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Maurice P, Garel J, Garel C, Dhombres F, Friszer S, Guilbaud L, Maisonneuve E, Ducou Le Pointe H, Blondiaux E, Jouannic JM. New insights in cerebral findings associated with fetal myelomeningocele: a retrospective cohort study in a single tertiary centre. BJOG 2020; 128:376-383. [PMID: 32112473 DOI: 10.1111/1471-0528.16185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate cerebral anomalies other than Chiari type 2 malformation in fetuses with myelomeningocele (MMC). DESIGN A retrospective cohort study in a single tertiary centre. SETTING A review of associated cerebral anomalies in cases with prenatal diagnosis of myelomeningocele. POPULATION Seventy cases of fetal myelomeningocele. METHODS Ultrasound and MRI images were blindly reviewed. Postnatal imaging and results of the postmortem results were also reviewed. The association between cerebral anomalies and the following ultrasound findings was measured: level of the defect, ventriculomegaly, microcephaly and fetal talipes. MAIN OUTCOME MEASURES A microcephaly was observed in 32/70 cases (46%) and a ventriculomegaly was observed in 39/70 cases (56%). Other cerebral anomalies were diagnosed in 47/70 (67%). RESULTS Other cerebral anomalies were represented by 42/70 cases with abnormal CC (60%), 8/70 cases with perinodular heterotopia (PNH; 11%), 2/70 cases with abnormal gyration (3%). MRI performed only in fetal surgery cases confirmed the ulltrasound findings in all cases and provided additional findings in two cases (PNH). Risk ratios of fetal cerebral anomalies associated with MMC did not reach significance for microcephaly, ventriculomegaly, talipes or the level of the defect There was an overall good correlation between pre- and postnatal findings with a Kappa value of 0.79 [95% CI 0.57-1] and 82% agreement. CONCLUSION Fetal brain anomalies other than Chiari type 2 malformation are frequently observed in fetuses with myelomeningocele, predominantly represented by CC anomalies. Whether these associated cerebral anomalies have an impact on selecting cases eligible for fetal surgery needs further evaluation. TWEETABLE ABSTRACT Fetal cerebral anomalies other than Chiari type 2 malformation, microcephaly, and ventriculomegaly may be associated with MMC in up to 67% of the cases.
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Affiliation(s)
- P Maurice
- Service de Médecine Foetale, Centre de Référence Maladie Rares MAVEM, Hôpital Armand Trousseau, Médecine Sorbonne Université, APHP, Paris, France.,Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies, Trousseau, France
| | - J Garel
- Service de Radiopédiatrie, Hôpital Armand Trousseau, Médecine Sorbonne Université, APHP, Paris, France
| | - C Garel
- Service de Radiopédiatrie, Hôpital Armand Trousseau, Médecine Sorbonne Université, APHP, Paris, France
| | - F Dhombres
- Service de Médecine Foetale, Centre de Référence Maladie Rares MAVEM, Hôpital Armand Trousseau, Médecine Sorbonne Université, APHP, Paris, France.,Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies, Trousseau, France
| | - S Friszer
- Service de Médecine Foetale, Centre de Référence Maladie Rares MAVEM, Hôpital Armand Trousseau, Médecine Sorbonne Université, APHP, Paris, France.,Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies, Trousseau, France
| | - L Guilbaud
- Service de Médecine Foetale, Centre de Référence Maladie Rares MAVEM, Hôpital Armand Trousseau, Médecine Sorbonne Université, APHP, Paris, France.,Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies, Trousseau, France
| | - E Maisonneuve
- Service de Médecine Foetale, Centre de Référence Maladie Rares MAVEM, Hôpital Armand Trousseau, Médecine Sorbonne Université, APHP, Paris, France.,Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies, Trousseau, France
| | - H Ducou Le Pointe
- Service de Radiopédiatrie, Hôpital Armand Trousseau, Médecine Sorbonne Université, APHP, Paris, France
| | - E Blondiaux
- Service de Radiopédiatrie, Hôpital Armand Trousseau, Médecine Sorbonne Université, APHP, Paris, France
| | - J-M Jouannic
- Service de Médecine Foetale, Centre de Référence Maladie Rares MAVEM, Hôpital Armand Trousseau, Médecine Sorbonne Université, APHP, Paris, France.,Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies, Trousseau, France
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Zhang X, Chen L, Wang X, Wang X, Jia M, Ni S, He W, Zhu S. Changes in maternal age and prevalence of congenital anomalies during the enactment of China's universal two-child policy (2013-2017) in Zhejiang Province, China: An observational study. PLoS Med 2020; 17:e1003047. [PMID: 32092053 PMCID: PMC7039412 DOI: 10.1371/journal.pmed.1003047] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 01/28/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND China implemented a partial two-child policy (2013) followed by a universal two-child policy (2015), replacing the former one-child policy mandated by the government. The changes affect many aspects of China's population as well as maternal and infant health, but their potential impact on birth defects (BDs) remains unknown. In this study, we investigated the associations of these policy changes with BDs in Zhejiang Province, China. METHODS AND FINDINGS We used data from the BD surveillance system in Zhejiang Province, China, which covers 90 hospitals in 30 urban districts and rural counties, capturing one-third of the total births in this province. To fully consider the time interval between conception and delivery, we defined the one-child policy period as data from 2013 (births from October 2012 to September 2013), the partial two-child policy period as data from 2015 (births from October 2014 to September 2015), and the universal two-child policy period as data from 2017 (births from October 2016 to September 2017). Data from 2009 and 2011 were also used to show the changes in the proportion of births to women with advanced maternal age (35 years and older) prior to the policy changes. Main outcome measures were changes in the proportion of mothers with advanced maternal age, prevalence of BDs, rankings of BD subtypes by prevalence, prenatal diagnosis rate, and live birth rate of BDs over time. A total of 1,260,684 births (including live births, early fetal losses, stillbirths, and early neonatal deaths) were included in the analyses. Of these, 644,973 (51.16%) births were to women from urban areas, and 615,711 (48.84%) births were to women from rural areas. In total, 135,543 (10.75%) births were to women with advanced maternal age. The proportion increased by 85.68%, from 8.52% in 2013 to 15.82% in 2017. However, it had remained stable prior to policy changes. Overall, 23,095 BDs were identified over the policy changes (2013-2017). The prevalence of BDs during 2013, 2015, and 2017 was 245.95, 264.86, and 304.36 per 10,000 births, respectively. Trisomy 21 and other chromosomal defects increased in both risk and ranking from 2013 to 2017 (crude odds ratio [95% confidence interval] 2.13 [1.75-2.60], from ranking 10th to 5th, and 3.63 [2.84-4.69], from ranking 16th to 6th, respectively). The prenatal diagnosis rate increased by 3.63 (2.2-5.1) percentage points (P < 0.001), from 31.10% to 34.72%, and identification of BDs occurred 1.88 (1.81-1.95) weeks earlier (P < 0.001). The live birth rate for infants with BDs born before 28 gestational weeks increased from 1.29% to 11.45%. The major limitations of this observational study include an inability to establish causality and the possible existence of unknown confounding factors, some of which could contribute to BDs. CONCLUSIONS In this study, we observed significant increases in maternal age and the prevalence of total and age-related anomalies following China's new two-child policy. Increases in live birth rate for infants with BDs born before 28 gestational weeks suggest that healthcare for very preterm births with BDs may be warranted in the future, as well as updating the definition of perinatal period.
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Affiliation(s)
- Xiaohui Zhang
- Chronic Disease Research Institute, School of Public Health, and Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Nutrition and Food Hygiene, School of Public Health, Zhejiang University, Hangzhou, Zhejiang, China
- Department of Women’s Health, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Lijin Chen
- Chronic Disease Research Institute, School of Public Health, and Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Nutrition and Food Hygiene, School of Public Health, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xuemiao Wang
- Chronic Disease Research Institute, School of Public Health, and Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Nutrition and Food Hygiene, School of Public Health, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaoyan Wang
- Chronic Disease Research Institute, School of Public Health, and Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Nutrition and Food Hygiene, School of Public Health, Zhejiang University, Hangzhou, Zhejiang, China
| | - Menghan Jia
- Chronic Disease Research Institute, School of Public Health, and Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Nutrition and Food Hygiene, School of Public Health, Zhejiang University, Hangzhou, Zhejiang, China
| | - Saili Ni
- Chronic Disease Research Institute, School of Public Health, and Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Nutrition and Food Hygiene, School of Public Health, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wei He
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Shankuan Zhu
- Chronic Disease Research Institute, School of Public Health, and Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Nutrition and Food Hygiene, School of Public Health, Zhejiang University, Hangzhou, Zhejiang, China
- * E-mail:
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Demikova NS, Podolnaya MA, Lapina AS. Prevalence and time trends of neural tube defects in regions of the Russian Federation. ACTA ACUST UNITED AC 2020. [DOI: 10.21508/1027-4065-2019-64-6-30-38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Neural tube defects – a group of severe congenital malformations with a high level of mortality, childhood disability. The average prevalence of these defects is approximately 1 per 1000 births. The main measures to reduce the prevalence of neural tube defects are primary and secondary prevention measures, the effectiveness of which can be determined by congenital malformations monitoring.Research purpose. To determine the prevalence of neural tube defects, as well as trends in their prevalence for 2011 to 2017 in the Russian Federation according to monitoring of congenital malformations.Results. The total prevalence of anencephaly among newborns and fetuses was 4.63 (95% confidence interval - CI 4.40–4.88) per 10000 births, spina bifida – 6.18 (95% CI 5.91–6.46) and encephalocele 1.34 (95% CI 1.21–1.47). At the same time, the prevalence of anencephaly only among live births was 0.11 (95% CI 0.08–0.15) per 10000, spina bifida – 2.24 (95% CI 2.08–2.41) and encephalocele – 0 25 (95% CI 0.20–0.31). The decrease in prevalence of birth defects among live births compared with the total prevalence is provided by a high level of detection of these defects by ultrasound examination during pregnancy with the subsequent elimination of the affected fetuses. The maximum proportion of eliminated fetuses is observed for anencephaly (90.5%), for encephalocele the proportion of aborted fetuses is 77.4% and for spina bifida – 59.3%. Over the 7-year period, the multidirectional prevalence trends were noted: the increasing trend for total prevalence of neural tube defects and the decreasing trend for prevalence of these defects among live-born children.Conclusion. Estimates of the prevalence of neural tube defects in Russian Federation regions are obtained. The dynamics of the studied defects prevalence indicates that the decreasing of neural tube defects prevalence among live births is associated with secondary prevention measures.
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Affiliation(s)
- N. S. Demikova
- Research and Clinical Institute for Pediatrics named after Academician Yu.E. Veltischev of the FSBEI of Higher Education Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation; Medical University of the Ministry of Health of the Russian Federation
| | - M. A. Podolnaya
- Research and Clinical Institute for Pediatrics named after Academician Yu.E. Veltischev of the FSBEI of Higher Education Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation; Medical University of the Ministry of Health of the Russian Federation
| | - A. S. Lapina
- Research and Clinical Institute for Pediatrics named after Academician Yu.E. Veltischev of the FSBEI of Higher Education Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation; Medical University of the Ministry of Health of the Russian Federation
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Chen Z, Xing Y, Yu X, Dou Y, Ma D. Effect of Folic Acid Intake on Infant and Child Allergic Diseases: Systematic Review and Meta-Analysis. Front Pediatr 2020; 8:615406. [PMID: 33537268 PMCID: PMC7848186 DOI: 10.3389/fped.2020.615406] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/14/2020] [Indexed: 11/17/2022] Open
Abstract
Objective: This study aimed to analyze the effect of folic acid supplements on infant and child allergic diseases through systematic review and meta-analysis. Design: PubMed, The Cochrane Library and references of related articles published before January 1, 2020 were searched. Setting: Meta-analysis was used to explore the influence of folic acid on skin allergies (eczema, and atopic dermatitis) and respiratory allergies (asthma, wheezing, and allergic rhinitis). Participants: Data were collected from 15 studies with 244,018 individual participants from five different countries for meta-analysis. Results: Folic acid was confirmed as a risk factor for allergic diseases in infant and child. The risk of allergic diseases dramatically increased when maternal folic acid intake <400 μg/day (RR = 1.050; 95% CI = 1.027-1.073) during pregnancy. Stratified analyses revealed that the association was significant only for respiratory allergy (RR = 1.067; 95% CI = 1.028-1.108) and pregnant women who only used folic acid supplements (RR = 1.070; 95% CI = 1.030-1.112) and that countries without folic acid fortification (RR = 1.046; 95% CI = 1.026-1.067). Conclusions: This study suggested that folic acid intake can be a risk factor for allergic diseases, especially respiratory tract allergies among infants and young children. Furthermore, pregnant women should pay attention to supplementation of folic acid from both folic acid supplements and fortified foods with folic acid during pregnancy.
