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1.
BMC Pregnancy Childbirth ; 19(1): 326, 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31484502

RESUMO

BACKGROUND: Identifying and understanding the knowledge, attitude and practice (KAP) level of women at the periconceptional period has implications for formulating and measuring the adverse pregnancy outcomes for primary prevention. METHODS: A cross-sectional study among pregestational and pregnant women was conducted in Shaanxi during 2016-2017. RESULTS: Among 791 participants, the average score of periconceptional healthcare knowledge awareness was 6.32 ± 1.78, whereas 28.8% of women have failed. Women who planned to or had undergone premarital and pre-pregnancy examinations accounted for 50.2, and 62.5%, respectively. Less than half (42.0%) of the women started taking folic acid (FA) before pregnancy, and only 37.9% of them took FA regularly at the right time. Multivariate analysis showed that age was the main factor influencing the Attitude and Practice level of women at the periconceptional period, and demonstrated a positive effect on the awareness of right timing of folic acid supplementation, and high rates of premarital and pre-pregnancy examinations. Also, the knowledge pass rate was increased with education level. Fewer women who have birth experience were willing to take FA consistently at the right time compared to those women without birth. CONCLUSIONS: The women at the periconceptional period in Shaanxi lacked the total KAP level of periconceptional healthcare, especially those who live in rural areas and have less education. Government agencies should reinforce more effective primary preventive measures and policies for the prevention of adverse pregnancy outcomes.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Cuidado Pré-Concepcional , Gestantes , Cuidado Pré-Natal , Prevenção Primária , Adulto , China , Anormalidades Congênitas , Estudos Transversais , Escolaridade , Feminino , Ácido Fólico/uso terapêutico , Humanos , Hipertensão Induzida pela Gravidez , Recém-Nascido , Pessoa de Meia-Idade , Triagem Neonatal , Defeitos do Tubo Neural/prevenção & controle , Gravidez , Complicações Cardiovasculares na Gravidez , Complicações Infecciosas na Gravidez , Resultado da Gravidez , População Rural , Sepse , Hemorragia Uterina , Complexo Vitamínico B/uso terapêutico , Adulto Jovem
2.
BMC Res Notes ; 12(1): 495, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399144

RESUMO

OBJECTIVE: Although infant mortality because of birth defect has increased in both developed and developing countries, had not got attention like other health issues at national, regional, or local levels. Documenting the risk factors that influence the occurrence of birth defects and its seasonality will help to inform the community and to develop preventive strategies for the country. RESULTS: Factors associated with higher likelihood of a major structural birth defects included maternal age; neonates born from women living in urban; and in Dega; history of fever during pregnancy; intake of herbal medicine; and drinking alcohol. Counselling for pregnancy preparation and folic acid supplementation was found protective for the likelihood of birth defect.


Assuntos
Fenda Labial/epidemiologia , Fissura Palatina/epidemiologia , Anormalidades Congênitas/epidemiologia , Anormalidades Musculoesqueléticas/epidemiologia , Defeitos do Tubo Neural/epidemiologia , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Estudos de Casos e Controles , Fenda Labial/etiologia , Fenda Labial/prevenção & controle , Fissura Palatina/etiologia , Fissura Palatina/prevenção & controle , Anormalidades Congênitas/etiologia , Anormalidades Congênitas/prevenção & controle , Países em Desenvolvimento , Suplementos Nutricionais , Etiópia/epidemiologia , Feminino , Febre/complicações , Ácido Fólico/administração & dosagem , Humanos , Lactente , Recém-Nascido , Masculino , Idade Materna , Anormalidades Musculoesqueléticas/etiologia , Anormalidades Musculoesqueléticas/prevenção & controle , Defeitos do Tubo Neural/etiologia , Defeitos do Tubo Neural/prevenção & controle , Parto , Gravidez , Encaminhamento e Consulta , Fatores de Risco , Estações do Ano , População Urbana
3.
Cochrane Database Syst Rev ; 7: CD012150, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31257574

