Maternal Folate Status and the Risk for Neural Tube Defects. The Role of Dietary Folate (original) (raw)
Determination of Risk Factors Associated with Neural Tube Defects in Infants
Neural tube defects (NTDs) are serious birth defects of the brain and spine, NTDs is the major cause of disabilities in developing countries, there are many risk factors for this problem such as folic acid deficiency, consanguinity, genetic factors, exposure to x-ray radiation, chronic disease such as maternal diabetes and treatment of epilepsy such as valporic acid. Material and Methods: A descriptive cross-sectional facilitybased study, the study population were all infants with NTDs who were coming to the neurosurgery clinic at the time of the study (June 2018 to September 2018) at Ibrahim Malik Teaching Hospital-Khartoum, the data were collected by questionnaire, by convenience sampling method, sample size is total coverage during the study period, data were analyzed by the computerized method Statistical Package for the Social Sciences (SPSS) version 20. The results: The current study revealed that most of all groups of infants were female (56%) their mean 1.56 ±. 501. The mothers whom conducted antenatal care and taking folic acid immediately after amenorrhea their mean 2.28 ± 1.29 & 3.58 ± 1.79 respectively. There is a significant relationship between early taking folic acid and mother education level p-value (. 000). 60% of children, their parent firstdegree cousin, there mean 1.62 ±. 83. Previous family history of NTDs in close sibling (46%) with mean 1.62 ±. 64. Mothers having a chronic disease (Diabetes mellitus & epilepsy) the mean 2.88 ±1. 37. (82%) of mothers, not exposed to x-ray radiation, their mean 1.82 ±. 39. Conclusion: The majority of mothers, not taking folic acid during pregnancy, their awareness is poor regarding the importance of taking folic acid and their husband were related to them.
2012
Background—Periconceptional use of folic acid prevents most neural tube defects (NTDs). Whether folic acid and/or multivitamins can prevent other congenital anomalies is not clear. This study tested whether maternal blood levels of folate and vitamin B12 in pregnancies affected by congenital malformations excluding NTDs are lower when compared to non-affected pregnancies. Methods—We measured pregnancy red cell folate (RCF), vitamin B12, and homocysteine (tHcy) concentrations in blood samples taken at the first antenatal clinic in Dublin maternity hospitals in 1986–1990 when vitamin supplementation was rare. The cases were mothers who delivered a baby with a congenital malformation other than NTD identified by the Dublin EUROCAT Registry; controls were a systematic sample of mothers of offspring without congenital malformations from the same hospitals in the same time period. Results—The median maternal levels of RCF and tHcy did not differ significantly between cases and controls fo...
Long Term Maintenance of Neural Tube Defects Prevention in a High Prevalence State
The Journal of Pediatrics, 2011
Objective-To assess the efficacy of folic acid (FA) supplementation and fortification in preventing neural tube defects (NTDs) in a high prevalence region of the US. Study design-Active and passive surveillance methods were used to identify all fetuses/infants affected by an NTD in South Carolina. Prevalence rates were compared with FA intake to determine the effects of increased intake on NTD occurrence and recurrence. Results-From 1992-2009, 916 NTD cases occurred in South Carolina with isolated defects comprising 79% of cases. The NTD rate decreased 58% during this period. There was one NTDaffected pregnancy among 418 subsequent pregnancies (0.2%) in mothers with previous NTDaffected pregnancies who consumed periconceptional FA supplements and four NTDs among 66 pregnancies (6.1%) in which the mother did not take FA supplements. Folic acid supplementation increased from 8% to 35% from 1992-2007 and knowledge of the protective benefits of FA increased from 8% to 65% in women of childbearing age. Conclusions-Increased periconceptional intake of FA appeared to reduce NTDs in a high prevalence region. The rate of spina bifida and anencephaly in South Carolina is now essentially the same (0.69 cases per 1000 live births and fetal deaths) as the 1998-2005 US rate (0.69). Keywords birth defects; folic acid; South Carolina; spina bifida; anencephaly; encephalocele Neural tube defects (NTDs) are serious forms of craniospinal birth defects that result from the failure of the neural tube to close during the first month of embryonic development. 1,2 The three major forms of NTDs are spina bifida, anencephaly, and encephalocele. Spina bifida usually results in paralysis below the level of the spinal lesion and hydrocephaly, whereas anencephaly results in death in utero or death shortly after birth, and the effects and outcome of encephalocele are variable. 2,3 Although specific genetic and environmental causes are known for a minority of NTDs, especially those with associated malformations,
Chapter in Neural Tube Defects, Ed KL Narashimhan. InTec Publications, 2012
Diagnosis of neural tube defect (NTD) in early pregnancy and selective termination is the dominant strategy for control of NTD births in European countries whereas in North America the need for selective termination is considerably curtailed by folic acid fortification of flour, bread and rice. There are arguments against fortification on the grounds that it may have deletarious effects on older subjects. The pros and cons for fortification are discussed in detail with reference to the latest evidence.
