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Arkorful J, Ackom S, Fiagbedzi E, Obour E, Nyamson J, Ofori IN. Antenatally diagnosed myelomeningocele with associated chiari ii malformation in the third trimester. A case report. Radiol Case Rep 2024; 19:5990-5994. [PMID: 39328952 PMCID: PMC11424767 DOI: 10.1016/j.radcr.2024.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Revised: 09/05/2024] [Accepted: 09/07/2024] [Indexed: 09/28/2024] Open
Abstract
Myelomeningocele, a severe form of open neural tube defect which is mostly associated with Chiari II malformation remains a cause of adverse neonatal outcomes. Myelomeningocele is mostly detected in the second trimester and subsequently followed up in the third trimester. We present a case of myelomeningocele with associated Chiari II malformation that was diagnosed for the first time in the third trimester in a 32-year-old pregnant woman. Previously performed ultrasound at 12 weeks gestation was unremarkable. Considering the prognosis of the detected anomalies, the patient opted for medical termination of the pregnancy after receiving thorough counselling. Third trimester anomaly screening should be encouraged as part of routine third trimester scans; particularly in women who report late for antenatal care and those who lack periconceptional folate supplementation.
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Affiliation(s)
- Joseph Arkorful
- Department of Imaging Technology and Sonography, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Samuel Ackom
- Department of Imaging Technology and Sonography, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Emmanuel Fiagbedzi
- Department of Imaging Technology and Sonography, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Eric Obour
- Department of Imaging Technology and Sonography, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Juliana Nyamson
- Department of Imaging Technology and Sonography, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Ishmael Nii Ofori
- Department of Imaging Technology and Sonography, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
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Xu P, Liu B, Chen H, Wang H, Guo X, Yuan J. PAHs as environmental pollutants and their neurotoxic effects. Comp Biochem Physiol C Toxicol Pharmacol 2024; 283:109975. [PMID: 38972621 DOI: 10.1016/j.cbpc.2024.109975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 06/19/2024] [Accepted: 07/04/2024] [Indexed: 07/09/2024]
Abstract
Polycyclic aromatic hydrocarbons (PAHs), which are widely present in incompletely combusted air particulate matter <2.5 μm (PM2.5), tobacco and other organic materials, can enter the human body through various routes and are a class of environmental pollutants with neurotoxic effects. PAHs exposure can lead to abnormal development of the nervous system and neurobehavioral abnormalities in animals, including adverse effects on the nervous system of children and adults, such as a reduced learning ability, intellectual decline, and neural tube defects. After PAHs enter cells of the nervous system, they eventually lead to nervous system damage through mechanisms such as oxidative stress, DNA methylation and demethylation, and mitochondrial autophagy, potentially leading to a series of nervous system diseases, such as Alzheimer's disease. Therefore, preventing and treating neurological diseases caused by PAHs exposure are particularly important. From the perspective of the in vitro and in vivo effects of PAHs exposure, as well as its effects on human neurodevelopment, this paper reviews the toxic mechanisms of action of PAHs and the corresponding prevention and treatment methods to provide a relevant theoretical basis for preventing the neurotoxicity caused by PAHs, thereby reducing the incidence of diseases related to the nervous system and protecting human health.
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Affiliation(s)
- Peixin Xu
- Department of Clinical Laboratory, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Bingchun Liu
- Stem Cell Laboratory / Central Laboratory Of Organ Transplantation / Inner Mongolia Autonomous Region Engineering Laboratory For Genetic Test And Research Of Tumor Cells, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Hong Chen
- Department of Clinical Laboratory, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Huizeng Wang
- Department of Clinical Laboratory, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Xin Guo
- Department of Clinical Laboratory, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Jianlong Yuan
- Department of Clinical Laboratory, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China.