RESUMO

BACKGROUND: Folate is a B-vitamin required for DNA synthesis, methylation, and cellular division. Wheat and maize (corn) flour are staple crops consumed widely throughout the world and have been fortified with folic acid in over 80 countries to prevent neural tube defects. Folic acid fortification may be an effective strategy to improve folate status and other health outcomes in the overall population. OBJECTIVES: To evaluate the health benefits and safety of folic acid fortification of wheat and maize flour (i.e. alone or in combination with other micronutrients) on folate status and health outcomes in the overall population, compared to wheat or maize flour without folic acid (or no intervention). SEARCH METHODS: We searched the following databases in March and May 2018: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and MEDLINE In Process, Embase, CINAHL, Web of Science (SSCI, SCI), BIOSIS, Popline, Bibliomap, TRoPHI, ASSIA, IBECS, SCIELO, Global Index Medicus-AFRO and EMRO, LILACS, PAHO, WHOLIS, WPRO, IMSEAR, IndMED, and Native Health Research Database. We searched the International Clinical Trials Registry Platform and ClinicalTrials.gov for ongoing or planned studies in June 2018, and contacted authors for further information. SELECTION CRITERIA: We included randomised controlled trials (RCTs), with randomisation at the individual or cluster level. We also included non-RCTs and prospective observational studies with a control group; these studies were not included in meta-analyses, although their characteristics and findings were described. Interventions included wheat or maize flour fortified with folic acid (i.e. alone or in combination with other micronutrients), compared to unfortified flour (or no intervention). Participants were individuals over two years of age (including pregnant and lactating women), from any country. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study eligibility, extracted data, and assessed risk of bias. MAIN RESULTS: We included 10 studies: four provided data for quantitative analyses (437 participants); five studies were randomised trials (1182 participants); three studies were non-RCTs (1181 participants, 8037 live births); two studies were interrupted time series (ITS) studies (1 study population of 2,242,438, 1 study unreported). Six studies were conducted in upper-middle-income countries (China, Mexico, South Africa), one study was conducted in a lower-middle-income country (Bangladesh), and three studies were conducted in a high-income country (Canada). Seven studies examined wheat flour fortified with folic acid alone or with other micronutrients. Three studies included maize flour fortified with folic acid alone or with other micronutrients. The duration of interventions ranged from two weeks to 36 months, and the ITS studies included postfortification periods of up to seven years. Most studies had unclear risk of bias for randomisation, blinding, and reporting, and low/unclear risk of bias for attrition and contamination.Neural tube defects: none of the included RCTs reported neural tube defects as an outcome. In one non-RCT, wheat flour fortified with folic acid and other micronutrients was associated with significantly lower occurrence of total neural tube defects, spina bifida, and encephalocoele, but not anencephaly, compared to unfortified flour (total neural tube defects risk ratio (RR) 0.32, 95% confidence interval (CI) 0.21 to 0.48; 1 study, 8037 births; low-certainty evidence).Folate status: pregnant women who received folic acid-fortified maize porridge had significantly higher erythrocyte folate concentrations (mean difference (MD) 238.90 nmol/L, 95% CI 149.40 to 328.40); 1 study, 38 participants; very low-certainty evidence) and higher plasma folate (MD 14.98 nmol/L, 95% CI 9.63 to 20.33; 1 study, 38 participants; very low-certainty evidence), compared to no intervention. Women of reproductive age consuming maize flour fortified with folic acid and other micronutrients did not have higher erythrocyte folate (MD -61.80 nmol/L, 95% CI -152.98 to 29.38; 1 study, 35 participants; very low-certainty evidence) or plasma folate (MD 0.00 nmol/L, 95% CI -0.00 to 0.00; 1 study, 35 participants; very low-certainty evidence) concentrations, compared to women consuming unfortified maize flour. Adults consuming folic acid-fortified wheat flour bread rolls had higher erythrocyte folate (MD 0.66 nmol/L, 95% CI 0.13 to 1.19; 1 study, 30 participants; very low-certainty evidence) and plasma folate (MD 27.00 nmol/L, 95% CI 15.63 to 38.37; 1 study, 30 participants; very low-certainty evidence), versus unfortified flour. In two non-RCTs, serum folate concentrations were significantly higher among women who consumed flour fortified with folic acid and other micronutrients compared to women who consumed unfortified flour (MD 2.92 nmol/L, 95% CI 1.99 to 3.85; 2 studies, 657 participants; very low-certainty evidence).Haemoglobin or anaemia: in a cluster-randomised trial among children, there were no significant effects of fortified wheat flour flatbread on haemoglobin concentrations (MD 0.00 nmol/L, 95% CI -2.08 to 2.08; 1 study, 334 participants; low-certainty evidence) or anaemia (RR 1.07, 95% CI 0.74 to 1.55; 1 study, 334 participants; low-certainty evidence), compared to unfortified wheat flour flatbread. AUTHORS' CONCLUSIONS: Fortification of wheat flour with folic acid may reduce the risk of neural tube defects; however, this outcome was only reported in one non-RCT. Fortification of wheat or maize flour with folic acid (i.e. alone or with other micronutrients) may increase erythrocyte and serum/plasma folate concentrations. Evidence is limited for the effects of folic acid-fortified wheat or maize flour on haemoglobin levels or anaemia. The effects of folic acid fortification of wheat or maize flour on other primary outcomes assessed in this review is not known. No studies reported on the occurrence of adverse effects. Limitations of this review were the small number of studies and participants, limitations in study design, and low-certainty of evidence due to how included studies were designed and reported.


