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OBJECTIVE: To determine the proportion of women who take daily folic acid supplements in the month before conception and to identify factors associated with supplement use. DESIGN: Cross-sectional survey by self-administered questionnaire. SETTING: Tertiary care teaching hospital in Hamilton, Ont. PARTICIPANTS: Four hundred eighty-four (43%) of 1132 women who delivered normal babies between November 1997 and March 1998. MAIN OUTCOME MEASURES: Reports of daily vitamin supplement use in the month before pregnancy and after pregnancy, and having heard or read about the need to take folic acid before pregnancy; sources of information about folic acid; factors associated with preconceptional vitamin use. RESULTS: Thirty-four percent of respondents reported taking vitamins before conception (use ranged from 21% for those with unplanned pregnancies to 40% for those with planned pregnancies); 80% after conception. Of all respondents, 63% were aware of the need for preconceptional folic acid. Key information sources were family doctors and the mass media: the media were more important before conception, doctors after. Being older (30 years or more), having post-secondary education, and having a planned pregnancy were associated with knowing about the benefits of folic acid; knowledge, regular exercise, perceived good health, and planned pregnancy were associated with preconceptional use of vitamins. CONCLUSIONS: Even in this sample of well educated, English-speaking women, only one third took vitamin supplements before conception, which indicates that current educational efforts do not reach most women early enough. A coordinated, multi-pronged strategy that targets and involves physicians and capitalizes on opportunities to work with schools, public health outlets, and the media is needed.