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Affiliation(s)
- Zekun Chen
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Yan Xing
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Xue Yu
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Yuqi Dou
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Defu Ma
- School of Public Health, Peking University Health Science Center, Beijing, China
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55
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Molloy J, Collier F, Saffery R, Allen KJ, Koplin JJ, Louise Ponsonby A, Tang MLK, Ward AC, Martino D, Burgner D, Carlin JB, Ranganathan S, Symeonedies C, Dwyer T, Vuillermin P. Folate levels in pregnancy and offspring food allergy and eczema. Pediatr Allergy Immunol 2020; 31:38-46. [PMID: 31566807 DOI: 10.1111/pai.13128] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 09/09/2019] [Accepted: 09/16/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND High folate status in pregnancy has been implicated in the increased prevalence of allergic disease, but there are no published data relating directly measured folate status in pregnancy to challenge-proven food allergy among offspring. The study aim was to examine the association between red blood cell (RBC) folate status in trimester three of pregnancy and allergic disease among offspring. METHODS Red blood cell folate levels were measured at 28-32 weeks' gestation in a prospective birth cohort (n = 1074). Food allergy outcomes were assessed in 1-year-old infants by skin prick testing and subsequent food challenge. Eczema was assessed by questionnaire and clinical review. High trimester three RBC folate was defined as greater than (>) 1360 nmol/L. Binomial regression was used to examine associations between trimester three RBC folate and allergic outcomes, adjusting for potential confounders. RESULTS Red blood cell folate levels were measured in 88% (894/1064) of pregnant women. The mean concentration was 1695.6 nmol/L (standard deviation 415.4) with 82% (731/894) >1360 nmol/L. There was no evidence of either linear or non-linear relationships between trimester three RBC folate and allergic outcomes, nor evidence of associations between high RBC folate and food allergy (adjusted risk ratio (aRR) 2.89, 95% CI 0.90-9.35), food sensitization (aRR 1.72, 95% CI 0.85-3.49), or eczema (aRR 0.97, 95% CI 0.67-1.38). CONCLUSION The majority of pregnant women in this study had high RBC folate levels. There was no evidence of associations between trimester three RBC folate and food allergy, food sensitization, or eczema among the offspring, although larger studies are required.
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Affiliation(s)
- John Molloy
- School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia.,Child Health Research Unit, Barwon Health, Geelong, Victoria, Australia.,Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Centre for Food and Allergy Research, Parkville, Victoria, Australia
| | - Fiona Collier
- School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia.,Child Health Research Unit, Barwon Health, Geelong, Victoria, Australia
| | - Richard Saffery
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Katrina J Allen
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Centre for Food and Allergy Research, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Jennifer J Koplin
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Centre for Food and Allergy Research, Parkville, Victoria, Australia.,Centre for Epidemiology and Biostatistics, The University of Melbourne, Carlton, Victoria, Australia
| | - Anne Louise Ponsonby
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Centre for Food and Allergy Research, Parkville, Victoria, Australia
| | - Mimi L K Tang
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Centre for Food and Allergy Research, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Alister C Ward
- School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia
| | - David Martino
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Centre for Food and Allergy Research, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - David Burgner
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - John B Carlin
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Centre for Epidemiology and Biostatistics, The University of Melbourne, Carlton, Victoria, Australia
| | - Sarath Ranganathan
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of Respiratory Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Christos Symeonedies
- Child Health Research Unit, Barwon Health, Geelong, Victoria, Australia.,Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Terence Dwyer
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | | | - Peter Vuillermin
- School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia.,Child Health Research Unit, Barwon Health, Geelong, Victoria, Australia.,Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Centre for Food and Allergy Research, Parkville, Victoria, Australia
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Morris JK, Wellesley DG, Barisic I, Addor MC, Bergman JEH, Braz P, Cavero-Carbonell C, Draper ES, Gatt M, Haeusler M, Klungsoyr K, Kurinczuk JJ, Lelong N, Luyt K, Lynch C, O'Mahony MT, Mokoroa O, Nelen V, Neville AJ, Pierini A, Randrianaivo H, Rankin J, Rissmann A, Rouget F, Schaub B, Tucker DF, Verellen-Dumoulin C, Wiesel A, Zymak-Zakutnia N, Lanzoni M, Garne E. Epidemiology of congenital cerebral anomalies in Europe: a multicentre, population-based EUROCAT study. Arch Dis Child 2019; 104:1181-1187. [PMID: 31243007 DOI: 10.1136/archdischild-2018-316733] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/09/2019] [Accepted: 05/31/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To describe the epidemiology and geographical differences in prevalence of congenital cerebral anomalies in Europe. DESIGN AND SETTING Congenital cerebral anomalies (International Classification of Diseases, 10th Revision code Q04) recorded in 29 population-based EUROCAT registries conducting surveillance of 1.7 million births per annum (29% of all European births). PARTICIPANTS All birth outcomes (live births, fetal deaths from 20 weeks gestation and terminations of pregnancy after prenatal diagnosis of a fetal anomaly (TOPFA)) from 2005 to 2014. MAIN OUTCOME MEASURES Prevalence, proportion of associated non-cerebral anomalies, prenatal detection rate. RESULTS 4927 cases with congenital cerebral anomalies were identified; a prevalence (adjusted for under-reporting) of 9.8 (95% CI: 8.5 to 11.2) per 10 000 births. There was a sixfold difference in prevalence across the registries. Registries with higher proportions of prenatal diagnoses had higher prevalence. Overall, 55% of all cases were liveborn, 3% were fetal deaths and 41% resulted in TOPFA. Forty-eight per cent of all cases were an isolated cerebral anomaly, 25% had associated non-cerebral anomalies and 27% were chromosomal or part of a syndrome (genetic or teratogenic). The prevalence excluding genetic or chromosomal conditions increased by 2.4% per annum (95% CI: 1.3% to 3.5%), with the increases occurring only for congenital malformations of the corpus callosum (3.0% per annum) and 'other reduction deformities of the brain' (2.8% per annum). CONCLUSIONS Only half of the cases were isolated cerebral anomalies. Improved prenatal and postnatal diagnosis may account for the increase in prevalence of congenital cerebral anomalies from 2005 to 2014. However, major differences in prevalence remain between regions.
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Affiliation(s)
- Joan K Morris
- Population Health Research Institute, St George's, University of London, London, UK
| | - Diana G Wellesley
- Department Clinical Genetics, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ingeborg Barisic
- Children's Hospital Zagreb, Centre of Excellence for Reproductive and Regenerative Medicine, Medical School University of Zagreb, Zagreb, Croatia
| | - Marie-Claude Addor
- Department of Mother-Woman-Child, University Hospital Center, Lausanne, Switzerland
| | - Jorieke E H Bergman
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Paula Braz
- Department of Epidemiology, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
| | - Clara Cavero-Carbonell
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, Valencia, Spain
| | | | - Miriam Gatt
- Department of Health Information and Research, National Obstetric Information Systems, Valletta, Malta
| | - Martin Haeusler
- Department of Obstetrics, Medical University of Graz, Graz, Austria
| | - Kari Klungsoyr
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen and Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Natalie Lelong
- Paris Registry of Congenital Malformations, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Biostatistics and Epidemiology, INSERM, Paris, France
| | - Karen Luyt
- Translational Health Sciences, University of Bristol Medical School, Bristol, Bristol, UK
| | - Catherine Lynch
- Department of Public Health, Health Service Executive-South, Kilkenny, Ireland
| | - Mary T O'Mahony
- Department of Public Health, Health Service Executive-South, Cork, Ireland
| | - Olatz Mokoroa
- Public Health Department of Gipuzkoa, Biodonostia Instituto de Investigacion Sanitaria, Donostia-San Sebastian, Spain
| | - Vera Nelen
- Provinciaal Instituut voor Hygiene, Antwerpen, Belgium
| | - Amanda J Neville
- IMER Registry, University of Ferrara and St Anna University Hospital, Ferrara, Italy
| | - Anna Pierini
- Tuscany Registry of Congenital Defects, National Research Council Institute of Clinical Physiology/Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Hanitra Randrianaivo
- Registre des Malformations Congenitales de la Reunion, Saint Pierre, Réunion, France
| | - Judith Rankin
- Institute of Health & Society, Newcastle University, Newcastle, UK
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty Otto-von-Guericke University, Magdeburg, Germany
| | - Florence Rouget
- Brittany Registry of Congenital Anomalies, Univ Rennes, CHU Rennes,Inserm, EHESP, Rennes, France
| | - Bruno Schaub
- Maison de la Femme de la Mère et de l'Enfant, University Hospital of Martinique, Fort-de-France, Martinique
| | - David F Tucker
- Congenital Anomaly Register and Information Service for Wales, Public Health Wales, Swansea, UK
| | | | - Awi Wiesel
- Mainz Model Birth Registry, Center of Child and Adolescence Medicine, University Medical Center, Mainz, Germany
| | | | - Monica Lanzoni
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - Ester Garne
- Paediatric Department, Hospital Lillebaelt, Kolding, Denmark
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Birth Defects After Exposure to Efavirenz-Based Antiretroviral Therapy at Conception/First Trimester of Pregnancy: A Multicohort Analysis. J Acquir Immune Defic Syndr 2019; 80:316-324. [PMID: 30570524 DOI: 10.1097/qai.0000000000001922] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To investigate the association between efavirenz (EFV) use during conception or first trimester (T1) of pregnancy and the occurrence of birth defects. SETTING Seven observational studies of pregnant HIV-positive women across 13 European countries and Thailand. METHODS Individual-level data were pooled on singleton pregnancies included in participating cohorts in 2002-2015. Birth defects were coded according to ICD-10 and the EUROCAT classification. We performed mixed-effects logistic regression models to assess the association between EFV exposure in utero and likelihood of birth defects. RESULTS We included 24,963 live births from 21,093 women. At conception, 30.2% (7537) women were on a non-EFV-based regimen, 4.8% (1200) on EFV, and 65% (16,226) were unexposed to antiretroviral therapy (ART). There were 412 infants with ≥1 birth defect, a prevalence of 1.65% (95% confidence interval: 1.50 to 1.82). Limb/musculoskeletal and congenital heart defects were the most common defects reported. Birth defects were present in 2.4%, 1.6%, and 1.3% of infants exposed to non-EFV, EFV, and unexposed to ART during conception/T1 (P = 0.135), respectively. The association between exposure to ART during conception/T1 and birth defects remained nonsignificant in adjusted analyses, as did exposure to EFV versus non-EFV (adjusted odds ratio 0.61; 95% confidence interval: 0.36 to 1.03, P = 0.067). Among the 21 birth defects in 19 infants on EFV, no neural tube defects were reported. CONCLUSIONS Prevalence of birth defects after exposure to EFV-based compared with non-EFV-based ART in conception/T1 was not statistically different in this multicohort study, and even lower. EFV is at least as safe as other ART drugs currently recommended for antenatal use.
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Kehoe L, Walton J, Hopkins SM, McNulty BA, Nugent AP, Flynn A. Modelling the impact of mandatory folic acid fortification of bread or flour in Ireland on the risk of occurrence of NTD-affected pregnancies in women of childbearing age and on risk of masking vitamin B 12 deficiency in older adults. Eur J Nutr 2019; 59:2631-2639. [PMID: 31646387 DOI: 10.1007/s00394-019-02111-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/04/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE The rate of neural tube defects (NTDs) in Europe has remained similar since the 1990s despite folic acid supplement recommendations (400 µg/day) for women of childbearing age. Mandatory folic acid fortification of staple foods has proved effective for reducing the prevalence of NTDs in over 80 countries. This study estimated the impact of addition of folic acid to bread or flour in the Republic of Ireland on reducing the risk of occurrence of NTD-affected pregnancies and the possible risk of masking (undiagnosed) vitamin B12 deficiency in older adults. METHODS Analyses were based on the Irish National Adult Nutrition Survey (2008-2010). Folic acid fortification was modelled using DaDiet© software. Estimates were made of the increase in average daily folic acid intake in women (18-50 years) and the risk of exceeding the tolerable upper intake level (UL) of 1000 µg for folic acid in adults over 50 years of age. RESULTS The fortification scenarios examined would reduce the risk of NTD-affected pregnancies by 8-32%, corresponding to an increase of 39-152 μg in the mean daily folic acid intake of WCBA. The risk of masking anaemia associated with vitamin B12 deficiency in older adults would be negligible as the probability of exceeding the UL for folic acid, even by a small amount, is very low (≤ 0.2%). CONCLUSIONS These levels of addition of folic acid to bread or flour would effectively reduce the risk of NTDs while allowing safe consumption of folic acid at current levels from other fortified foods and supplements.
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Affiliation(s)
- Laura Kehoe
- School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland.
| | - Janette Walton
- School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland
- Department of Biological Sciences, Cork Institute of Technology, Cork, Republic of Ireland
| | - Sinead M Hopkins
- UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
| | - Breige A McNulty
- UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
| | - Anne P Nugent
- UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
- Institute for Global Food Security, Queens University Belfast, Belfast, Northern Ireland, UK
| | - Albert Flynn
- School of Food and Nutritional Sciences, University College Cork, Cork, Republic of Ireland
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Sacco A, Ushakov F, Thompson D, Peebles D, Pandya P, De Coppi P, Wimalasundera R, Attilakos G, David AL, Deprest J. Fetal surgery for open spina bifida. THE OBSTETRICIAN & GYNAECOLOGIST : THE JOURNAL FOR CONTINUING PROFESSIONAL DEVELOPMENT FROM THE ROYAL COLLEGE OF OBSTETRICIANS & GYNAECOLOGISTS 2019; 21:271-282. [PMID: 31787844 PMCID: PMC6876677 DOI: 10.1111/tog.12603] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/15/2019] [Indexed: 11/30/2022]
Abstract
KEY CONTENT Spina bifida is a congenital neurological condition with lifelong physical and mental effects.Open fetal repair of the spinal lesion has been shown to improve hindbrain herniation, ventriculoperitoneal shunting, independent mobility and bladder outcomes for the child and, despite an increased risk of prematurity, does not seem to increase the risk of neurodevelopmental impairment.Open fetal surgery is associated with maternal morbidity.Surgery at our institution is offered and performed according to internationally agreed criteria and protocols.Further evidence regarding long-term outcomes, fetoscopic repair and alternative techniques is awaited. LEARNING OBJECTIVES To understand the clinical effects, potential prevention and prenatal diagnosis of spina bifida.To understand the rationale and evidence supporting the benefits and risks of fetal repair of open spina bifida.To understand the criteria defining those who are likely to benefit from fetal surgery. ETHICAL ISSUES The concept of the fetus as a patient, and issues surrounding fetal death or the need for resuscitation during fetal surgery.The associated maternal morbidity in a procedure performed solely for the benefit of the fetus/child.The financial implications of new surgical treatments.