Assuntos
Farinha , Ácido Fólico/administração & dosagem , Alimentos Fortificados , Defeitos do Tubo Neural/prevenção & controle , Complexo Vitamínico B/administração & dosagem , Feminino , Humanos , Cuidado Pré-Concepcional , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Triticum , Zea mays
5.
Nutrients ; 11(5)2019 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-31109064

RESUMO

Most professional and international organizations recommend folic acid supplementation for women planning pregnancy. Various studies have shown high levels of non-compliance with this recommendation. This study aimed to identify sociodemographic characteristics related to this compliance. The analyses were based on 16,809 women from the French nationwide ELFE cohort (Etude Longitudinale Française depuis l'Enfance). Folic acid supplementation was assessed at delivery, and sociodemographic characteristics were collected at two months postpartum. The association between sociodemographic characteristics and compliance with recommendations on folic acid supplementation (no supplementation, periconceptional supplementation, and supplementation only after the periconceptional period) was examined using multivariate multinomial logistic regression. Only 26% of French women received folic acid supplementation during the periconceptional period, 10% of women received supplementation after the periconceptional period, and 64% received no supplementation. Young maternal age, low education level, low family income, multiparity, single parenthood, maternal unemployment, maternal overweight, and smoking during pregnancy were related to lower likelihood of folic acid supplementation during the periconceptional period compared to no supplementation. These associations were not explained by unplanned pregnancy. Immigrant and underweight women were more likely to receive folic acid supplementation after the periconceptional period. Our study confirms great social disparities in France regarding the compliance with the recommendations on folic acid supplementation.


Assuntos
Suplementos Nutricionais , Ácido Fólico/administração & dosagem , Ácido Fólico/farmacologia , Defeitos do Tubo Neural/epidemiologia , Defeitos do Tubo Neural/prevenção & controle , Fenômenos Fisiológicos da Nutrição Pré-Natal , Adulto , Criança , Feminino , França , Humanos , Gravidez , Fatores Socioeconômicos , Adulto Jovem
6.
Am J Clin Nutr ; 109(5): 1452-1461, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31005964

RESUMO

BACKGROUND: For women of reproductive age, a population-level red blood cell (RBC) folate concentration below the threshold 906 nmol/L or 400 ng/mL indicates folate insufficiency and suboptimal neural tube defect (NTD) prevention. A corresponding population plasma/serum folate concentration threshold for optimal NTD prevention has not been established. OBJECTIVE: The aim of this study was to examine the association between plasma and RBC folate concentrations and estimated a population plasma folate insufficiency threshold (pf-IT) corresponding to the RBC folate insufficiency threshold (RBCf-IT) of 906 nmol/L. METHODS: We analyzed data on women of reproductive age (n = 1673) who participated in a population-based, randomized folic acid supplementation trial in northern China. Of these women, 565 women with anemia and/or vitamin B-12 deficiency were ineligible for folic acid intervention (nonintervention group); the other 1108 received folic acid supplementation for 6 mo (intervention group). We developed a Bayesian linear model to estimate the pf-IT corresponding to RBCf-IT by time from supplementation initiation, folic acid dosage, methyltetrahydrofolate reductase (MTHFR) genotype, body mass index (BMI), vitamin B-12 status, or anemia status. RESULTS: Using plasma and RBC folate concentrations of the intervention group, the estimated median pf-IT was 25.5 nmol/L (95% credible interval: 24.6, 26.4). The median pf-ITs were similar between the baseline and postsupplementation samples (25.7 compared with 25.2 nmol/L) but differed moderately (±3-4 nmol/L) by MTHFR genotype and BMI. Using the full population-based baseline sample (intervention and nonintervention), the median pf-IT was higher for women with vitamin B-12 deficiency (34.6 nmol/L) and marginal deficiency (29.8 nmol/L) compared with the sufficient group (25.6 nmol/L). CONCLUSIONS: The relation between RBC and plasma folate concentrations was modified by BMI and genotype and substantially by low plasma vitamin B-12. This suggests that the threshold of 25.5 nmol/L for optimal NTD prevention may be appropriate in populations with similar characteristics, but it should not be used in vitamin B-12 insufficient populations. This trial was registered at clinicaltrials.gov as NCT00207558.


Assuntos
Suplementos Nutricionais , Eritrócitos/metabolismo , Deficiência de Ácido Fólico/diagnóstico , Ácido Fólico/uso terapêutico , Defeitos do Tubo Neural/prevenção & controle , Cuidado Pré-Concepcional/métodos , Vitamina B 12/sangue , Adulto , Teorema de Bayes , Índice de Massa Corporal , China , Feminino , Ácido Fólico/sangue , Deficiência de Ácido Fólico/sangue , Deficiência de Ácido Fólico/tratamento farmacológico , Genótipo , Humanos , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Terapia Nutricional , Saúde da População , Cuidado Pré-Concepcional/normas , Gravidez , Valores de Referência , Deficiência de Vitamina B 12/sangue , Adulto Jovem
7.
Am J Clin Nutr ; 109(6): 1696-1708, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30997493