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Gandelman-Marton R, Theitler J. Folic acid supplementation in women of childbearing age with epilepsy: No association with type or number of antiepileptic drugs. Birth Defects Res 2024; 116:e2283. [PMID: 38093463 DOI: 10.1002/bdr2.2283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/21/2023] [Accepted: 11/15/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND For over two decades, a daily folic acid (FA) supplementation has been recommended for women of childbearing age with epilepsy. This recommendation is based on evidence that FA administration before conception and during pregnancy can decrease the risk of fetal malformations in the general population, improve cognitive development, and reduce the risk of autistic traits in children exposed in utero to antiepileptic drugs (AEDs). OBJECTIVE The aim of this study was to evaluate FA supplementation rate in nonpregnant women of childbearing age with epilepsy and its relation to AED type and number. METHODS We retrospectively reviewed the computerized database and the medical records of all the women who had a first visit to our outpatient epilepsy clinic (Shamir-Assaf Harofeh Medical Center, Zerifin, Israel) during a 10-year period (2012-2021). RESULTS Only 61 (22%) of 282 nonpregnant women of childbearing age with epilepsy treated with AEDs received FA supplementation. Ninety-two (33%) of the women were treated with AED polytherapy, and 41 (15%) received valproic acid in monotherapy or polytherapy. FA supplementation rate was higher in women aged ≤40 versus >40 (25% vs. 8.5%) (p = .004). No correlation was found between FA supplementation and AED type or number. CONCLUSIONS FA supplementation rate was low and was unaffected by AED treatment. Patient and physician-targeted interventions should be implemented to increase FA prescription and patient adherence.
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Affiliation(s)
- Revital Gandelman-Marton
- Neurology Department, Shamir-Assaf Harofeh Medical Center, Zerifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacques Theitler
- Neurology Department, Shamir-Assaf Harofeh Medical Center, Zerifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Hassan AA, Hassan AM, Bashir AO, Adam GK, AlHabardi N, Adam I. Periconceptional folic acid usage and its associated factors in eastern Sudan: A cross-sectional study. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057231224176. [PMID: 38279794 PMCID: PMC10822062 DOI: 10.1177/17455057231224176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/08/2023] [Accepted: 12/15/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND Several countries poorly adhere to the World Health Organization's recommendation of folic acid supplementation in the periconceptional period, especially in limited-resource settings. OBJECTIVE The objective of this study was to investigate the prevalence of and the factors associated with folic acid usage in the periconceptional period among pregnant women at Gadarif Maternity Hospital in eastern Sudan. STUDY DESIGN This is a cross-sectional study. METHODS This study was conducted in eastern Sudan from April to September 2022. A total of 720 pregnant women in their first trimester were enrolled. The sociodemographic characteristics and clinical and obstetrical data of pregnant women in their first trimester were assessed using a face-to-face questionnaire. In addition, multivariate regression analysis was performed. RESULTS In this study, the median (interquartile range) of the age and gravidity of the enrolled women was 26.3 (24.14-29.52) years and 2 (1-4), respectively. Of these 720 women, 423 (58.8%) used folic acid during the periconceptional period, while 27 (3.7%) women used folic acid in the preconceptional period. None of the investigated factors (age, residence, education, employment, body mass index, or gravidity) were associated with periconceptional use of folic acid. CONCLUSION The study revealed a low prevalence of folic acid usage in preconceptional period among pregnant women in eastern Sudan. Additional efforts are needed to promote folic acid usage in the preconceptional period as well as in the first trimester.
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Affiliation(s)
| | - Albagir M Hassan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Umm Al-Qura University, Mekkah, Saudi Arabia
| | - Amal O Bashir
- Faculty of Public Health and Health Informatics, Umm Al-Qura University, Mekkah, Saudi Arabia
| | - Gamal K Adam
- Faculty of Medicine, Gadarif University, Gadarif, Sudan
| | - Nadiah AlHabardi
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
| | - Ishag Adam
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
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Fardous AM, Heydari AR. Uncovering the Hidden Dangers and Molecular Mechanisms of Excess Folate: A Narrative Review. Nutrients 2023; 15:4699. [PMID: 37960352 PMCID: PMC10648405 DOI: 10.3390/nu15214699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/26/2023] [Accepted: 11/03/2023] [Indexed: 11/15/2023] Open
Abstract
This review delves into the intricate relationship between excess folate (vitamin B9) intake, especially its synthetic form, namely, folic acid, and its implications on health and disease. While folate plays a pivotal role in the one-carbon cycle, which is essential for DNA synthesis, repair, and methylation, concerns arise about its excessive intake. The literature underscores potential deleterious effects, such as an increased risk of carcinogenesis; disruption in DNA methylation; and impacts on embryogenesis, pregnancy outcomes, neurodevelopment, and disease risk. Notably, these consequences stretch beyond the immediate effects, potentially influencing future generations through epigenetic reprogramming. The molecular mechanisms underlying these effects were examined, including altered one-carbon metabolism, the accumulation of unmetabolized folic acid, vitamin-B12-dependent mechanisms, altered methylation patterns, and interactions with critical receptors and signaling pathways. Furthermore, differences in the effects and mechanisms mediated by folic acid compared with natural folate are highlighted. Given the widespread folic acid supplementation, it is imperative to further research its optimal intake levels and the molecular pathways impacted by its excessive intake, ensuring the health and well-being of the global population.
