strongly associated with reduced FAS use. Decomposition analysis established maternal education as the primary driver of inequality and accounted for the largest disparity in adequate use. Although maternal factors mediated the influence of paternal education on overall use, low paternal education persisted as an independent barrier to adequate adherence.

Conclusions

Our study confirms a relatively low rate of adequate periconceptional FAS use. Prevention efforts should target high-risk groups by addressing specific risk factors and broader determinants of health.