RESUMO

BACKGROUND: Micronutrient malnutrition is highly prevalent in low- and middle-income countries (LMICs) and disproportionately affects women and children. Although the effectiveness of large-scale food fortification (LSFF) of staple foods to prevent micronutrient deficiencies in high-income settings has been demonstrated, its effectiveness in LMICs is less well characterized. This is important as food consumption patterns, potential food vehicles, and therefore potential for impact may vary substantially in these contexts. OBJECTIVES: The aim of this study was to determine the real-world impact of LSFF with key micronutrients (vitamin A, iodine, iron, folic acid) on improving micronutrient status and functional health outcomes in LMICs. METHODS: All applicable published/unpublished evidence was systematically retrieved and analyzed. Studies were not restricted by age or sex. Meta-analyses were performed for quantitative outcomes and results were presented as summary RRs, ORs, or standardized mean differences (SMDs) with 95% CIs. RESULTS: LSFF increased serum micronutrient concentrations in several populations and demonstrated a positive impact on functional outcomes, including a 34% reduction in anemia (RR: 0.66; 95% CI: 0.59, 0.74), a 74% reduction in the odds of goiter (OR: 0.26; 95% CI: 0.16, 0.43), and a 41% reduction in the odds of neural tube defects (OR: 0.59; 95% CI: 0.49, 0.70). Additionally, we found that LSFF with vitamin A could protect nearly 3 million children per year from vitamin A deficiency. We noted an age-specific effect of fortification, with women (aged >18 y) attaining greater benefit than children, who may consume smaller quantities of fortified staple foods. Several programmatic/implementation factors were also reviewed that may facilitate or limit program potential. CONCLUSIONS: Measurable improvements in the micronutrient and health status of women and children are possible with LSFF. However, context and implementation factors are important when assessing programmatic sustainability and impact, and data on these are quite limited in LMIC studies.


Assuntos
Alimentos Fortificados/análise , Micronutrientes/administração & dosagem , Micronutrientes/deficiência , Adolescente , Anemia/prevenção & controle , Criança , Pré-Escolar , Países em Desenvolvimento/economia , Feminino , Ácido Fólico/administração & dosagem , Humanos , Lactente , Iodo/administração & dosagem , Iodo/deficiência , Ferro/administração & dosagem , Ferro/deficiência , Masculino , Defeitos do Tubo Neural/prevenção & controle , Estado Nutricional , Ensaios Clínicos Controlados Aleatórios como Assunto , Vitamina A/administração & dosagem
8.
J Neonatal Perinatal Med ; 12(2): 195-201, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30932895

RESUMO

BACKGROUND: Neural tube defects (NTDs) are among the most common congenital anomalies worldwide with an incidence of 300,000/year. Spina bifida, which is the most prevalent NTD, has an incidence of 1.2/1000 live births in Saudi Arabia. Our study aimed to assess the awareness of NTDs and the implementation of preventative measures against them. In addition, to gauge public opinion regarding abortion following early diagnosis of NTDs. METHODS: This was a cross-sectional study in which questionnaires were distributed using non-probability convenient sampling technique and data was collected in a face-to-face interview. Subjects were approached in an outpatient clinic and in a shopping mall in Jeddah city, Saudi Arabia. RESULTS: Out of 353 subjects, 35.7% were males, 64.3% females (33% pregnant), and the median age was 34 (IQR = 14) years. Of subjects, 66.3% were not aware of NTDs, and regarding folic acid 54% believed that it helps in preventing NTDs, and only 25% agreed on starting it before pregnancy. However, only 19% agreed on all points, which even dropped to 9% after considering planned pregnancies. Gender differences were extremely significant (p-value <0.001) as females were more aware. Interestingly, 62% would abort in early-diagnosed NTD cases. Of pregnant women, only 20% started taking folic acid before pregnancy. CONCLUSIONS: The data shows that the majority of the study's population are in favor of terminating the pregnancy in justified NTD cases. There is a need for increasing public awareness, especially to males, and should be provided through all channels of knowledge.


Assuntos
Aborto Eugênico , Ácido Fólico/uso terapêutico , Conhecimentos, Atitudes e Prática em Saúde , Defeitos do Tubo Neural/prevenção & controle , Complexo Vitamínico B/uso terapêutico , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Defeitos do Tubo Neural/diagnóstico , Gravidez , Diagnóstico Pré-Natal , Fatores de Risco , Arábia Saudita
9.
Am J Epidemiol ; 188(6): 1136-1143, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30976786

RESUMO

We aimed to investigate associations between individual and concurrent (≥2) intakes of one-carbon cofactors vitamins B6 and B12, choline, betaine, and methionine and neural tube defect (NTD) outcomes among mothers meeting the folic acid recommendations. In the Slone Birth Defects Study (case-control design; North America, 1998-2015), mothers of 164 NTD cases and 2,831 nonmalformed controls completed food frequency questionnaires and structured interviews. Estimated intakes of one-carbon cofactors were dichotomized (high vs. low) for all except betaine (low or middle vs. high). We used logistic regression models to estimate odds ratios and 95% confidence intervals adjusted for center, age, and race. The analysis was restricted to mothers with estimated daily total folate intake of ≥400 µg during periconception. Fewer cases, compared with controls, had high intakes for each one-carbon cofactor except betaine, where the starkest contrast occurred in the middle group. Women with concurrent high intakes of B6, B12, choline, and methionine and moderate intake of betaine had approximately half the risk of an NTD-affected pregnancy (odds ratio = 0.49, 95% confidence interval: 0.23, 1.08). These findings suggest that, in the presence of folic acid, one-carbon cofactors-notably when consumed together-might reduce NTD risk. Additional research should inform any changes to clinical recommendations.