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Affiliation(s)
- Ali M. Fardous
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI 48202, USA;
| | - Ahmad R. Heydari
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI 48202, USA;
- Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI 48202, USA
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Petersen JM, Smith-Webb RS, Shaw GM, Carmichael SL, Desrosiers TA, Nestoridi E, Darling AM, Parker SE, Politis MD, Yazdy MM, Werler MM. Periconceptional intakes of methyl donors and other micronutrients involved in one-carbon metabolism may further reduce the risk of neural tube defects in offspring: a United States population-based case-control study of women meeting the folic acid recommendations. Am J Clin Nutr 2023; 118:720-728. [PMID: 37661108 PMCID: PMC10624769 DOI: 10.1016/j.ajcnut.2023.05.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/23/2023] [Accepted: 05/31/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Neural tube defects (NTDs) still occur among some women who consume 400 μg of folic acid for prevention. It has been hypothesized that intakes of methyl donors and other micronutrients involved in one-carbon metabolism may further protect against NTDs. OBJECTIVES To investigate whether intakes of vitamin B6, vitamin B12, choline, betaine, methionine, thiamine, riboflavin, and zinc, individually or in combination, were associated with NTD risk reduction in offspring of women meeting the folic acid recommendations. METHODS Data were from the National Birth Defects Prevention Study (United States population-based, case-control). We restricted deliveries between 1999 and 2011 with daily periconceptional folic acid supplementation or estimated dietary folate equivalents ≥400 μg. NTD cases were live births, stillbirths, or terminations affected by spina bifida, anencephaly, or encephalocele (n = 1227). Controls were live births without a major birth defect (n = 7095). We categorized intake of each micronutrient as higher or lower based on a combination of diet (estimated from a food frequency questionnaire) and periconceptional vitamin supplementation. We estimated NTD associations for higher compared with lower intake of each micronutrient, individually and in combination, expressed as odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for age, race/ethnicity, education, and study center. RESULTS NTD associations with each micronutrient were weak to modest. Greater NTD reductions were observed with concurrent higher-amount intakes of multiple micronutrients. For instance, NTD odds were ∼50% lower among participants with ≥4 micronutrients with higher-amount intakes than among participants with ≤1 micronutrient with higher-amount intake (adjusted OR: 0.53; 95% CI: 0.33, 0.86). The strongest reduction occurred with concurrent higher-amount intakes of vitamin B6, vitamin B12, choline, betaine, and methionine (adjusted OR: 0.26; 95% CI: 0.09, 0.77) compared with ≤1 micronutrient with higher-amount intake. CONCLUSIONS Our findings support that NTD prevention, in the context of folic acid fortification, could be augmented with intakes of methyl donors and other micronutrients involved in folate metabolism.
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Affiliation(s)
- Julie M Petersen
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States; Massachusetts Center for Birth Defects Research and Prevention, Massachusetts Department of Public Health, Boston, MA, United States.
| | - Rashida S Smith-Webb
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Gary M Shaw
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - Suzan L Carmichael
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States; Center for Population Health Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Tania A Desrosiers
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Eirini Nestoridi
- Massachusetts Center for Birth Defects Research and Prevention, Massachusetts Department of Public Health, Boston, MA, United States
| | - Anne Marie Darling
- Massachusetts Center for Birth Defects Research and Prevention, Massachusetts Department of Public Health, Boston, MA, United States
| | - Samantha E Parker
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Maria D Politis
- Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Mahsa M Yazdy
- Massachusetts Center for Birth Defects Research and Prevention, Massachusetts Department of Public Health, Boston, MA, United States
| | - Martha M Werler
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
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Martinez H, Benavides-Lara A, Arynchyna-Smith A, Ghotme KA, Arabi M, Arynchyn A. Global strategies for the prevention of neural tube defects through the improvement of folate status in women of reproductive age. Childs Nerv Syst 2023; 39:1719-1736. [PMID: 37103517 DOI: 10.1007/s00381-023-05913-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/28/2023] [Indexed: 04/28/2023]
Abstract
INTRODUCTION Neural tube defects represent a global public health problem, mainly in countries where effective prevention strategies are not yet in place. The global prevalence of neural tube defects is estimated at 18.6/10,000 (uncertainty interval: 15.3-23.0) live births, where ~ 75% of cases result in under-five mortality. Most of the mortality burden is in low- and middle-income countries. The main risk factor for this condition is insufficient folate levels in women of reproductive age. METHODS This paper reviews the extent of the problem, including the most recent global information on folate status in women of reproductive age and the most recent estimates of the prevalence of neural tube defects. Additionally, we provide an overview of the available interventions worldwide to reduce the risk of neural tube defects by improving folate status in the population, including dietary diversification, supplementation, education, and fortification. RESULTS Large-scale food fortification with folic acid is the most successful and effective intervention to reduce the prevalence of neural tube defects and associated infant mortality. This strategy requires the coordination of several sectors, including governments, the food industry, health services providers, the education sector, and entities that monitor the quality of the service processes. It also requires technical knowledge and political will. An international collaboration between governmental and non-governmental organizations is essential to succeed in saving thousands of children from a disabling but preventable condition. DISCUSSION We propose a logical model for building a national-level strategic plan for mandatory LSFF with folic acid and explain the actions needed for promoting sustainable system-level change.