Neural tube defects: Sex ratio changes after fortification with folic acid
PloS one, 2018
Historically, neural tube defects (NTDs) have predominated in female infants but the reasons remain unclear. In South America, the pre- folic acid fortification (FAF) rates of NTDs were around 18/10,000 births for females and 12/10,000 births for males, with an estimated sex ratio (male/female) of 0.67. During the post- FAF period, unpublished routine reports have indicated changes in the sex ratio for these defects while some descriptive reports are controversial. To date and to our knowledge, however, no studies specifically focusing on these changes to test this hypothesis directly have been undertaken. The aim of this study was to analyze changes in the sex ratio of infants with NTDs after FAF in South American countries. With a descriptive cross-sectional study design, 2,597 infants with isolated NTDs born between 1990 and 2013 in 3 countries participating in the Latin American Collaborative Study of Congenital Malformations (ECLAMC) network were included: (Chile N = 521 and Ar...
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC, 2015
Objective: To provide updated information on the pre- and post-conception use of oral folic acid with or without a multivitamin/micronutrient supplement for the prevention of neural tube defects and other congenital anomalies. This will help physicians, midwives, nurses, and other health care workers to assist in the education of women about the proper use and dosage of folic acid/multivitamin supplementation before and during pregnancy. Evidence: Published literature was retrieved through searches of PubMed, Medline, CINAHL, and the Cochrane Library in January 2011 using appropriate controlled vocabulary and key words (e.g., folic acid, prenatal multivitamins, folate sensitive birth defects, congenital anomaly risk reduction, pre-conception counselling). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies published in English from 1985 and June 2014. Searches were updated on a regular basis and incorporated ...
Effects and safety of periconceptional folate supplementation for preventing birth defects
Background It has been reported that neural tube defects can be prevented with periconceptional folic acid supplementation. The effects of different doses, forms and schemes of folate supplementation for the prevention of other birth defects and maternal and infant outcomes are unclear. Objectives This review updates and expands a previous Cochrane Review assessing the effects of periconceptional supplementation with folic acid to reduce neural tube defects (NTDs). We examined whether folate supplementation before and during early pregnancy can reduce neural tube and other birth defects (including cleft palate) without causing adverse outcomes for mothers or babies. Search strategy We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (July 2010). Additionally, we searched the international clinical trials registry platform and contacted relevant organisations to identify ongoing and unpublished studies. Selection criteria We included all randomised or quasi-randomised trials evaluating the effect of periconceptional folate supplementation alone, or in combination with other vitamins and minerals, in women independent of age and parity. Data collection and analysis We assessed trials for methodological quality using the standard Cochrane criteria. Two authors independently assessed the trials for inclusion, one author extracted data and a second checked for accuracy. Main results Five trials involving 6105 women (1949 with a history of a pregnancy affected by a NTD and 4156 with no history of NTDs) were included. Overall, the results are consistent in showing a protective effect of daily folic acid supplementation (alone or in combination with other vitamins and minerals) in preventing NTDs compared with no interventions/placebo or vitamins and minerals without folic acid (risk ratio (RR) 0.28, 95% confidence interval (CI) 0.15 to 0.52). Only one study assessed the incidence of NTDs and the effect was not statistically significant (RR 0.08, 95% CI 0.00 to 1.33) although no events were found in the group that received folic acid. Folic acid had a significant protective effect for reoccurrence (RR 0.32, 95% CI 0.17 to 0.60). There is no statistically significant evidence of any effects on prevention of cleft palate, cleft lip, congenital cardiovascular defects, miscarriages or any other birth defects. There were no included trials assessing the effects of this intervention on maternal blood folate or anaemia at term. We found no evidence of short-term side effects. Authors' conclusions Folic acid, alone or in combination with vitamins and minerals, prevents NTDs but does not have a clear effect on other birth defects.