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Affiliation(s)
- Adalina Sacco
- Clinical Research Fellow, Fetal Medicine UnitElizabeth Garrett Anderson WingUniversity College London Hospital NHS Foundation Trust235 Euston RoadLondonNW1 2BUUK
| | - Fred Ushakov
- Specialist in Fetal Medicine, Fetal Medicine UnitElizabeth Garrett Anderson WingUniversity College London Hospital NHS Foundation Trust235 Euston RoadLondonNW1 2BUUK
| | - Dominic Thompson
- Consultant in Paediatric NeurosurgerySpecialist Neonatal and Paediatric SurgeryGreat Ormond Street Hospital for Children NHS Foundation TrustGreat Ormond StreetLondonWC1N 3JHUK
| | - Donald Peebles
- Professor of Fetal Medicine, Fetal Medicine UnitElizabeth Garrett Anderson WingUniversity College London Hospital NHS Foundation Trust235 Euston RoadLondonNW1 2BUUK
| | - Pranav Pandya
- Consultant in Fetal Medicine, Fetal Medicine UnitElizabeth Garrett Anderson WingUniversity College London Hospital NHS Foundation Trust235 Euston RoadLondonNW1 2BUUK
| | - Paolo De Coppi
- Professor of Paediatric SurgerySpecialist Neonatal and Paediatric SurgeryGreat Ormond Street Hospital for Children NHS Foundation TrustGreat Ormond StreetLondonWC1N 3JHUK
| | - Ruwan Wimalasundera
- Consultant in Fetal Medicine, Fetal Medicine UnitElizabeth Garrett Anderson WingUniversity College London Hospital NHS Foundation Trust235 Euston RoadLondonNW1 2BUUK
| | - George Attilakos
- Consultant in Fetal Medicine, Fetal Medicine UnitElizabeth Garrett Anderson WingUniversity College London Hospital NHS Foundation Trust235 Euston RoadLondonNW1 2BUUK
| | - Anna Louise David
- Professor of Fetal Medicine, Fetal Medicine UnitElizabeth Garrett Anderson WingUniversity College London Hospital NHS Foundation Trust235 Euston RoadLondonNW1 2BUUK
| | - Jan Deprest
- Professor of Fetal Medicine, Fetal Medicine UnitElizabeth Garrett Anderson WingUniversity College London Hospital NHS Foundation Trust235 Euston RoadLondonNW1 2BUUK
- Professor of Obstetrics and GynaecologyClinical Department Obstetrics and GynaecologyUniversity Hospitals LeuvenLeuvenBelgium
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Preconception Folic Acid Supplement Use in Immigrant Women (1999-2016). Nutrients 2019; 11:nu11102300. [PMID: 31569600 PMCID: PMC6836227 DOI: 10.3390/nu11102300] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 09/20/2019] [Accepted: 09/24/2019] [Indexed: 12/11/2022] Open
Abstract
This study examines how preconception folic acid supplement use varied in immigrant women compared with non-immigrant women. We analyzed national population-based data from Norway from 1999–2016, including 1,055,886 pregnancies, of which 202,234 and 7,965 were to 1st and 2nd generation immigrant women, respectively. Folic acid supplement use was examined in relation to generational immigrant category, maternal country of birth, and length of residence. Folic acid supplement use was lower overall in 1st and 2nd generation immigrant women (21% and 26%, respectively) compared with Norwegian-born women (29%). The lowest use among 1st generation immigrant women was seen in those from Eritrea, Ethiopia, Morocco, and Somalia (around 10%). The highest use was seen in immigrant women from the United States, the Netherlands, Denmark, and Iceland (>30%). Folic acid supplement use increased with increasing length of residence in immigrant women from most countries, but the overall prevalence was lower compared with Norwegian-born women even after 20 years of residence (adjusted odds ratio: 0.63; 95% confidence interval: 0.60–0.67). This study suggests that immigrant women from a number of countries are less likely to use preconception folic acid supplements than non-immigrant women, even many years after settlement.
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Mullaney L, Cawley S, Kennedy R, O'Higgins AC, McCartney D, Turner MJ. Maternal nutrient intakes from food and drinks consumed in early pregnancy in Ireland. J Public Health (Oxf) 2019; 39:754-762. [PMID: 27679659 DOI: 10.1093/pubmed/fdw106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 08/15/2016] [Indexed: 11/13/2022] Open
Abstract
Background The aim of this observational study was to measure food, macronutrient and micronutrient intakes of women presenting for antenatal care and assess compliance with current nutritional recommendations. Methods Women were recruited in the first trimester of pregnancy. Maternal weight and height were measured and body mass index (BMI) calculated. Body composition was measured using bioelectrical impedance analysis. Maternal energy and nutrient intakes were estimated using a validated Willett Food Frequency Questionnaire and misreporting of energy intakes (EI) determined. Results Plausible EIs were reported in 402 women. Mean age, weight and BMI were 30.8 years, 67.1 kg and 24.6 kg/m2 respectively. Median EIs were 2111 kcal, and median protein, carbohydrate and fat intakes were 17.3, 48.1 and 36.2 g/MJ/day, respectively. More than 90% of women exceeded the recommended daily allowance for saturated fat. Nearly all of the women (99%) did not meet estimated average requirements (EAR) for vitamin D. One in three women failed to achieve a dietary folate intake of 400 µg/day. Over one in five women failed to meet the EAR for iron, and 14% failed to achieve the EAR for calcium. Conclusions Our findings highlight concerning deficits in nutrient intakes among women and will help guide professional dietary advice to women attending for future obstetric care in Ireland.
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Affiliation(s)
- Laura Mullaney
- School of Biological Sciences, Dublin Institute of Technology, Dublin 8, Republic of Ireland
| | - Shona Cawley
- School of Biological Sciences, Dublin Institute of Technology, Dublin 8, Republic of Ireland
| | - Rachel Kennedy
- School of Biological Sciences, Dublin Institute of Technology, Dublin 8, Republic of Ireland
| | - Amy C O'Higgins
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Republic of Ireland
| | - Daniel McCartney
- School of Biological Sciences, Dublin Institute of Technology, Dublin 8, Republic of Ireland
| | - Michael J Turner
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Republic of Ireland
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Kancherla V, Black RE. Historical perspective on folic acid and challenges in estimating global prevalence of neural tube defects. Ann N Y Acad Sci 2019. [PMID: 29532513 DOI: 10.1111/nyas.13601] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Neural tube defects (NTD) are major congenital malformations affecting births worldwide. NTD are associated with life-long disability, significant medical care costs, and child mortality. Their prevalence varies worldwide. We conducted a review of published literature and surveillance systems to examine challenges in estimating an overall global prevalence estimate for NTD. Our review showed that most low- and middle-income countries do not track NTD and indicate a high prevalence of these malformations where data are available. Challenges in global NTD prevalence estimation include (1) quality of surveillance methods, (2) existing risk factors (including geographic or socioeconomic factors, availability and use of folic acid, and racial-ethnic and genetic factors), and (3) limitations in education and access to care. We recommend population-based surveillance systems tracking all pregnancy outcomes and major risk factors. Countries should invest in sustainable, multisource surveillance systems, in parallel to folic acid interventions, for gaining a more accurate knowledge of global prevalence of NTD than we currently have. Such efforts will assist in both global prevention of NTD and periodic evaluation of folic acid interventions for NTD reduction. Global NTD prevalence data can drive political will and accelerate the implementation and evaluation of NTD prevention programs.
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Affiliation(s)
- Vijaya Kancherla
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, Georgia
| | - Robert E Black
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland
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Turner MJ. Neural Tube Defects and Folic Acid Food Fortification in Europe. Am J Public Health 2019; 108:601-602. [PMID: 29617604 DOI: 10.2105/ajph.2018.304389] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Michael J Turner
- Michael J. Turner is with the University College Dublin Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland
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Abstract
A randomized trial demonstrated that fetal spina bifida (SB) repair is safe and effective yet invasive. New less invasive techniques are proposed but are not supported by adequate experimental studies. A validated animal model is needed to bridge the translational gap to the clinic and should mimic the human condition. Introducing a standardized method, we comprehensively and reliably characterize the SB phenotype in two lamb surgical models with and without myelotomy as compared to normal lambs. Hindbrain herniation measured on brain magnetic resonance imaging (MRI) was the primary outcome. Secondary outcomes included gross examination with cerebrospinal fluid (CSF) leakage test, neurological examination with locomotor assessment, whole-body MRI, motor and somatosensory evoked potentials; brain, spinal cord, hindlimb muscles, bladder and rectum histology and/or immunohistochemistry. We show that the myelotomy model best phenocopies the anatomy, etiopathophysiology and symptomatology of non-cystic SB. This encompasses hindbrain herniation, ventriculomegaly, posterior fossa anomalies, loss of brain neurons; lumbar CSF leakage, hindlimb somatosensory-motor deficit with absence of motor and somatosensory evoked potentials due to loss of spinal cord neurons, astroglial cells and myelin; urinary incontinence. This model obtains the highest validity score for SB animal models and is adequate to assess the efficacy of novel fetal therapies.
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Addressing optimal folate and related B-vitamin status through the lifecycle: health impacts and challenges. Proc Nutr Soc 2019; 78:449-462. [DOI: 10.1017/s0029665119000661] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The functional effects of folate within C1 metabolism involve interrelationships with vitamin B12, vitamin B6 and riboflavin, and related gene–nutrient interactions. These B vitamins have important roles throughout life, from pregnancy, through childhood, to middle and older age. Achieving optimal nutritional status for preventing folate-related disease is challenging, however, primarily as a result of the poor stability and incomplete bioavailability of folate from natural food sources when compared with the synthetic vitamin form, folic acid. Thus, in European countries, measures to prevent neural tube defects (NTD) have been largely ineffective because of the generally poor compliance of women with folic acid supplementation as recommended before and in early pregnancy. In contrast, countries worldwide with mandatory folic acid fortification policies have experienced marked reductions in NTD. Low vitamin B12 status is associated with increased risk of cognitive dysfunction, CVD and osteoporosis. Achieving optimal B12 status can be problematic for older people, however, primarily owing to food-bound B12 malabsorption which leads to sub-clinical deficiency even with high dietary B12 intakes. Optimising B-vitamin intake may be particularly important for sub-populations with impaired folate metabolism owing to genetic characteristics, most notably the 677C→T variant in the gene encoding the enzyme methylenetetrahydrofolate reductase (MTHFR). This common folate polymorphism is linked with several adverse health outcomes, including stroke, however, recent evidence has identified its novel interaction with riboflavin (the MTHFR cofactor) in relation to blood pressure and risk of developing hypertension. This review addresses why and how the optimal status of folate-related B vitamins should be achieved through the lifecycle.
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66
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Sher J, Frank JW, Doi L, de Caestecker L. Failures in reproductive health policy: overcoming the consequences and causes of inaction. J Public Health (Oxf) 2019; 41:e209-e215. [PMID: 30137572 PMCID: PMC6636687 DOI: 10.1093/pubmed/fdy131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/29/2018] [Indexed: 12/13/2022] Open
Abstract
It is assumed that long-established research findings and internationally accepted evidence should, and will, be translated into policy and practice. Knowledge about what prevents harm and promotes health has, in fact, guided and resulted in numerous beneficial public health actions. However, such is not always the case. The authors examine three notable, and unwelcome, exceptions in the UK-all in the field of reproductive health and all focused on the period prior to pregnancy. The three examples of counterproductive inaction discussed are: fortifying flour with Vitamin B9 (folic acid); preventing foetal alcohol spectrum disorders; and reducing risks and better regulating a highly teratogenic medication (valproate). The adverse consequences, as well as the causes, of inaction are analysed for each example. Reasons for optimism, and recommendations for overcoming inaction, are also offered, in particular, greater priority should be accorded to preconception health, education and care.