Assuntos
Carbono/administração & dosagem , Suplementos Nutricionais , Ácido Fólico/administração & dosagem , Defeitos do Tubo Neural/prevenção & controle , Adulto , Betaína/administração & dosagem , Estudos de Casos e Controles , Colina/administração & dosagem , Relação Dose-Resposta a Droga , Feminino , Humanos , Metionina/administração & dosagem , Razão de Chances , Gravidez , Fatores de Risco , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Vitamina B 12/administração & dosagem , Vitamina B 6/administração & dosagem
10.
Z Geburtshilfe Neonatol ; 223(4): 213-220, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-30452071

RESUMO

INTRODUCTION: The intake of folic acid before and during pregnancy is known to reduce the risk of neural tube defects. Many pregnant women do take folic acid at some point during their pregnancy. Very few of them start taking supplements before conception as recommended. The aim of this study was to find out more about the supplementation behavior among pregnant women and postpartum women in Berlin. METHODS: Pregnant women and postpartum women were asked to anonymously fill in a questionnaire about potential folic acid intake. We conducted a logistic regression analysis to identify independent predictors of folic acid intake during pregnancy. RESULTS: 90.7% (n=1069) of women did take folic acid at some point during their pregnancy, 37.8% (n=445) before conception as advised. Women are more likely to take folic acid before conception when they have planned their pregnancy, when they are better educated, earn more money and are older. Non-German(-speaking) women took significantly less folic acid than German women. Education, income and planning of the pregnancy were identified as independent predictors of folic acid intake prior to conception. CONCLUSION: Almost two thirds of pregnant women do not take folic acid when they need it most, especially those women who do not make much money, are not well educated, are young, and/or have not planned their pregnancy. Additionally, the supplementation rate is lower among non-German women and/or women who do not speak any German.


Assuntos
Suplementos Nutricionais , Status Econômico , Ácido Fólico/administração & dosagem , Mães/psicologia , Defeitos do Tubo Neural/prevenção & controle , Gestantes/psicologia , Berlim , Feminino , Humanos , Período Pós-Parto , Gravidez , Cuidado Pré-Natal
12.
Am J Med Genet A ; 179(1): 20-28, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30569628

RESUMO

Several countries, as Brazil, have public policies for periconceptional folic acid supplementation (FAS) in order to prevent unfavorable outcomes. Our aim was to evaluate the FAS situation in a public reference hospital from Southern Brazil. This study included all mothers who had children born at the Hospital Materno Infantil Presidente Vargas, RS, Brazil, in a 1-year period. Data collection was conducted through interviews with application of a clinical protocol and analysis of the patients' records. FAS was defined as the use of folic acid in any period of the periconceptional period, irrespective of the duration and amount. We also classified those mothers who correctly followed the national recommendation proposed by the Health Ministry of Brazil. The sample consisted of 765 mothers evaluated soon after childbirth. Their ages ranged from 12 to 45 years (mean 25.2 years). The overall level of FAS was 51.5%, and the use according to the national recommendation occurred in only 1.6%. Factors associated with non-FAS consisted of lower maternal age (p = .009) and maternal schooling (p = .023), higher number of pregnancies (p = .003), fewer prenatal visits (p = .050) and later prenatal care onset (p = .037). Periconceptional FAS in our midst seems to be very far from the ideal goal. Susceptible groups appeared to be mothers who were younger, less educated, multiparous, and had inadequate prenatal care. We believe that efforts of education and awareness should be especially targeted for these groups. These recommendations should also be strengthened among those who prescribe the FAS.


Assuntos
Suplementos Nutricionais , Ácido Fólico/administração & dosagem , Defeitos do Tubo Neural/dietoterapia , Cuidado Pré-Natal , Adolescente , Adulto , Brasil/epidemiologia , Criança , Feminino , Humanos , Pessoa de Meia-Idade , Defeitos do Tubo Neural/epidemiologia , Defeitos do Tubo Neural/prevenção & controle , Gravidez , Adulto Jovem
13.
Congenit Anom (Kyoto) ; 59(4): 110-117, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29900595

RESUMO

We evaluated the relationship between preconception folic acid supplementation and the occurrence of neural tube defects (NTDs) in offspring, using data from the Japan Environment and Children's Study (a nationwide prospective birth cohort study) database. Of 92 269 participants with single pregnancies, 74 cases (offspring or fetuses) had NTDs, including 32 cases of spina bifida, 24 cases of anencephaly, and 19 cases of encephalocele. A total of 7634 participants (8.27%) used preconception folic acid supplementation, and of these, 621 (0.67%) also took in dietary folic acid at ≥480 µg/day. Multivariate logistic regression analyses demonstrated no association between preconception folic acid supplementation and NTDs in offspring or fetuses (odds ratio [OR] 0.622; 95% confidence interval [CI]: 0.226-1.713). Moreover, the participants who combined preconception folic acid supplement use with dietary folic acid intake ≥480 µg/day demonstrated no incidence of NTDs in offspring or fetuses. Our analysis is limited by the absence of the data on the daily amount of supplementary folic acid intake, requiring careful attention to the interpretation. Additional surveys are required in Japan to resolve those limitations for further comprehensive assessment.