Prevention of Neural Tube Defects: Results of the Medical Research Council Vitamin Study
Obstet Gynecol Surv, 1992
A randomised double-blind prevention trial with a factorial design was conducted at 33 centres in seven countries to determine whether supplementation with folic acid (one of the vitamins in the B group) or a mixture of seven other vitamins (A, D, B1, B2, B6, C, and nicotinamide) around the time of conception can prevent neural tube defects (anencephaly, spina bifida, encephalocele). A total of 1817 women at high risk of having a pregnancy with a neural tube defect, because of a previous affected pregnancy, were allocated at random to one of four groups— namely, folic acid, other vitamins, both, or neither. 1195 had a completed pregnancy in which the fetus or infant was known to have or not have a neural tube defect; 27 of these had a known neural tube defect, 6 in the folic acid groups and 21 in the two other groups, a 72% protective effect (relative risk 0·28, 95% confidence interval 0·12-0·71). The other vitamins showed no significant protective effect (relative risk 0·80, 95% Cl 0·32-1·72). There was no demonstrable harm from the folic acid supplementation, though the ability of the study to detect rare or slight adverse effects was limited. Folic acid supplementation starting before pregnancy can now be firmly recommended for all women who have had an affected pregnancy, and public health measures should be taken to ensure that the diet of all women who may bear children contains an adequate amount of folic acid.
Decline of neural tube defects cases after a folic acid campaign in Nuevo Le�n, M�xico
Teratology, 2002
Background: Nuevo León is a state in northeastern Mexico, near the border of Texas. Mean mortality rate from 1996-98 due to anencephaly cases was 0.6/1,000. In 1999 a surveillance program for the registry and prevention of neural tube defects (NTD) cases was initiated. Methods: Cases were obtained from hospitals and OB-GYN clinics by immediate notification, death certificates, or fetal death registries. Only isolated cases of NTD were included. In August 1999 a folic acid campaign was initiated with the free distribution of the vitamin to low-income women with a recommendation to take a 5.0-mg pill once a week. Number of cases and rates from 1999 to 2001 were compared (2 test). Results: After 2 years there has been a significant reduction in the number of cases and rates. In 1999 there were 95 NTD cases and in the years 2000 and 2001 there were only 59 and 55 respectively (P Ͻ 0.
Birth Defects Research Part A-clinical and Molecular Teratology, 2006
BACKGROUND: Two crucial issues relative to the benefits and impact of folic acid in the prevention of birth defects are whether supplementation recommendations alone, without fortification, are effective in reducing the population-wide rates of neural tube defects (NTDs), and whether such policies can reduce the occurrence of other birth defects. Using data from 15 registries, we assessed rates and trends of 14 major defects, including NTDs, in areas with official recommendations or fortification to assess the effectiveness of recommendations and fortification on a wide range of major birth defects. METHODS: We evaluated surveillance data through 2003 on major birth defects from population-based registries from Europe, North America, and Australia. All included ascertainment of pregnancy terminations (where legal). Trends before and after policies or fortification were assessed via Poisson regression and were compared via rate ratios. RESULTS: Significant changes in trends were seen for NTDs in areas with fortification but not in areas with supplementation recommendations alone. For other major birth defects, there was an overall lack of major trend changes after recommendations or fortification. However, some significant declines were observed for select birth defects in individual areas. CONCLUSIONS: Recommendations alone remain an ineffective approach in translating the known protective effect of folic acid in population-wide decline in NTD rates. Fortification appears to be effective in reducing NTDs. The effect on other birth defects remains unclear. Birth Defects Research (Part A), 2006. © 2006 Wiley-Liss, Inc.