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Affiliation(s)
- Jonathan Sher
- Independent Consultant on Preconception Health, Edinburgh, UK
| | - John W Frank
- Scottish Collaboration for Public Health Research and Policy, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Lawrence Doi
- Scottish Collaboration for Public Health Research and Policy, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
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67
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Affiliation(s)
- Takashi Yorifuji
- Department of Human Ecology, Graduate School of Environmental and Life Science, Okayama University
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68
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Bakketun T, Gilhus NE, Rekand T. Myelomeningocele: need for long-time complex follow-up-an observational study. SCOLIOSIS AND SPINAL DISORDERS 2019; 14:3. [PMID: 30891504 PMCID: PMC6407184 DOI: 10.1186/s13013-019-0177-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 02/25/2019] [Indexed: 12/26/2022]
Abstract
Background Myelomeningocele (MMC) is a congenital disorder that causes a variety of acute as well as late complications. Numerous health problems in adulthood have been described by the persons with MMC but not studied in clinical setting. This study gives implications for organization of the follow-up in adulthood. Objectives To investigate the need for follow-up from different medical specialists as well as the need for organized focused rehabilitation among adults with MMC. Methods Retrospective cohort study on adults with MMC including multiple departments in a university hospital in Norway. The number and cause of specialized hospital consultations were recorded for every patient. Correlation between childhood health condition related to MMC and the need for specialized consultations in adulthood as well as correlations between number of consultations and anatomical level of MMC, age, and observation time was performed for the whole group. Results In total, 38 patients had 672 consultations related to MMC. The most frequent departments were neurology, neurosurgery, urology, gastroenterology, and orthopedics. Most consultations were planned. Complexity of MMC-related health condition correlated to number of specialist consultations (rho = 0.420, p = 0.009). Anatomical level of MMC, age, and length of observation time did not correlate with consultations. Pain and shunt failure were the most common reasons for consultations. Conclusions Persons with MMC have a need for continuous, life-long multispecialized follow-up and rehabilitation. This is crucial for optimal function, satisfaction with life, and for long-term survival. Systematic follow-up together with rehabilitation will optimize health service.
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Affiliation(s)
- Thomas Bakketun
- 1Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Nils Erik Gilhus
- 1Department of Clinical Medicine, University of Bergen, Bergen, Norway.,2Department of Neurology, Haukeland University Hospital, Postbox 1400, 5020 Bergen, Norway
| | - Tiina Rekand
- 2Department of Neurology, Haukeland University Hospital, Postbox 1400, 5020 Bergen, Norway.,3Institute for Clinical Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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69
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Liu S, Evans J, MacFarlane AJ, Ananth CV, Little J, Kramer MS, Joseph KS. Association of maternal risk factors with the recent rise of neural tube defects in Canada. Paediatr Perinat Epidemiol 2019; 33:145-153. [PMID: 30920008 DOI: 10.1111/ppe.12543] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/17/2018] [Accepted: 01/20/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND We sought to assess the recent trend in NTD prevalence at birth in the post-folic acid food fortification era and to identify the maternal risk factors associated with that trend. METHODS We carried out a population-based study of all livebirths and stillbirths (including late pregnancy terminations) delivered in hospitals in Canada (excluding Quebec) from 2004 to 2015 (n = 3 439 330). We examined NTD birth prevalence by year, multiple pregnancy, maternal age, parity, pregestational diabetes, chronic illness, and problematic substance use. Poisson regression was used to quantify the association between spina bifida and cranial defects and maternal characteristics and other risk factors. RESULTS We identified 1517 non-chromosomal NTDs, yielding a birth prevalence of 4.4 per 10 000 total births. NTD prevalence rose from 3.6 in 2004 to 4.6 per 10 000 in 2015 (Ptrend = 0.03). Among NTD subtypes, only spina bifida showed a temporal increase (Ptrend = 0.03). Birth prevalence of spina bifida was higher among younger mothers, those with type 2 diabetes (rate ratio (RR) 3.74, 95% confidence interval (CI) 2.21, 6.35), chronic illness (RR 3.16, 95% CI 1.97, 5.07), and problematic substance use (RR 1.88, 95% CI 1.31, 2.71). Adjusting for risk factors attenuated the significant temporal trend in spina bifida (unadjusted average annual prevalence ratio (aAAPR) 1.016, 95% CI 1.001, 1.032; adjusted AAPR 1.014, 95% CI 0.998, 1.029). CONCLUSIONS Increases in the frequency of maternal risk factors such as pregestational diabetes mellitus, substance use, and chronic illness may be partly responsible for the recent rise in NTDs, particularly spina bifida.
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Affiliation(s)
- Shiliang Liu
- Maternal, Child and Youth Health Division, Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Jane Evans
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amanda J MacFarlane
- Nutrition Research Division, Bureau of Nutritional Sciences, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - Cande V Ananth
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Julian Little
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Michael S Kramer
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - K S Joseph
- Department of Obstetrics and Gynaecology and the School of Population and Public Health, University of British Columbia and the Children's and Women's Hospital of British Columbia, Vancouver, British Columbia, Canada
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Clare CE, Brassington AH, Kwong WY, Sinclair KD. One-Carbon Metabolism: Linking Nutritional Biochemistry to Epigenetic Programming of Long-Term Development. Annu Rev Anim Biosci 2019; 7:263-287. [DOI: 10.1146/annurev-animal-020518-115206] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
One-carbon (1C) metabolism comprises a series of interlinking metabolic pathways that include the methionine and folate cycles that are central to cellular function, providing 1C units (methyl groups) for the synthesis of DNA, polyamines, amino acids, creatine, and phospholipids. S-adenosylmethionine is a potent aminopropyl and methyl donor within these cycles and serves as the principal substrate for methylation of DNA, associated proteins, and RNA. We propose that 1C metabolism functions as a key biochemical conduit between parental environment and epigenetic regulation of early development and that interindividual and ethnic variability in epigenetic-gene regulation arises because of genetic variants within 1C genes, associated epigenetic regulators, and differentially methylated target DNA sequences. We present evidence to support these propositions, drawing upon studies undertaken in humans and animals. We conclude that future studies should assess the epigenetic effects of cumulative (multigenerational) dietary imbalances contemporaneously in both parents, as this better represents the human experience.
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Affiliation(s)
- Constance E. Clare
- School of Biosciences, University of Nottingham, Sutton Bonington, Leicestershire LE12 5RD, United Kingdom
| | - Amey H. Brassington
- School of Biosciences, University of Nottingham, Sutton Bonington, Leicestershire LE12 5RD, United Kingdom
| | - Wing Yee Kwong
- School of Biosciences, University of Nottingham, Sutton Bonington, Leicestershire LE12 5RD, United Kingdom
| | - Kevin D. Sinclair
- School of Biosciences, University of Nottingham, Sutton Bonington, Leicestershire LE12 5RD, United Kingdom
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71
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Abstract
Objective: Neural tube defects (NTDs) are congenital disorders that significantly increase the risk of death and disability in the 1st year of life. The aim of this study was to retrospectively evaluate the patients admitted to our neonatal intensive care unit because of NTD. Materials and Methods: We retrospectively examined the demographic features, familial risk factors, physical examination and radiological findings, and accompanying diseases of 69 patients with NTD. Results: Of the 69 patients hospitalized in a 5-year period, 38 were female and 31 were male. The median birth weight was 3150 g and the median delivery week was 38 weeks. Forty-nine of the patients (71%) had meningomyelocele, 11 patients (16%) had encephalocele, and nine patients (13%) had meningocele. Forty-five of the patients (65.2%) had Arnold–Chiari type 2 malformation. Twenty-five percent of the mothers had a history of periconceptional use of folic acid. The median time of making a diagnosis of NTD by prenatal ultrasonography was 20 (16–24) weeks. Thirty-nine of the patients (56.5%) had other organ disorders, some with multiple systemic disorders. Conclusion: The use of periconceptional folic acid in mothers and a decision for termination in selected cases may be effective in reducing the frequency of NTD.
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Affiliation(s)
- Ali Haydar Turhan
- Department of Pediatrics, Division of Neonatology, University of Baskent School of Medicine, Istanbul, Turkey
| | - Semra Isik
- Department of Neurosurgery, University of Baskent School of Medicine, Istanbul, Turkey
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Aertsen M, Verduyckt J, De Keyzer F, Vercauteren T, Van Calenbergh F, De Catte L, Dymarkowski S, Demaerel P, Deprest J. Reliability of MR Imaging-Based Posterior Fossa and Brain Stem Measurements in Open Spinal Dysraphism in the Era of Fetal Surgery. AJNR Am J Neuroradiol 2018; 40:191-198. [PMID: 30591508 DOI: 10.3174/ajnr.a5930] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 10/06/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Fetal MR imaging is part of the comprehensive prenatal assessment of fetuses with open spinal dysraphism. We aimed to assess the reliability of brain stem and posterior fossa measurements; use the reliable measurements to characterize fetuses with open spinal dysraphism versus what can be observed in healthy age-matched controls; and document changes in those within 1 week after prenatal repair. MATERIALS AND METHODS Retrospective evaluation of 349 MR imaging examinations took place, including 274 in controls and 52 in fetuses with open spinal dysraphism, of whom 23 underwent prenatal repair and had additional early postoperative MR images. We evaluated measurements of the brain stem and the posterior fossa and the ventricular width in all populations for their reliability and differences between the groups. RESULTS The transverse cerebellar diameter, cerebellar herniation level, clivus-supraocciput angle, transverse diameter of the posterior fossa, posterior fossa area, and ventricular width showed an acceptable intra- and interobserver reliability (intraclass correlation coefficient > 0.5). In fetuses with open spinal dysraphism, these measurements were significantly different from those of healthy fetuses (all with P < .0001). Furthermore, they also changed significantly (P value range = .01 to < .0001) within 1 week after the fetal operation with an evolution toward normal, most evident for the clivus-supraocciput angle (65.9 ± 12.5°; 76.6 ± 10.9; P < .0001) and cerebellar herniation level (-9.9 ± 4.2 mm; -0.7 ± 5.2; P < .0001). CONCLUSIONS In fetuses with open spinal dysraphism, brain stem measurements varied substantially between observers. However, measurements characterizing the posterior fossa could be reliably assessed and were significantly different from normal. Following a fetal operation, these deviations from normal values changed significantly within 1 week.
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Affiliation(s)
- M Aertsen
- From the Department of Imaging and Pathology (M.A., J.V., F.D.K., S.D., P.D.), Clinical Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - J Verduyckt
- From the Department of Imaging and Pathology (M.A., J.V., F.D.K., S.D., P.D.), Clinical Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - F De Keyzer
- From the Department of Imaging and Pathology (M.A., J.V., F.D.K., S.D., P.D.), Clinical Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - T Vercauteren
- School of Biomedical Engineering and Imaging Sciences (T.V.), King's College, London
| | - F Van Calenbergh
- Department of Neurosurgery (F.V.C.), University Hospitals Leuven, Leuven, Belgium
| | - L De Catte
- Academic Department of Development and Regeneration, Cluster Woman and Child (L.D.C., J.D.), Group Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - S Dymarkowski
- From the Department of Imaging and Pathology (M.A., J.V., F.D.K., S.D., P.D.), Clinical Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - P Demaerel
- From the Department of Imaging and Pathology (M.A., J.V., F.D.K., S.D., P.D.), Clinical Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - J Deprest
- Academic Department of Development and Regeneration, Cluster Woman and Child (L.D.C., J.D.), Group Biomedical Sciences, KU Leuven, Leuven, Belgium.,Institute for Women's Health, University College London, (J.D.), London, UK
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73
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Lowry RB, Bedard T, MacFarlane AJ, Crawford S, Sibbald B, Agborsangaya BC. Prevalence rates of spina bifida in Alberta, Canada: 2001–2015. Can we achieve more prevention? Birth Defects Res 2018; 111:151-158. [DOI: 10.1002/bdr2.1438] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 10/30/2018] [Accepted: 11/17/2018] [Indexed: 12/14/2022]
Affiliation(s)
- R. Brian Lowry
- Alberta Congenital Anomalies Surveillance System, Clinical Genetics, Alberta Health Services Calgary Alberta Canada
- Departments of Pediatrics and Medical GeneticsUniversity of Calgary and Alberta Children's Hospital Calgary Alberta Canada
- Alberta Children's Hospital Research Institute Calgary Alberta Canada
| | - Tanya Bedard
- Alberta Congenital Anomalies Surveillance System, Clinical Genetics, Alberta Health Services Calgary Alberta Canada
| | | | - Susan Crawford
- Alberta Perinatal Health Program, Alberta Health Services Calgary Alberta Canada
| | - Barbara Sibbald
- Alberta Congenital Anomalies Surveillance System, Clinical Genetics, Alberta Health Services Calgary Alberta Canada
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74
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Monier I, Lelong N, Ancel PY, Benachi A, Khoshnood B, Zeitlin J, Blondel B. Indications leading to termination of pregnancy between 22 +0 and 31 +6 weeks of gestational age in France: A population-based cohort study. Eur J Obstet Gynecol Reprod Biol 2018; 233:12-18. [PMID: 30544027 DOI: 10.1016/j.ejogrb.2018.11.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/22/2018] [Accepted: 11/26/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To estimate the prevalence and indications of terminations of pregnancy (TOP) between 22+0 and 31+6 weeks of gestational age in France and to examine the characteristics of women by indication of TOP. STUDY DESIGN From the EPIPAGE 2 population-based cohort study of preterm births in France in 2011, we selected 5009 singleton live births, stillbirths and TOP that occurred between 22 and 31 weeks. We estimated the proportion of TOP by gestational age. We then classified terminations by indications into 4 categories: fetal anomalies (TOPFA), preterm premature rupture of the membranes (PPROM), maternal conditions and fetal growth restriction (FGR). We also classified TOPFA by type of anomaly. Maternal characteristics were compared between TOPFA and TOP for maternal or fetal conditions without congenital anomaly. RESULTS 23.1% of all births and 54.3% of stillbirths were terminations. The proportion of terminations was 36.9% of all births at 22 weeks, 50.2% at 24 weeks and <10% at 30-31 weeks. 85.8% of terminations were for fetal anomaly, 4.4% for PPROM, 6.1% for maternal complications and 3.7% for severe FGR. Compared to women with a TOPFA, those with a termination for maternal or fetal conditions were more often nulliparous, single, African, obese, smokers and covered by non-standard insurance for women in socially deprived circumstances. CONCLUSION In France, there is a high proportion of TOP of which 14% are for indications other than congenital anomalies. Because rates of terminations have an impact on very preterm birth and perinatal mortality rates, studies on pregnancy outcome should report all terminations, not only those for congenital anomalies.