Assuntos
Suplementos Nutricionais , Ácido Fólico/administração & dosagem , Defeitos do Tubo Neural/epidemiologia , Defeitos do Tubo Neural/etiologia , Cuidado Pré-Concepcional , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Japão/epidemiologia , Pessoa de Meia-Idade , Defeitos do Tubo Neural/diagnóstico , Defeitos do Tubo Neural/prevenção & controle , Razão de Chances , Fenótipo , Gravidez , Vigilância em Saúde Pública , Inquéritos e Questionários , Adulto Jovem
14.
Nutr J ; 17(1): 115, 2018 12 12.
Artigo em Inglês | MEDLINE | ID: mdl-30541549

RESUMO

BACKGROUND: Folic acid (FA) supplementation is known to prevent neural tube defects (NTDs). We examined whether this preventive effect differs by the sex of the infant. METHODS: Data were gathered from a large population-based cohort study in China that evaluated the effects of FA supplementation on NTDs. All births at 20 complete gestational weeks, including live births, stillbirths, and pregnancy terminations, and all NTDs, regardless of gestational age, were recorded. In a northern China province, a total of 30,801 singleton live births to women whose use of FA supplements during the first trimester was known at the time were included in the study. The birth prevalence of NTDs was classified by sex, subtype, and maternal FA supplementation. Male to female rate ratios [RR] and their 95% confidence intervals [CI] were calculated. RESULTS: A total of 106 NTDs cases were recorded. The overall prevalence of NTDs was 2.5‰ among males and 4.4‰ among females; NTDs were less prevalent among males than among females (RR, 0.58; 95% CI, 0.54-0.63). There was a higher prevalence of anencephaly (RR, 0.34; 95% CI, 0.27-0.43) and spina bifida (RR, 0.73; 95% CI, 0.63-0.84) among females. However, FA supplementation led to significantly greater decreases in the rates of anencephaly (4.8‰) and total NTDs (7.6‰) in females than in males (1.6‰ and 2.8‰, respectively). CONCLUSIONS: FA supplementation successfully reduces the prevalence of NTDs in both male and female infants, although we found a significantly greater decrease in anencephaly and total NTDs in females than in males. How the protective effects of FA supplementation affect the sexes differently needs to be studied further.


Assuntos
Suplementos Nutricionais/estatística & dados numéricos , Ácido Fólico/uso terapêutico , Serviços de Saúde Materna/estatística & dados numéricos , Fenômenos Fisiológicos da Nutrição Materna/fisiologia , Defeitos do Tubo Neural/prevenção & controle , Complexo Vitamínico B/uso terapêutico , China/epidemiologia , Estudos de Coortes , Feminino , Ácido Fólico/administração & dosagem , Humanos , Recém-Nascido , Masculino , Defeitos do Tubo Neural/epidemiologia , Gravidez , Prevalência , Estudos Prospectivos , Distribuição por Sexo , Complexo Vitamínico B/administração & dosagem , Adulto Jovem
15.
Am J Clin Nutr ; 108(6): 1357-1368, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30541097

RESUMO

The Government of Canada and the Society of Obstetricians and Gynaecologists of Canada both recommend a daily multivitamin supplement containing 400 µg folic acid (FA) for the primary prevention of neural tube defects among low-risk women from before conception and throughout lactation. Prenatal supplements marketed and prescribed in Canada typically exceed the recommended dose, usually providing ≥1000 µg FA/d. This high daily dose, coupled with staple-food FA fortification, has resulted in the observation of very high blood folate concentrations among reproductive-aged women consuming FA-containing supplements. The long-term consequences of high folate status on fetal development are unknown; however, evidence from animal studies and some human epidemiologic data suggest potential adverse consequences. To address this issue, a workshop was convened with the overall goal to identify challenges and solutions to aligning supplemental FA intakes with current evidence-based recommendations. Thirty-eight stakeholders from academia, industry, government, and health professional groups participated. Group discussions facilitated the identification and prioritization of 5 key challenges for which solutions and implementation strategies were proposed. The 5 themes encompassed clarity and harmonization of evidence-based guidelines, reformulation or relabeling of FA-containing supplements, access to FA for all women, knowledge dissemination strategies and education of the public and health care professionals, and attitude change to overcome the perception of "more is better." A combination of the proposed implementation strategies involving all key stakeholders and directed to health care professionals and the public may enable a sustainable change to align FA intake during the periconceptional period with evidence-based recommendations.


Assuntos
Ácido Fólico/administração & dosagem , Política Nutricional , Cuidado Pré-Concepcional/métodos , Cuidado Pré-Natal/métodos , Canadá , Suplementos Nutricionais/efeitos adversos , Educação , Feminino , Ácido Fólico/efeitos adversos , Ácido Fólico/sangue , Humanos , Defeitos do Tubo Neural/prevenção & controle , Estado Nutricional , Gravidez
16.
BMJ Open ; 8(11): e022565, 2018 11 08.
Artigo em Inglês | MEDLINE | ID: mdl-30413501

