Abstract / Summary
Background/Objectives: Periconceptional folic acid (FA) supplementation is a cornerstone of primary prevention of neural tube defects (NTDs). However, adequate preconceptional FA intake remains suboptimal in Italy. This study aimed to assess FA use among pregnant women in the Calabria region, determine whether their intake met United States Preventive Services Task Force (USPSTF) recommendations, and explore potential predictors that shape these practices. Methods: This cross-sectional study was conducted among pregnant women using face-to-face interviews. The adequacy of FA intake was based on the USPSTF guidelines, which recommend a daily FA intake of 400–800 μg, starting at least one month before conception and continuing through the first two to three months of pregnancy. Results: Among 421 women, 92.3% reported FA intake, predominantly following a medical prescription (86.3%), usually by a gynecologist rather than a general practitioner. General awareness of FA was notably high (79.3%), whereas preconceptional adherence was strikingly low (25.8%). Indeed, among women with planned pregnancies, only 22.6% achieved adequate intake. Furthermore, the strongest predictors of preconception FA use were having received a healthcare worker’s recommendation (aOR: 26.84; 95% CI: 11.40–63.17) and having a planned pregnancy (aOR: 6.03; 95% CI: 1.92–18.90). Conclusions: Despite widespread general knowledge, timely preconceptional FA use remains low, reflecting a “knowing–doing” gap and an over-reliance on specialist-driven prescription. These findings support integrating FA counseling into routine primary care and considering mandatory food fortification to ensure equitable, population-level prevention of NTDs, independent of women’s education status or pregnancy intention.