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Affiliation(s)
- Isabelle Monier
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France; Antoine Beclere Maternity Unit, Department of Obstetrics and Gynaecology, University Paris Sud, AP-HP, Paris, France.
| | - Nathalie Lelong
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
| | - Pierre-Yves Ancel
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
| | - Alexandra Benachi
- Antoine Beclere Maternity Unit, Department of Obstetrics and Gynaecology, University Paris Sud, AP-HP, Paris, France
| | - Babak Khoshnood
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
| | - Jennifer Zeitlin
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
| | - Béatrice Blondel
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
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75
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Avagliano L, Massa V, George TM, Qureshy S, Bulfamante GP, Finnell RH. Overview on neural tube defects: From development to physical characteristics. Birth Defects Res 2018; 111:1455-1467. [PMID: 30421543 DOI: 10.1002/bdr2.1380] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 07/29/2018] [Indexed: 12/18/2022]
Abstract
Neural tube defects (NTDs) are the second most common congenital malformations in humans affecting the development of the central nervous system. Although NTD pathogenesis has not yet been fully elucidated, many risk factors, both genetic and environmental, have been extensively reported. Classically divided in two main sub-groups (open and closed defects) NTDs present extremely variable prognosis mainly depending on the site of the lesion. Herein, we review the literature on the histological and pathological features, epidemiology, prenatal diagnosis, and prognosis, based on the type of defect, with the aim of providing important information based on NTDs classification for clinicians and scientists.
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Affiliation(s)
- Laura Avagliano
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Valentina Massa
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Timothy M George
- Pediatric Neurosurgery, Dell Children's Medical Center, Department of Neurosurgery, The University of Texas at Austin Dell Medical School, Austin, Texas
| | - Sarah Qureshy
- Department of Pediatrics, The University of Texas at Austin Dell Medical School, Austin, Texas
| | | | - Richard H Finnell
- Department of Pediatrics, The University of Texas at Austin Dell Medical School, Austin, Texas.,Center for Precision Environmental Health, Department of Molecular and Cellular Biology and Medicine, Baylor College of Medicine, Houston, Texas
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76
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Joyeux L, Danzer E, Flake AW, Deprest J. Fetal surgery for spina bifida aperta. Arch Dis Child Fetal Neonatal Ed 2018; 103:F589-F595. [PMID: 30006470 DOI: 10.1136/archdischild-2018-315143] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 06/20/2018] [Accepted: 06/21/2018] [Indexed: 11/04/2022]
Abstract
Spina bifida aperta (SBA) is one of the most common congenital malformations. It can cause severe lifelong physical and neurodevelopmental disabilities. Experimental and clinical studies have shown that the neurological deficits associated with SBA are not simply caused by incomplete neurulation at the level of the lesion. Additional damage is caused by prolonged exposure of the spinal cord and nerves to the intrauterine environment and a suction gradient due to cerebrospinal fluid leakage, leading to progressive downward displacement of the hindbrain. This natural history can be reversed by prenatal repair. A randomised controlled trial demonstrated that mid-gestational maternal-fetal surgery for SBA decreases the need for ventriculoperitoneal shunting and hindbrain herniation at 12 months and improves neurological motor function at 30 months of age. This came at the price of maternal and fetal risks, the most relevant ones being increased prematurity and a persistent uterine corporeal scar. Recently minimally invasive fetal approaches have been introduced clinically yet they lack extensive experimental or clinical trials. We aim to provide clinicians with the essential information necessary to counsel SBA parents as the basis for considering referral of selected patients to expert fetal surgery centres. We review the reported clinical outcomes and discuss recent developments of potentially less invasive fetal SBA approaches.
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Affiliation(s)
- Luc Joyeux
- Academic Department Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium.,Center for Surgical Technologies, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
| | - Enrico Danzer
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Surgery, Children's Center for Fetal Research, Abramson Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Alan W Flake
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Surgery, Children's Center for Fetal Research, Abramson Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jan Deprest
- Academic Department Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium.,Center for Surgical Technologies, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium.,Division Woman and Child, Fetal Medicine Unit, Clinical Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Leuven, Belgium.,Institute of Women's Health, University College London Hospitals, London, UK
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77
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Blencowe H, Moorthie S, Darlison MW, Gibbons S, Modell B. Methods to estimate access to care and the effect of interventions on the outcomes of congenital disorders. J Community Genet 2018; 9:363-376. [PMID: 29549604 PMCID: PMC6167260 DOI: 10.1007/s12687-018-0359-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 02/15/2018] [Indexed: 12/11/2022] Open
Abstract
In the absence of intervention, early-onset congenital disorders lead to pregnancy loss, early death, or disability. Currently, lack of epidemiological data from many settings limits the understanding of the burden of these conditions, thus impeding health planning, policy-making, and commensurate resource allocation. The Modell Global Database of Congenital Disorders (MGDb) seeks to meet this need by combining general biological principles with observational and demographic data, to generate estimates of the burden of congenital disorders. A range of interventions along the life course can modify adverse outcomes associated with congenital disorders. Hence, access to and quality of services available for the prevention and care of congenital disorders affects both their birth prevalence and the outcomes for affected individuals. Information on this is therefore important to enable burden estimates for settings with limited observational data, but is lacking from many settings. This paper, the third in this special issue on methods used in the MGDb for estimating the global burden of congenital disorders, describes key interventions that impact on outcomes of congenital disorders and methods used to estimate their coverage where empirical data are not available.
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Affiliation(s)
- Hannah Blencowe
- Centre for Maternal, Adolescent, Reproductive, and Child Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Matthew W Darlison
- Centre for Health Informatics and Multiprofessional Education (CHIME), University College London, London, UK.
| | - Stephen Gibbons
- Department of Geography and Environment, London School of Economics, London, UK
| | - Bernadette Modell
- Centre for Health Informatics and Multiprofessional Education (CHIME), University College London, London, UK
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78
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Moorthie S, Blencowe H, Darlison MW, Lawn J, Morris JK, Modell B, Bittles AH, Blencowe H, Christianson A, Cousens S, Darlison MW, Gibbons S, Hamamy H, Khoshnood B, Howson CP, Lawn J, Mastroiacovo P, Modell B, Moorthie S, Morris JK, Mossey PA, Neville AJ, Petrou M, Povey S, Rankin J, Schuler-Faccini L, Wren C, Yunnis KA. Estimating the birth prevalence and pregnancy outcomes of congenital malformations worldwide. J Community Genet 2018; 9:387-396. [PMID: 30218347 PMCID: PMC6167261 DOI: 10.1007/s12687-018-0384-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 08/29/2018] [Indexed: 12/22/2022] Open
Abstract
Congenital anomaly registries have two main surveillance aims: firstly to define baseline epidemiology of important congenital anomalies to facilitate programme, policy and resource planning, and secondly to identify clusters of cases and any other epidemiological changes that could give early warning of environmental or infectious hazards. However, setting up a sustainable registry and surveillance system is resource-intensive requiring national infrastructure for recording all cases and diagnostic facilities to identify those malformations that that are not externally visible. Consequently, not all countries have yet established robust surveillance systems. For these countries, methods are needed to generate estimates of prevalence of these disorders which can act as a starting point for assessing disease burden and service implications. Here, we describe how registry data from high-income settings can be used for generating reference rates that can be used as provisional estimates for countries with little or no observational data on non-syndromic congenital malformations.
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Affiliation(s)
| | - Hannah Blencowe
- Centre for Maternal, Adolescent, Reproductive, and Child Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew W Darlison
- Centre for Health Informatics and Multiprofessional Education (CHIME), University College London, London, UK.
| | - Joy Lawn
- Centre for Maternal, Adolescent, Reproductive, and Child Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Joan K Morris
- Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Bernadette Modell
- Centre for Health Informatics and Multiprofessional Education (CHIME), University College London, London, UK
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79
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Mills JL, Dimopoulos A, Bailey RL. What is standing in the way of complete prevention of folate preventable neural tube defects? ACTA ACUST UNITED AC 2018; 106:517-9. [PMID: 27418028 DOI: 10.1002/bdra.23518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 04/07/2016] [Indexed: 01/21/2023]
Affiliation(s)
- James L Mills
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Aggeliki Dimopoulos
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Regan L Bailey
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana
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80
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van Gool JD, Hirche H, Lax H, De Schaepdrijver L. Folic acid and primary prevention of neural tube defects: A review. Reprod Toxicol 2018; 80:73-84. [DOI: 10.1016/j.reprotox.2018.05.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/03/2018] [Accepted: 05/14/2018] [Indexed: 12/31/2022]
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81
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Garcia R, Ali N, Griffiths M, Randhawa G. Understanding the consumption of folic acid during preconception, among Pakistani, Bangladeshi and white British mothers in Luton, UK: a qualitative study. BMC Pregnancy Childbirth 2018; 18:234. [PMID: 29902973 PMCID: PMC6003022 DOI: 10.1186/s12884-018-1884-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 06/05/2018] [Indexed: 01/28/2023] Open
Abstract
Background To review the similarities and differences in Pakistani, Bangladeshi and White British mothers health beliefs (attitudes, knowledge and perceptions) and health behaviour regarding their consumption of folic acid pre-conception, to reduce the risk of neural tube defects. Methods Our study used a descriptive qualitative research approach, implementing face-to-face focus group discussions with Pakistani, Bangladeshi or White British mothers (normal birth outcomes and mothers with poor birth outcomes) and semi-structured interviews or focus groups with service providers using semi-structured topic guides. This method is well suited for under researched areas where in-depth information is sought. There were three sample groups:Pakistani, Bangladeshi and White British mothers with normal birth outcomes (delivery after 37 weeks of gestation, in the preceding 6 to 24 months, weighing 2500 g and living within a specified postcode area in Luton, UK). Pakistani Bangladeshi and white British bereaved mothers who had suffered a perinatal mortality (preceding 6 to 24 months, residing within a specificied postcode area). Healthcare professionals working on the local maternity care pathway (i.e. services providing preconception, antenatal, antepartum and postpartum care).
Transcribed discussions were analysed using the Framework Analysis approach. Results The majority of mothers in this sample did not understand the benefits or optimal time to take folic acid pre-conception. Conversely, healthcare professionals believed the majority of women did consume folic acid, prior to conception. Conclusions There is a need to increase public health awareness of the optimal time and subsequent benefits for taking folic acid, to prevent neural tube defects. Electronic supplementary material The online version of this article (10.1186/s12884-018-1884-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rebecca Garcia
- The School of Healthcare Practice, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Luton, LU2 8LE, England.
| | - Nasreen Ali
- The Institute For Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Luton, LU2 8LE, England
| | - Malcolm Griffiths
- Luton & Dunstable University Hospital NHS Foundation Trust, Lewsey Rd, Luton, LU4 0DZ, England
| | - Gurch Randhawa
- The Institute For Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Luton, LU2 8LE, England
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82
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Ross ME, Mason CE, Finnell RH. Genomic approaches to the assessment of human spina bifida risk. Birth Defects Res 2018; 109:120-128. [PMID: 27883265 DOI: 10.1002/bdra.23592] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/02/2016] [Accepted: 10/10/2016] [Indexed: 12/30/2022]
Abstract
Structural birth defects are a leading cause of mortality and morbidity in children world-wide, affecting as much as 6% of all live births. Among these conditions, neural tube defects (NTDs), including spina bifida and anencephaly, arise from a combination of complex gene and environment interactions that are as yet poorly understood within human populations. Rapid advances in massively parallel DNA sequencing and bioinformatics allow for analyses of the entire genome beyond the 2% of the genomic sequence covering protein coding regions. Efforts to collect and analyze these large datasets hold promise for illuminating gene network variations and eventually epigenetic events that increase individual risk for failure to close the neural tube. In this review, we discuss current challenges for DNA genome sequence analysis of NTD affected populations, and compare experience in the field with other complex genetic disorders for which large datasets are accumulating. The ultimate goal of this research is to find strategies for optimizing conditions that promote healthy birth outcomes for individual couples. Birth Defects Research 109:120-128, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- M Elizabeth Ross
- Center for Neurogenetics, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York
| | - Christopher E Mason
- Center for Neurogenetics, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York.,Department of Physiology and Biophysics, Weill Cornell Medicine, New York, New York
| | - Richard H Finnell
- Dell Pediatric Research Institute, Department of Nutritional Sciences, The University of Texas at Austin, Austin, Texas
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83
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Tucker FD, Morris JK, Neville A, Garne E, Kinsner-Ovaskainen A, Lanzoni M, Loane MA, Martin S, Nicholl C, Rankin J, Rissmann AK. EUROCAT: an update on its functions and activities. J Community Genet 2018; 9:407-410. [PMID: 29736796 DOI: 10.1007/s12687-018-0367-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 04/19/2018] [Indexed: 02/08/2023] Open
Abstract
This paper provides an outline of the development and growth of EUROCAT, the European network of congenital anomaly registers. In recent years the network has been through a period of transition and change. The Central Register of data has transferred from the Ulster University to the EU Joint-Research-Centre, Ispra, Italy.The benefits of combining data from across Europe, from different populations and countries are described by the uses to which these data can be put. These uses include:. surveillance of anomalies at a local, regional or pan-European level. pharmacovigilance. registration of rare diseasesNew studies and projects are underway, including EUROlinkCAT (a Horizon 2020 funded data-linkage project), promising a fruitful future in further research of congenital anomalies.