RESUMO

OBJECTIVES: Sex differences in prevalence of neural tube defects (NTDs) have previously been recognised; however, the different susceptibility of men and women have not been examined in relation to the effects of folic acid (FA) supplementation. We hypothesised that FA may have a disproportionate effect that alters the sex-specific prevalence of NTDs. SETTING: Data from two time points, before (2003-2004) and after (2011-2016) the start of the supplementation programme, were obtained from a population-based birth defect surveillance programme among five counties in northern China. All live births (28 or more complete gestational weeks), all stillbirths of at least 20 weeks' gestational age and pregnancy terminations at any gestational age following the prenatal diagnosis of NTDs were included. PARTICIPANTS: A total of 25 249 and 83 996 births before and after the programme were included respectively. PRIMARY AND SECONDARY OUTCOME MEASURES: The prevalence of NTDs by sex and subtype, Male:female rate ratios and their 95% CI were calculated. RESULTS: Overall, NTDs were less prevalent among men than among women (rate ratio (RR) 0.92; 95% CI 0.90 to 0.94), so was anencephaly (RR 0.77; 95% CI 0.73 to 0.81) and encephalocele (RR 0.75; 95% CI 0.61 to 0.92), while spina bifida showed a male predominance (RR 1.10; 95% CI 1.05 to 1.15). The overall prevalence of NTDs decreased by 78/10 000 in men and 108.7/10 000 in women from 2003 to 2004 to 2011 to 2016. There was a significant sex difference in the magnitude of reduction, being greater in women than men, particularly for anencephaly. CONCLUSIONS: The prevalence of NTDs decreased in both sexes after the implementation of a massive FA supplementation programme. While female predominance was observed in open NTDs and total NTDs, they also had a greater rate of decrease in NTDs after the supplementation programme.


Assuntos
Suplementos Nutricionais , Ácido Fólico/uso terapêutico , Defeitos do Tubo Neural , Complexo Vitamínico B/uso terapêutico , China/epidemiologia , Feminino , Humanos , Recém-Nascido , Masculino , Defeitos do Tubo Neural/epidemiologia , Defeitos do Tubo Neural/prevenção & controle , Vigilância da População , Gravidez , Prevalência , Distribuição por Sexo
17.
Neurosurg Focus ; 45(4): E20, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30269587

RESUMO

Neural tube defects (NTDs) are one of the greatest causes of childhood mortality and disability-adjusted life years worldwide. Global prevalence at birth is approximately 18.6 per 10,000 live births, with more than 300,000 infants with NTDs born every year. Substantial strides have been made in understanding the genetics, pathophysiology, and surgical treatment of NTDs, yet the natural history remains one of high morbidity and profound impairment of quality of life. Direct and indirect costs of care are enormous, which ensures profound inequities and disparities in the burden of disease in countries of low and moderate resources. All indices of disease burden are higher for NTDs in developing countries. The great tragedy is that the majority of NTDs can be prevented with folate fortification of commercially produced food. Unequivocal evidence of the effectiveness of folate to reduce the incidence of NTDs has existed for more than 25 years. Yet, the most comprehensive surveys of effectiveness of implementation strategies show that more than 100 countries fail to fortify, and consequently only 13% of folate-preventable spina bifida is actually prevented. Neurosurgeons harbor a disproportionate, central, and fundamental role in the management of NTDs and enjoy high standing in society. No organized group in medicine can speak as authoritatively or convincingly. As a result, neurosurgeons and organized neurosurgery harbor disproportionate potential to advocate for more comprehensive folate fortification, and thereby prevent the most common and severe birth defect to impact the human nervous system. Assertive, proactive, informed advocacy for folate fortification should be a central and integral part of the neurosurgical approach to NTDs. Only by making the prevention of dysraphism a priority can we best address the inequities often observed worldwide.


Assuntos
Ácido Fólico/administração & dosagem , Alimentos Fortificados , Defeitos do Tubo Neural/prevenção & controle , Neurocirurgiões , Papel do Médico , Complexo Vitamínico B/administração & dosagem , Criança , Saúde Global , Disparidades nos Níveis de Saúde , Humanos , Incidência , Recém-Nascido , Defeitos do Tubo Neural/epidemiologia , Prevalência
18.
Eur J Obstet Gynecol Reprod Biol ; 231: 80-84, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30336308

RESUMO

OBJECTIVE: There is good evidence that periconceptual Folic Acid (FA) supplementation can prevent two thirds of Neural Tube Defects (NTDs). A two-fold increase in NTD rates have been associated with maternal obesity and, based on limited evidence, national guidelines have recommended prescribing high dose FA for women with a Body Mass Index (BMI) >29.9 kg/m2. This observational study examined the relationship between maternal BMI and serum folate, red blood cell (RBC) folate and plasma vitamin B12 measurements in early pregnancy. STUDY DESIGN: Women were recruited at their convenience during their first antenatal visit to the hospital following sonographic confirmation of an ongoing pregnancy. Clinical, sociodemographic, dietary and supplementation details were collected and computerised. At the time of routine phlebotomy, samples were collected for serum folate, red blood cell (RBC) folate and plasma B12. RESULTS: Of the 496 women, 19.6%. (n = 97) were obese based on a BMI > 29.9 kg/m2. After excluding energy under-reporters, there was no difference between obese women and women with a normal BMI in their dietary or supplementation intakes of folate. Compared with women with a normal BMI (n = 263), obese women had a lower median serum folate (32.0 nmol/L IQR 20.2 vs 36.2 nmol/L IQR 16.3, P = 0.02) and a lower median serum B12 (203.0 pmol/L IQR 102.5 vs 208.0 pmol/L IQR 125.3, P = 0.03), but there was no difference in the mean red blood cell (RBC) folate measurement. There was a negative correlation between increasing BMI and both serum folate (P = 0.03) and plasma B12 (P = 0.03), but no correlation between BMI and RBC folate (P = 0.13). CONCLUSION: Our findings support existing recommendations that obese women should be prescribed higher doses of FA periconceptually. However, to prevent NTDs successfully they may also require B12 supplementation.


