Periconceptional folic acid use: still room to improve.

BACKGROUND: Folic acid use before and during pregnancy prevents neural tube defects. Since 1995, six surveys have been carried out among pregnant women to measure their knowledge and use of folic acid. The results of the most recent survey in 2009 will be discussed and compared with earlier surveys. METHODS: Pregnant women in the Northern Netherlands were asked to fill out a questionnaire when visiting their midwife or gynecologist. RESULTS: Of the 515 participating women, 87.0% knew of folic acid before they became pregnant. Of all respondents, 51.6% reported to have used folic acid during the entire recommended period. Multivariate analysis showed that planned pregnancy (odds ratio [OR], 7.1; 95% confidence interval [CI], 2.4-20.7), smoking (OR, 0.2; 95% CI, 0.1-0.7), folic acid use during a former pregnancy (OR, 22.6; 95% CI, 5.5-92.8) and the number of previous children (per child OR, 0.5; 95% CI, 0.3-0.9) were predicting factors for the recommended use of folic acid; 89.9% of women were sufficiently knowledgeable to start to use folic acid before pregnancy. CONCLUSIONS: The knowledge about folic acid has declined over recent years, and the use during the recommended period did not improve since the survey of 2005. Based on this survey, there is still room for improvement in the knowledge and actual use of folic acid before pregnancy. Attention to these aspects should focus on younger, low-educated women and should include information about family planning and contraceptives.

Disturbed development of the enteric nervous system after in utero exposure of selective serotonin re-uptake inhibitors and tricyclic antidepressants. Part 1: Literature review.

The increase in selective serotonin re-uptake inhibitor (SSRI) use during pregnancy, questions concerning abnormal development of the enteric nervous system (ENS), increase in laxative use in children and the association of fluoxetine with infantile hypertrophic pyloric stenosis (IHPS) gave rise to this pharmacological literature review. The role of 5-HT and the NE uptake in ontogeny of the ENS and the effects SSRIs and TCAs might have on the development of the ENS were investigated. The literature study showed that SSRIs may influence the development of the ENS in two ways. Blockage of the serotonin re-uptake transporter (SERT) during foetal development could influence migration, differentiation and survival of cells. This could lead to abnormal development in the first trimester of pregnancy. The other way is that 5-HT seems to be a growth factor in the primitive ENS. This growth factor like action is mediated through the 5-HT(2B) receptor and stimulation of this receptor by SSRIs influences the fate of late-developing enteric neurons. This could lead to abnormal development in the second and third trimester. TCAs could influence the development of the ENS, besides through inhibition of the SERT, through inhibition of the norepinephrine transporter (NET). Expression of the NET seems to be essential for a full development of enteric neurons and especially for serotonergic neurons. In addition the NET was detected early in ontogeny and precedes neuronal differentiation, which suggests that TCAs might influence development of the ENS when exposed early in pregnancy. The insights of this study gave rise to hypotheses which will be tested in an epidemiological cohort study.

The history of DES, lessons to be learned.

Since the 1940s, diaethylstilbestrol (DES) has been used by millions of pregnant women to prevent miscarriages and many other disorders in pregnancy. In 1971, it became clear that this apparently innocent treatment proved to be a time bomb for the infants exposed to DES during the first trimester of pregnancy. DES is now associated with an increased risk of breast cancer, clear cell adenocarcinoma (CCAC) of the vagina and cervix, and reproductive anomalies. This article summarises the potential long-term health implications of DES on the mother, DES daughters and DES sons, and the possible side effects on the third generation. Health care professionals have to know the history of DES to prevent future disasters with drugs prescribed.