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Affiliation(s)
- F D Tucker
- Congenital Anomaly Register & Information Service for Wales (CARIS) Public Health Wales, Swansea, UK.
| | - J K Morris
- Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - A Neville
- IMER Registry (Emilia Romagna Registry of Birth Defects), University of Ferrara and Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - E Garne
- Paediatric Department, Hospital Lillebaelt, Kolding, Denmark
| | - A Kinsner-Ovaskainen
- DG Joint Research Centre, Directorate F - Health Consumers and Reference Materials, Ispra, Italy
| | - M Lanzoni
- DG Joint Research Centre, Directorate F - Health Consumers and Reference Materials, Ispra, Italy
| | - M A Loane
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - S Martin
- DG Joint Research Centre, Directorate F - Health Consumers and Reference Materials, Ispra, Italy
| | - C Nicholl
- DG Joint Research Centre, Directorate F - Health Consumers and Reference Materials, Ispra, Italy
| | - J Rankin
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - A K Rissmann
- Institute of Health and Society, Newcastle University, Newcastle, UK.,Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
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84
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Birth Prevalence of Neural Tube Defects in Iran: A Systematic Review. JOURNAL OF PEDIATRICS REVIEW 2018. [DOI: 10.5812/jpr.62091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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85
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Morris JK, Springett AL, Greenlees R, Loane M, Addor MC, Arriola L, Barisic I, Bergman JEH, Csaky-Szunyogh M, Dias C, Draper ES, Garne E, Gatt M, Khoshnood B, Klungsoyr K, Lynch C, McDonnell R, Nelen V, Neville AJ, O'Mahony M, Pierini A, Queisser-Luft A, Randrianaivo H, Rankin J, Rissmann A, Kurinczuk J, Tucker D, Verellen-Dumoulin C, Wellesley D, Dolk H. Trends in congenital anomalies in Europe from 1980 to 2012. PLoS One 2018; 13:e0194986. [PMID: 29621304 PMCID: PMC5886482 DOI: 10.1371/journal.pone.0194986] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 03/14/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Surveillance of congenital anomalies is important to identify potential teratogens. METHODS This study analysed the prevalence of 61 congenital anomaly subgroups (excluding chromosomal) in 25 population-based EUROCAT registries (1980-2012). Live births, fetal deaths and terminations of pregnancy for fetal anomaly were analysed with multilevel random-effects Poisson regression models. RESULTS Seventeen anomaly subgroups had statistically significant trends from 2003-2012; 12 increasing and 5 decreasing. CONCLUSIONS The annual increasing prevalence of severe congenital heart defects, single ventricle, atrioventricular septal defects and tetralogy of Fallot of 1.4% (95% CI: 0.7% to 2.0%), 4.6% (1.0% to 8.2%), 3.4% (1.3% to 5.5%) and 4.1% (2.4% to 5.7%) respectively may reflect increases in maternal obesity and diabetes (known risk factors). The increased prevalence of cystic adenomatous malformation of the lung [6.5% (3.5% to 9.4%)] and decreased prevalence of limb reduction defects [-2.8% (-4.2% to -1.5%)] are unexplained. For renal dysplasia and maternal infections, increasing trends may be explained by increased screening, and deceases in patent ductus arteriosus at term and increases in craniosynostosis, by improved follow up period after birth and improved diagnosis. For oesophageal atresia, duodenal atresia/stenosis and ano-rectal atresia/stenosis recent changes in prevalence appeared incidental when compared with larger long term fluctuations. For microcephaly and congenital hydronephrosis trends could not be interpreted due to discrepancies in diagnostic criteria. The trends for club foot and syndactyly disappeared once registries with disparate results were excluded. No decrease in neural tube defects was detected, despite efforts at prevention through folic acid supplementation.
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Affiliation(s)
- Joan K Morris
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Anna L Springett
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Ruth Greenlees
- Faculty Life & Health Sciences, University of Ulster, Newtownabbey, United Kingdom
| | - Maria Loane
- Faculty Life & Health Sciences, University of Ulster, Newtownabbey, United Kingdom
| | - Marie-Claude Addor
- Department of Woman-Mother-Child, University Hospital Center CHUV, Lausanne, Switzerland
| | - Larraitz Arriola
- Public Health Division of, Biodonostia Research Institute, San Sebastián, Spain
| | - Ingeborg Barisic
- Department of Medical Genetics and Reproductive Health,Children's Hospital Zagreb, Medical School University of Zagreb, Zagreb, Croatia
| | - Jorieke E H Bergman
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Melinda Csaky-Szunyogh
- National Public Health and Medical Officer Service, Hungarian Congenital Abnormality Registry, Budapest, Hungary
| | - Carlos Dias
- Centro de Estudos e registo de A C, Lisbon, Portugal
| | - Elizabeth S Draper
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Ester Garne
- Paediatric department, Hospital Lillebaelt, Kolding, Denmark
| | - Miriam Gatt
- Directorate for Health Information and Research, Guardamangia, Malta
| | - Babak Khoshnood
- Paris Registry of Congenital Anomalies, Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Kari Klungsoyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Division for mental and physical health, Norwegian Institute of Public Health, Bergen, Norway
| | - Catherine Lynch
- Department of Public Health, Health Service Executive, Kilkenny, Ireland
| | - Robert McDonnell
- Department of Public Health, Health Service Executive, Dublin, Ireland
| | - Vera Nelen
- Provincial Institute for Hygiene, Antwerp, Belgium
| | - Amanda J Neville
- IMER Registry, Center for Clinical and Epidemiological Research, University of Ferrara, Ferrara, Italy.,Azienda Ospedaliero- Universitaria di Ferrara, Ferrara, Italy
| | - Mary O'Mahony
- Department of Public Health, Health Service Executive, Cork, Ireland
| | - Anna Pierini
- CNR Institute of Clinical Physiology, Pisa, Italy
| | - Annette Queisser-Luft
- Center for child and adolescence medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Hanitra Randrianaivo
- Registre des Malformations Congenitales de la Reunion, St Pierre, Ile de la Reunion, France
| | - Judith Rankin
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Jennifer Kurinczuk
- National Perinatal and Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | | | | | - Diana Wellesley
- University of Southampton and Wessex Clinical Genetics Service, Southampton, United Kingdom
| | - Helen Dolk
- Faculty Life & Health Sciences, University of Ulster, Newtownabbey, United Kingdom
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86
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Blumberg JB, Cena H, Barr SI, Biesalski HK, Dagach RU, Delaney B, Frei B, Moreno González MI, Hwalla N, Lategan-Potgieter R, McNulty H, van der Pols JC, Winichagoon P, Li D. The Use of Multivitamin/Multimineral Supplements: A Modified Delphi Consensus Panel Report. Clin Ther 2018; 40:640-657. [DOI: 10.1016/j.clinthera.2018.02.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/19/2018] [Accepted: 02/23/2018] [Indexed: 12/13/2022]
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87
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Mukhtar A, Kramer MR, Oakley GP, Kancherla V. Race and ethnicity and preconception folic acid supplement use among pregnant women in Georgia, PRAMS 2009 to 2011. Birth Defects Res 2018; 109:38-48. [PMID: 27905191 DOI: 10.1002/bdra.23597] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 10/11/2016] [Accepted: 10/24/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND The United States Public Health Service recommends that all women of reproductive age consume 400 μg of folic acid daily to prevent major neural tube defects. Hispanics have the highest prevalence of neural tube defects compared with other race/ethnic groups. We studied prevalence of preconception folic acid supplement use, and its association with race/ethnicity among pregnant women in Georgia. METHODS Using state-wide population-based data from 2009 to 2011 Georgia Pregnancy Risk Assessment Monitoring System, we examined the prevalence of preconception folic acid supplement use among pregnant women aged 18 to 45 years. We conducted multivariable logistic regression and estimated adjusted odds ratios and 95% confidence intervals to examine the association between race/ethnicity and supplemental folic acid use among study participants. RESULTS Overall, 25% of all participants reported taking folic acid supplements daily before conception. Only 21% of Hispanic women reported preconception folic acid supplement use. Hispanic women were twice as likely to not take folic acid supplements (adjusted odds ratio = 2.15; 95% confidence interval, 1.35-3.40) compared with non-Hispanic whites, after controlling for maternal age, parity, pregnancy intention, knowledge that folic acid prevents birth defects, and preconception smoking and exercise. CONCLUSION Hispanics are a growing population in the United States with an expected 14 million women of child-bearing age by 2020, and the prevalence of preconception folic acid supplement use is low in this group with a high risk of neural tube defects. Promotion of voluntarily fortified corn masa flour can lower neural tube defects in Hispanics. Mandatory corn masa fortification will be a more effective public health policy.Birth Defects Research 109:38-48, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Ayesha Mukhtar
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Michael R Kramer
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Godfrey P Oakley
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia.,Center for Spina Bifida Prevention, Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Vijaya Kancherla
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia.,Center for Spina Bifida Prevention, Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
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88
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Joyeux L, De Bie F, Danzer E, Van Mieghem T, Flake AW, Deprest J. Safety and efficacy of fetal surgery techniques to close a spina bifida defect in the fetal lamb model: A systematic review. Prenat Diagn 2018; 38:231-242. [PMID: 29388237 DOI: 10.1002/pd.5222] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/16/2017] [Accepted: 01/23/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine the safety and efficacy of different neurosurgical techniques for closure of spina bifida (SB) in the fetal lamb model. METHOD Systematic review of studies reporting on fetal lambs undergoing induction and closure of SB compared with non-operated normal lambs (negative controls) and/or lambs not undergoing closure of the defect (positive controls). Primary outcomes were (1) survival at birth (safety) and/or (2) presence of Somatosensory Evoked Potentials on hind limbs and/or improvement in quantitative histological spinal cord findings and/or reversal of hindbrain herniation (efficacy). RESULTS Out of 1311, 36 full-text articles were eligible. Nineteen were included for quality assessment. Due to high bias, only 2 adequately powered studies were included in the final analysis. An open approach using a 2-layer closure (muscle flap or acellular-dermal-matrix patch plus skin) was the only safe (patch + skin) and effective (both techniques) technique for prenatal closure in this animal model. No comparable level of evidence was identified for other techniques. CONCLUSION The experimental literature on prenatal SB closure underscores the lack of standardization. At present, there is animal experimental evidence that a 2-layer closure by hysterotomy is safe and effective. This technique is currently clinically used in a subset of patients. As new clinical techniques are introduced, it would seem logic to preclinically validate them against this experimental standard.
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Affiliation(s)
- Luc Joyeux
- Academic Department Development and Regeneration, Cluster Organ Systems, Biomedical Sciences, Faculty of Medicine, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Felix De Bie
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Enrico Danzer
- Center for Fetal Diagnosis and Treatment, the Children's Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Surgery, Children's Center for Fetal Research, Abramson Research center, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Tim Van Mieghem
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, Mt. Sinai Hospital, University of Toronto, Toronto, Canada
| | - Alan W Flake
- Center for Fetal Diagnosis and Treatment, the Children's Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Surgery, Children's Center for Fetal Research, Abramson Research center, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jan Deprest
- Academic Department Development and Regeneration, Cluster Organ Systems, Biomedical Sciences, Faculty of Medicine, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division Woman and Child, Fetal Medicine Unit, University Hospital Gasthuisberg UZ Leuven, Leuven, Belgium
- Institute of Women's Health, University College London Hospitals, London, UK
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89
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Mills JL, Molloy AM, Reynolds EH. Do the benefits of folic acid fortification outweigh the risk of masking vitamin B 12 deficiency? BMJ 2018; 360:k724. [PMID: 29496696 PMCID: PMC6889897 DOI: 10.1136/bmj.k724] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Adding folate to cereals can prevent neural tube defects and other health problems, say James Mills and Anne Molloy, but Edward Reynolds is concerned that prolonged excessive folate risks harm unless vitamin B12 is also supplemented
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Affiliation(s)
- James L Mills
- Epidemiology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
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90
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Valentin M, Coste Mazeau P, Zerah M, Ceccaldi PF, Benachi A, Luton D. Acid folic and pregnancy: A mandatory supplementation. ANNALES D'ENDOCRINOLOGIE 2018; 79:91-94. [PMID: 29433770 DOI: 10.1016/j.ando.2017.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 09/15/2017] [Indexed: 11/30/2022]
Abstract
Neural tube defects (NTD) occur in 0.5 to 2 per 1000 pregnancies with various handicaps for the affected child. It is now well established that folic acid deficiency (absolute or relative) is a predisposing factor to this type of malformation. Several randomized controlled trials showed that high-dose folic acid (4mg) is an essential factor for prevention of neural tube defects recurrence and significantly prevents the first occurrence of neural tube defects with a lower dose (0.4mg). Other etiologies can favor the occurrence of NTD such as MTHFR polymorphism, some antiepileptic therapies, obesity and pregestational mellitus diabetes. Necessity of a preconception folic acid supplementation or at least folate nutritional status evaluation should be known for all of us including patients and public.