Assuntos
Ácido Fólico/sangue , Defeitos do Tubo Neural/prevenção & controle , Obesidade/sangue , Obesidade/complicações , Complicações na Gravidez/sangue , Vitamina B 12/sangue , Adulto , Índice de Massa Corporal , Suplementos Nutricionais , Eritrócitos/química , Feminino , Ácido Fólico/administração & dosagem , Humanos , Cuidado Pré-Concepcional , Gravidez , Cuidado Pré-Natal
19.
Ir Med J ; 111(3): 712, 2018 03 14.
Artigo em Inglês | MEDLINE | ID: mdl-30376230

RESUMO

Neural tube defects (NTD) are potentially preventable in two-thirds of cases by periconceptional maternal Folic Acid (FA) supplementation. A national audit for the years 2009-11 showed no decline in NTD rates over twenty years. The aim of this national audit was to determine trends/rates and inform revision of national FA supplementation and food fortification strategies. Of 274,732 live and stillbirths there were 121(42.0%) cases of anencephaly, 136(47.2%) cases of spina bifida and 31(10.8%) cases of encephalocoele giving a total of 288 and overall rate of 1.05/1000 compared with 1.04/1000 in 2009-11(NS). In the 184 women where the information was available, only 29.9%(n=55) reported starting FA before pregnancy. The number of cases diagnosed antenatally was 91%(n=262) and 53%(n=154) were live-born. This audit confirms that over a generation, healthcare interventions have not succeeded in decreasing the number of pregnancies in Ireland complicated by NTD, and that revised strategies need to be developed and implemented.


Assuntos
Auditoria Clínica , Suplementos Nutricionais , Ácido Fólico/administração & dosagem , Educação em Saúde/estatística & dados numéricos , Defeitos do Tubo Neural/prevenção & controle , Acesso à Informação , Anencefalia/epidemiologia , Anencefalia/prevenção & controle , Encefalocele/epidemiologia , Encefalocele/prevenção & controle , Feminino , Humanos , Incidência , Recém-Nascido , Irlanda/epidemiologia , Defeitos do Tubo Neural/diagnóstico , Defeitos do Tubo Neural/epidemiologia , Gravidez , Disrafismo Espinal/epidemiologia , Disrafismo Espinal/prevenção & controle , Natimorto/epidemiologia
20.
BMJ Open ; 8(7): e022394, 2018 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-30061446

RESUMO

OBJECTIVE: To determine the feasibility of long-term prospective follow-up and ascertainment of cancer in offspring and mothers from the 1993-1995 Chinese Community Intervention Program that provided folic acid supplements before and during early pregnancy to reduce neural tube defects. DESIGN: Feasibility pilot study for a prospective cohort study. SETTING: Families residing during 2012-2013 in one rural and one urban county from 21 counties in 3 provinces in China included in the Community Intervention Program campaign. PARTICIPANTS: The feasibility study targeted 560 families, including 280 from the rural and 280 from the urban county included in the large original study; about half of mothers in each group had taken and half had not taken folic acid supplements. INTERVENTION: The planned new study is observational. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary: incidence of paediatric cancers in offspring; secondary: other chronic diseases in offspring and chronic diseases in mothers RESULTS: Only 3.4% of pilot study families could not be found, 3.9% had moved out of the study area and 8.8% refused to participate. Interviews were completed by 82% of mothers, 79% of fathers and 83% of offspring in the 560 families. Almost all mothers and offspring who were interviewed also participated in anthropometric measurements. We found notable urban-rural differences in sociodemographic and lifestyle characteristics of the parents, but fewer differences among the offspring. In eight catchment area hospitals, we identified a broad range of paediatric cancers diagnosed during 1994-2013, although paediatric brain tumours, lymphomas and rarer cancers were likely under-represented. CONCLUSIONS: Overall, 20 years after the original Community Intervention Program, the pilot study achieved high levels of follow-up and family member interview participation, and identified substantial numbers of paediatric malignancies during 1994-2013 in catchment area hospitals. Next steps and strategies for overcoming limitations are described.


Assuntos
Ácido Fólico/uso terapêutico , Neoplasias/epidemiologia , Defeitos do Tubo Neural/prevenção & controle , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Complexo Vitamínico B/uso terapêutico , Adolescente , Adulto , Criança , China/epidemiologia , Estudos de Coortes , Suplementos Nutricionais , Estudos de Viabilidade , Feminino , Humanos , Incidência , Masculino , Projetos Piloto , Gravidez , Estudos Prospectivos , População Rural , População Urbana , Adulto Jovem
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