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Affiliation(s)
- Morgane Valentin
- Service de gynécologie-obstétrique, hôpital Bichat-Beaujon, université Denis-Diderot-Paris VII, DHU risque et grossesse, 46, rue Henri-Huchard, 75018 Paris, France.
| | - Perrine Coste Mazeau
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère, université Paris-Sud, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France
| | - Michel Zerah
- Service de neuro-chirurgie, hôpital Necker-Enfants Malades, université René-Descartes, 149, rue de Sèvres, 75015 Paris, France
| | - Pierre François Ceccaldi
- Service de gynécologie-obstétrique, hôpital Bichat-Beaujon, université Denis-Diderot-Paris VII, DHU risque et grossesse, 46, rue Henri-Huchard, 75018 Paris, France
| | - Alexandra Benachi
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère, université Paris-Sud, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France
| | - Dominique Luton
- Service de gynécologie-obstétrique, hôpital Bichat-Beaujon, université Denis-Diderot-Paris VII, DHU risque et grossesse, 46, rue Henri-Huchard, 75018 Paris, France
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91
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Ultrasound in Prenatal Diagnostics and Its Impact on the Epidemiology of Spina Bifida in a National Cohort from Denmark with a Comparison to Sweden. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9203985. [PMID: 29487873 PMCID: PMC5816888 DOI: 10.1155/2018/9203985] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/16/2017] [Accepted: 01/08/2018] [Indexed: 11/22/2022]
Abstract
Objectives The aim of this study was to assess the incidence, the prenatal detection rate by ultrasound, and the pregnancy outcome of spina bifida (SB) in Denmark (DK) in 2008–2015 and to compare results to national data from Sweden. Methods Data were retrieved from the Danish Fetal Medicine Database, which includes International Classification of Diseases- (ICD-) 10 codes for pre- or postnatally diagnoses and pregnancy outcome. Missing data were obtained from the National Patient Register. Livebirth data with myelomeningocele (MMC) in Sweden were obtained from different databases. Results There were 234 cases with SB in DK in 2008–2015. The incidence of SB was 4.9 : 10,000; 89% were detected with ultrasound prior to week 22; 90% of these pregnancies were terminated (ToP); 91% were isolated malformations of which 11% showed abnormal karyotype. The incidence of newborns with MMC was 1.3 : 10,000 in Sweden. Conclusions Ultrasound screening has a major impact on the epidemiology of SB. The prenatal detection rate of SB was high, and most SB cases were isolated and had a normal karyotype. Among women with a prenatal fetal diagnosis of SB, 90% chose to have ToP. The incidence of newborns with SB was higher in Sweden than in DK.
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92
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Wald NJ, Morris JK, Blakemore C. Public health failure in the prevention of neural tube defects: time to abandon the tolerable upper intake level of folate. Public Health Rev 2018; 39:2. [PMID: 29450103 PMCID: PMC5809909 DOI: 10.1186/s40985-018-0079-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 01/08/2018] [Indexed: 11/10/2022] Open
Abstract
The neural tube defects anencephaly and spina bifida are two of the most common serious congenital malformations. Most cases can be prevented by consuming sufficient folic acid immediately before pregnancy and in early pregnancy. Fortification of flour with folic acid to prevent these defects has been implemented in 81 countries without public objection or indication of harm. An obstacle to the wider adoption of fortification arises from the creation of a "tolerable upper intake level" for folate (which includes natural food folate as well as synthetic folic acid), and which has been set at 1 mg/day, thereby proscribing higher folate intakes. Increasing the intake of folic acid in a population will necessarily increase the number of people with a folate intake greater than 1 mg per day, and this concern is obstructing folic acid fortification. This paper shows that the scientific basis for setting any upper limit, let alone one at 1 mg/day, is flawed. An upper intake level is therefore unnecessary and should be removed, thus allaying unjustified concerns about folic acid fortification. As a result, the full global opportunity to prevent two serious fatal or disabling disorders can and should be realized.
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Affiliation(s)
- Nicholas J. Wald
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ UK
| | - Joan K. Morris
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ UK
| | - Colin Blakemore
- Centre for the Study of the Senses, School of Advanced Study, University of London, London, UK
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93
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Blencowe H, Kancherla V, Moorthie S, Darlison MW, Modell B. Estimates of global and regional prevalence of neural tube defects for 2015: a systematic analysis. Ann N Y Acad Sci 2018; 1414:31-46. [PMID: 29363759 DOI: 10.1111/nyas.13548] [Citation(s) in RCA: 163] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 10/10/2017] [Accepted: 10/15/2017] [Indexed: 12/19/2022]
Abstract
Neural tube defects (NTDs) are associated with substantial mortality, morbidity, disability, and psychological and economic costs. Many are preventable with folic acid, and access to appropriate services for those affected can improve survival and quality of life. We used a compartmental model to estimate global and regional birth prevalence of NTDs (live births, stillbirths, and elective terminations of pregnancy) and subsequent under-5 mortality. Data were identified through web-based reviews of birth defect registry databases and systematic literature reviews. Meta-analyses were undertaken where appropriate. For 2015, our model estimated 260,100 (uncertainty interval (UI): 213,800-322,000) NTD-affected birth outcomes worldwide (prevalence 18.6 (15.3-23.0)/10,000 live births). Approximately 50% of cases were elective terminations of pregnancy for fetal anomalies (UI: 59,300 (47,900-74,500)) or stillbirths (57,800 (UI: 35,000-88,600)). Of NTD-affected live births, 117,900 (∼75%) (UI: 105,500-186,600) resulted in under-5 deaths. Our systematic review showed a paucity of high-quality data in the regions of the world with the highest burden. Despite knowledge about prevention, NTDs remain highly prevalent worldwide. Lack of surveillance and incomplete ascertainment of affected pregnancies make NTDs invisible to policy makers. Improved surveillance of all adverse outcomes is needed to improve the robustness of total NTD prevalence estimation, evaluate effectiveness of prevention through folic acid fortification, and improve outcomes through care and rehabilitation.
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Affiliation(s)
- Hannah Blencowe
- Centre for Maternal, Adolescent, Reproductive, and Child Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Vijaya Kancherla
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | | | - Matthew W Darlison
- World Health Organization Collaborating Centre for Community Genetics, UCL Centre for Health Informatics and Multiprofessional Education (CHIME), University College London, London, UK
| | - Bernadette Modell
- World Health Organization Collaborating Centre for Community Genetics, UCL Centre for Health Informatics and Multiprofessional Education (CHIME), University College London, London, UK
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94
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De Lepeleire J, Strobbe S, Verstraete J, Blancquaert D, Ambach L, Visser RGF, Stove C, Van Der Straeten D. Folate Biofortification of Potato by Tuber-Specific Expression of Four Folate Biosynthesis Genes. MOLECULAR PLANT 2018; 11:175-188. [PMID: 29277427 DOI: 10.1016/j.molp.2017.12.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/08/2017] [Accepted: 12/08/2017] [Indexed: 05/24/2023]
Abstract
Insufficient dietary intake of micronutrients, known as "hidden hunger", is a devastating global burden, affecting two billion people. Deficiency of folates (vitamin B9), which are known to play a central role in C1 metabolism, causes birth defects in at least a quarter million people annually. Biofortification to enhance the level of naturally occurring folates in crop plants, proves to be an efficient and cost-effective tool in fighting folate deficiency. Previously, introduction of folate biosynthesis genes GTPCHI and ADCS, proven to be a successful biofortification strategy in rice and tomato, turned out to be insufficient to adequately increase folate levels in potato tubers. Here, we provide a proof of concept that additional introduction of HPPK/DHPS and/or FPGS, downstream genes in mitochondrial folate biosynthesis, enables augmentation of folates to satisfactory levels (12-fold) and ensures folate stability upon long-term storage of tubers. In conclusion, this engineering strategy can serve as a model in the creation of folate-accumulating potato cultivars, readily applicable in potato-consuming populations suffering from folate deficiency.
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Affiliation(s)
- Jolien De Lepeleire
- Laboratory of Functional Plant Biology, Department of Biology, Ghent University, K.L. Ledeganckstraat 35, 9000 Ghent, Belgium
| | - Simon Strobbe
- Laboratory of Functional Plant Biology, Department of Biology, Ghent University, K.L. Ledeganckstraat 35, 9000 Ghent, Belgium
| | - Jana Verstraete
- Laboratory of Toxicology, Department of Bioanalysis, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium
| | - Dieter Blancquaert
- Laboratory of Functional Plant Biology, Department of Biology, Ghent University, K.L. Ledeganckstraat 35, 9000 Ghent, Belgium
| | - Lars Ambach
- Laboratory of Toxicology, Department of Bioanalysis, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium
| | - Richard G F Visser
- Plant Breeding, Wageningen University & Research, Droevendaalsesteeg 1, 6700 Wageningen, the Netherlands
| | - Christophe Stove
- Plant Breeding, Wageningen University & Research, Droevendaalsesteeg 1, 6700 Wageningen, the Netherlands
| | - Dominique Van Der Straeten
- Laboratory of Functional Plant Biology, Department of Biology, Ghent University, K.L. Ledeganckstraat 35, 9000 Ghent, Belgium.
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95
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Boyle B, Addor MC, Arriola L, Barisic I, Bianchi F, Csáky-Szunyogh M, de Walle HEK, Dias CM, Draper E, Gatt M, Garne E, Haeusler M, Källén K, Latos-Bielenska A, McDonnell B, Mullaney C, Nelen V, Neville AJ, O’Mahony M, Queisser-Wahrendorf A, Randrianaivo H, Rankin J, Rissmann A, Ritvanen A, Rounding C, Tucker D, Verellen-Dumoulin C, Wellesley D, Wreyford B, Zymak-Zakutnia N, Dolk H. Estimating Global Burden of Disease due to congenital anomaly: an analysis of European data. Arch Dis Child Fetal Neonatal Ed 2018; 103:F22-F28. [PMID: 28667189 PMCID: PMC5750368 DOI: 10.1136/archdischild-2016-311845] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 03/15/2017] [Accepted: 04/18/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To validate the estimates of Global Burden of Disease (GBD) due to congenital anomaly for Europe by comparing infant mortality data collected by EUROCAT registries with the WHO Mortality Database, and by assessing the significance of stillbirths and terminations of pregnancy for fetal anomaly (TOPFA) in the interpretation of infant mortality statistics. DESIGN, SETTING AND OUTCOME MEASURES EUROCAT is a network of congenital anomaly registries collecting data on live births, fetal deaths from 20 weeks' gestation and TOPFA. Data from 29 registries in 19 countries were analysed for 2005-2009, and infant mortality (deaths of live births at age <1 year) compared with the WHO Mortality Database. Eight EUROCAT countries were excluded from further analysis on the basis that this comparison showed poor ascertainment of survival status. RESULTS According to WHO, 17%-42% of infant mortality was attributed to congenital anomaly. In 11 EUROCAT countries, average infant mortality with congenital anomaly was 1.1 per 1000 births, with higher rates where TOPFA is illegal (Malta 3.0, Ireland 2.1). The rate of stillbirths with congenital anomaly was 0.6 per 1000. The average TOPFA prevalence was 4.6 per 1000, nearly three times more prevalent than stillbirths and infant deaths combined. TOPFA also impacted on the prevalence of postneonatal survivors with non-lethal congenital anomaly. CONCLUSIONS By excluding TOPFA and stillbirths from GBD years of life lost (YLL) estimates, GBD underestimates the burden of disease due to congenital anomaly, and thus declining YLL over time may obscure lack of progress in primary, secondary and tertiary prevention.
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Affiliation(s)
- Breidge Boyle
- EUROCAT: WHO Collaborating Centre for the Surveillance of Congenital Anomalies, University of Ulster, Coleraine, UK,School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
| | | | - Larraitz Arriola
- Registro Anomalías Congénitas CAV Subdirección de Salud Pública Av Navarra, San Sebastian, Spain
| | - Ingeborg Barisic
- Children’s Hospital Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | - Melinda Csáky-Szunyogh
- Hungarian Congenital Abnormality Registry, National Public Health and Medical Officer Service, Budapest, Hungary
| | - Hermien E K de Walle
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Carlos Matias Dias
- Departamento de Epidemiologia, Registo Nacional de Anomalias Congénitas Av Padre Cruz, Lisbon, Portugal
| | - Elizabeth Draper
- Department of Epidemiology Public Health, East Midlands & South Yorkshire (EMSYCAR), University of Leicester, Leicester, UK
| | - Miriam Gatt
- Department of Health Information and Research, Guardamangia, Malta
| | - Ester Garne
- Department of Paediatric, Hospital Lillebaelt, Kolding, Denmark
| | - Martin Haeusler
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Karin Källén
- Swedish National Board of Health and Welfare and Department of Reproduction Epidemiology, Institution of Clinical Sciences, University of Lund, Lund, Sweden
| | | | | | | | - Vera Nelen
- Department of Environment, PIH, Province of Antwerp, Antwerp, Belgium
| | - Amanda J Neville
- Azienda Ospedaliero-Universitaria di Ferrara Corso Giovecca, Ferrara, Italy
| | | | - Annette Queisser-Wahrendorf
- Birth Registry Mainz Model, Children’s Hospital University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Hanitra Randrianaivo
- Register of Reunion Island, Centre Hospitalo-Universitaire, St Pierre La Reunion, Reunion, UK
| | - Judith Rankin
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Anke Rissmann
- Malformation Monitoring Centre, Saxony-Anhalt, Medical Faculty Otto-von-Guericke University, Magdeburg, Germany
| | - Annukka Ritvanen
- National Institute for Welfare and Health (THL), Helsinki, Finland
| | | | - David Tucker
- Public Health Wales, Congenital Anomaly Register and Information Service for Wales (CARIS), Swansea, UK
| | - Christine Verellen-Dumoulin
- Centre de Génétique Humaine IPG Institut de Pathologie et de Génétique Avenue G Lemaître, Charleroi, Belgium
| | - Diana Wellesley
- Faculty of Medicine, University of Southampton and Wessex Clinical Genetics Service, Southampton, UK
| | - Ben Wreyford
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Natalia Zymak-Zakutnia
- Khmelnytsky Perinatal Center, OMNI-Net Ukraine Birth Defects Program, Khmelnytsky, Ukraine
| | - Helen Dolk
- EUROCAT: WHO Collaborating Centre for the Surveillance of Congenital Anomalies, University of Ulster, Coleraine, UK
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96
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Vogt L, Rodermond B, Post P, Iborra S, Stickeler E, Schiefer J, Alt JP, Rossaint R, Röhl A. [Intramedullary injection with tethered cord : Case report of a rare complication during spinal anesthesia]. Anaesthesist 2017; 67:131-134. [PMID: 29270665 DOI: 10.1007/s00101-017-0400-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 10/18/2022]
Abstract
Although very rare, severe neurological complications can occur when undergoing spinal anesthesia. This report describes and analyses a case of spinal injury due to an undiagnosed tethered cord (TC) during spinal anesthesia for a cesarean section of a 31-year-old woman expecting twins. As a consequence of spinal dysraphism during embryogenesis, an atypically low conus level can occur and increase the risk of injury during neuraxial anesthesia, especially in the absence of symptoms. Injuries can be caused by mechanical trauma from direct needle injury, hematoma or neurotoxicity from local anesthetics. Special attention should therefore be paid to frequent symptoms, such as a hairy nevus on the back, deformities of the feet or bladder and bowels, voiding and micturition dysfunction in order to reduce the risk of complications.
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Affiliation(s)
- L Vogt
- Klinik für Anästhesiologie, Medizinische Fakultät, Uniklinik RWTH Aachen, Aachen, Deutschland.
| | - B Rodermond
- Klinik für Anästhesiologie, Medizinische Fakultät, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - P Post
- Klinik für Anästhesiologie, Medizinische Fakultät, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - S Iborra
- Klinik für Gynäkologie und Geburtsmedizin, Medizinische Fakultät, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - E Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Medizinische Fakultät, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - J Schiefer
- Klinik für Neurologie, Medizinische Fakultät, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - J P Alt
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Medizinische Fakultät, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - R Rossaint
- Klinik für Anästhesiologie, Medizinische Fakultät, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - A Röhl
- Klinik für Anästhesiologie, Medizinische Fakultät, Uniklinik RWTH Aachen, Aachen, Deutschland
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97
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Awareness, use and information sources of folic acid supplementation to prevent neural tube defects in pregnant Japanese women. Public Health Nutr 2017; 21:732-739. [PMID: 29160184 DOI: 10.1017/s1368980017003172] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Folic acid supplementation and folate-rich diets are recommended for women of childbearing age worldwide to prevent congenital anomalies. We aimed to determine the current status of folic acid supplementation among pregnant Japanese women and identify means to increase the intake of these supplements. DESIGN Cross-sectional study. SUBJECTS A total of 1862 pregnant women who consulted the perinatal centre from September 2014 to December 2015 completed a questionnaire concerning knowledge about folic acid, sources of information and the use of folic acid supplements. SETTING Osaka Medical Center and Research Institute for Maternal and Child Health (Japan). RESULTS In our study population, only 20·5 % of pregnant women took folic acid supplements periconceptionally even though 70·4 % knew about the protective effect of folic acid. A multivariate analysis demonstrated that age ≥35 years (OR=2·80; 95 % CI 1·24, 6·29) and knowledge of the benefits of folic acid (OR=2·64; 95 % CI 1·92, 3·62) were associated with periconceptional folic acid use, and multiparity was negatively associated with such use. Compared with those who took folic acid supplements periconceptionally, women who did not take supplements received information through passive and less interactive media. CONCLUSIONS Although folic acid awareness was relatively high among pregnant Japanese women, folic acid supplementation before conception was insufficient. To increase the intake of folic acid supplements in countries in which foods are not fortified with folic acid, an effective public health approach promoting behavioural change is necessary for women of reproductive age.
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98
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Ko HS, Kim DJ, Chung Y, Wie JH, Choi SK, Park IY, Park YG, Shin JC. A national cohort study evaluating infant and fetal mortality caused by birth defects in Korea. BMJ Open 2017; 7:e017963. [PMID: 29146644 PMCID: PMC5695452 DOI: 10.1136/bmjopen-2017-017963] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To analyse the prevalence of fetal and infant deaths due to birth defects in Korea and those trends according to maternal age. DESIGN Retrospective national cohort study SETTING: Korean Vital Statistics database of the Korean Statistical Information Service, between 2009 and 2015. PARTICIPANTS 2176 infant deaths and 4343 fetal deaths caused by birth defects, among 3 181 145 total live births and 43 385 fetal deaths during the study periods. METHODS Infant and fetal mortality rates (IMRs and FMRs) by birth defects, from deaths caused by birth defects, were analysed. They were compared, according to maternal age groups: (I) '10-19 years'; (II) '20-29 years'; (III) '30-34 years'; (IV) '35-39 years'; and (V) '40-55 years'. MAIN OUTCOME MEASURES IMRs and FMRs by birth defects and comparison according to maternal age group. RESULTS IMRs and FMRs by birth defects were 6.84 per 10 000 live births and 13.47 per 10 000 total births. The most common causes of infant deaths and fetal deaths by birth defect were anomaly of the circulatory system (51.1%, IMR 3.5) and chromosomal abnormality (33.1%, FMR 4.46), respectively. Among groups by maternal age, FMRs by birth defects were significantly higher in groups I and V compared with group III (OR 6.59, 95% CI 3.49 to 12.43; and OR 3.46, 95% CI 1.77 to 6.78, respectively). IMR and FMR by nervous system anomaly were significantly higher in group I at 3.63 (OR 2.0, 95% CI 1.97 to 2.03) and 29.84 (OR 15.04, 95% CI 3.59 to 62.96) compared with 0.32 and 1.97 in group III. CONCLUSION FMRs by birth defects were the highest in the extreme maternal age groups. Severe anomalies, except for chromosomal abnormality, were most prevalent in teenage pregnancies.
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Affiliation(s)
- Hyun Sun Ko
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong Joo Kim
- Department of Obstetrics and Gynecology, Graduate School, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Obstetrics and Gynecology, St Mary's Women's Hospital, Suwon, Republic of Korea
| | - Yoohyun Chung
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong Ha Wie
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sae Kyung Choi
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Yarg Park
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong Gyu Park
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong Chul Shin
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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99
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Cavadino A, Prieto-Merino D, Addor MC, Arriola L, Bianchi F, Draper E, Garne E, Greenlees R, Haeusler M, Khoshnood B, Kurinczuk J, McDonnell B, Nelen V, O'Mahony M, Randrianaivo H, Rankin J, Rissmann A, Tucker D, Verellen-Dumoulin C, de Walle H, Wellesley D, Morris JK. Use of hierarchical models to analyze European trends in congenital anomaly prevalence. ACTA ACUST UNITED AC 2017; 106:480-8. [PMID: 27301561 DOI: 10.1002/bdra.23515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 03/23/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Surveillance of congenital anomalies is important to identify potential teratogens. Despite known associations between different anomalies, current surveillance methods examine trends within each subgroup separately. We aimed to evaluate whether hierarchical statistical methods that combine information from several subgroups simultaneously would enhance current surveillance methods using data collected by EUROCAT, a European network of population-based congenital anomaly registries. METHODS Ten-year trends (2003 to 2012) in 18 EUROCAT registries over 11 countries were analyzed for the following groups of anomalies: neural tube defects, congenital heart defects, digestive system, and chromosomal anomalies. Hierarchical Poisson regression models that combined related subgroups together according to EUROCAT's hierarchy of subgroup coding were applied. Results from hierarchical models were compared with those from Poisson models that consider each congenital anomaly separately. RESULTS Hierarchical models gave similar results as those obtained when considering each anomaly subgroup in a separate analysis. Hierarchical models that included only around three subgroups showed poor convergence and were generally found to be over-parameterized. Larger sets of anomaly subgroups were found to be too heterogeneous to group together in this way. CONCLUSION There were no substantial differences between independent analyses of each subgroup and hierarchical models when using the EUROCAT anomaly subgroups. Considering each anomaly separately, therefore, remains an appropriate method for the detection of potential changes in prevalence by surveillance systems. Hierarchical models do, however, remain an interesting alternative method of analysis when considering the risks of specific exposures in relation to the prevalence of congenital anomalies, which could be investigated in other studies. Birth Defects Research (Part A) 106:480-10, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Alana Cavadino
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, United Kingdom
| | - David Prieto-Merino
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Farr Institute of Health Informatics Research, University College London, United Kingdom.,Catholic University of Murcia (UCAM), Spain
| | | | - Larraitz Arriola
- Public Health Division of Gipuzkoa, Instituto BIO-Donostia Basque Government CIBER Epidemiología y Salud Pública - CIBERESP, San Sebatian, Spain
| | - Fabrizio Bianchi
- CNR Institute of Clinical Physiology and Tuscany Registry of Congenital Defects, "Gabriele Monasterio" Foundation, Pisa, Italy
| | - Elizabeth Draper
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Ester Garne
- Paediatric Department, Hospital Lillebaelt-Kolding, Denmark
| | - Ruth Greenlees
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, United Kingdom
| | | | - Babak Khoshnood
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Biostatistics and Epidemiology, INSERM U1153, Maternité de Port-Royal, Paris, France
| | - Jenny Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
| | | | - Vera Nelen
- Provincial Institute for Hygiene, Antwerp, Belgium
| | - Mary O'Mahony
- Department of Public Health, Health Service Executive - South, Ireland
| | | | - Judith Rankin
- Institute of Health & Society, Newcastle University, Newcastle, United Kingdom
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty Otto-von-Guericke University, Magdeburg, Germany
| | | | - Christine Verellen-Dumoulin
- Center for Human Genetics, Institut de Recherche Scientifique en Pathologie et en Génétique, Charleroi, Belgium
| | - Hermien de Walle
- University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, Netherlands
| | - Diana Wellesley
- University Hospitals Southampton, Faculty of Medicine and Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, United Kingdom
| | - Joan K Morris
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, United Kingdom
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100
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Artificial Urinary Sphincter in Male Patients with Spina Bifida: Comparison of Perioperative and Functional Outcomes between Bulbar Urethra and Bladder Neck Cuff Placement. J Urol 2017; 199:791-797. [PMID: 29037862 DOI: 10.1016/j.juro.2017.09.140] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE We evaluated the perioperative and long-term functional outcomes of bladder neck and peribulbar cuff placement of an artificial urinary sphincter in a population of adult male patients with spinal dysraphism. MATERIALS AND METHODS We retrospectively analyzed the French spina bifida network database. Patients who underwent implantation of an artificial urinary sphincter from January 1985 to November 2015 were selected and stratified into 2 groups according to cuff location, that is bladder neck vs bulbar urethra. Explantation-free and revision-free device survival was estimated by the Kaplan-Meier method and compared with the log rank test. Cox regression models were created to assess prognostic factors of artificial urinary sphincter device failure. RESULTS A total of 65 patients were included in study. Most patients were not wheelchair bound. The cuff was implanted around the bulbar urethra at 46 procedures (59%) and around the bladder neck in 32 (41%). In the peribulbar and bladder neck groups median revision-free device survival was 11.7 and 14.3 years, respectively (p = 0.73). Median explantation-free device survival was 18.5 and 24.5 years, respectively (p = 0.08). On multivariate analysis clean intermittent catheterization was the only predictor of artificial urinary sphincter device failure. Cuff location had no influence. At the last followup satisfactory continence was similar in the 2 groups (83% vs 75%, p = 0.75). CONCLUSIONS In male patients with spinal dysraphism morbidity and functional outcomes were similar for bladder neck and bulbar urethra cuff placement but with a trend toward longer survival without explantation in the bladder neck group. Clean intermittent catheterization was the only predictor of shorter device survival on multivariate analysis.
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