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Affiliation(s)
- Homero Martinez
- Global Technical Services, Nutrition International, 180 Elgin St. suite 1000, ON, Ottawa, Canada.
- Hospital Infantil de México Federico Gómez, Mexico City, Mexico.
| | - Adriana Benavides-Lara
- Costa Rican Birth Defects Register Center (CREC), Costa Rican Institute of Research and Education in Nutrition and Health (INCIENSA), Cartago, Costa Rica
| | - Anastasia Arynchyna-Smith
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kemel A Ghotme
- Translational Neuroscience Research Lab, Faculty of Medicine, Universidad de La Sabana, Chia, Colombia
- Department of Neurosurgery, Fundación Santa Fe de Bogota, Bogota, Colombia
| | - Mandana Arabi
- Global Technical Services, Nutrition International, 180 Elgin St. suite 1000, ON, Ottawa, Canada
| | - Alexander Arynchyn
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Perera N, Rudland VL, Simmons D, Price SAL. Folate Supplementation in Women with Pre-Existing Diabetes. Nutrients 2023; 15:nu15081879. [PMID: 37111098 PMCID: PMC10145371 DOI: 10.3390/nu15081879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
Folate supplementation in the periconceptual period is the standard of care for the prevention of neural tube defects. To support dietary folate intake, some countries have introduced mandatory folic acid fortification of food products. Robust evidence supports the additional use of a low-dose folic acid supplement (0.4 mg/day) in all women from 2-3 months preconception until the end of the 12th week of gestation. For women with pre-existing diabetes, high-dose folic acid supplementation (5 mg/day) is recommended in some, but not all international guidelines. The recommendation is made based on consensus opinion and reflects the increased risk of neural tube defects in pregnant women with pre-existing diabetes. However, there is limited evidence to clarify the high-risk groups that benefit from high-dose folic acid versus those that do not. There are also some data to suggest that high-dose folic acid may be harmful to mothers and offspring, although this issue remains controversial. This narrative review explores the evidence that supports the recommendation for women with pre-existing diabetes to take high-dose folic acid in the periconceptual period. It explores the potential benefits of high-dose supplemental folate beyond the prevention of neural tube defects, and also the potential adverse impacts of high-dose folate use. These topics are considered with a specific focus on the issues that are pertinent to women with pre-existing diabetes. Based on the available evidence, a pragmatic approach to the use of folic acid supplements in women with pre-existing diabetes during the periconception period is suggested. The need for comprehensive preconception care that optimises glycaemic control and addresses other modifiable risk factors before pregnancy is emphasized.
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Affiliation(s)
- Nayomi Perera
- Department of Obstetric Medicine, Royal Women's Hospital, Flemington Rd, North Melbourne, VIC 3051, Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Grattan St, Parkville, VIC 3010, Australia
| | - Victoria L Rudland
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - David Simmons
- Macarthur Clinical School, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Sarah A L Price
- Department of Obstetric Medicine, Royal Women's Hospital, Flemington Rd, North Melbourne, VIC 3051, Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Grattan St, Parkville, VIC 3010, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Grattan St, Parkville, VIC 3010, Australia
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Msheik A, Abbass D, Bayram M, Awde A, Al Mokdad Z. Cervical Myelocystocele: A One-in-50,000 Congenital Abnormality of the Spinal Cord. Cureus 2023; 15:e37278. [PMID: 37168187 PMCID: PMC10165719 DOI: 10.7759/cureus.37278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 05/13/2023] Open
Abstract
Neural tube defects are a group of birth defects that affect the development of the spinal cord and brain. Myelomeningocele is a type of neural tube defect that results in the protrusion of the spinal cord and meninges through a defect in the vertebral column. While myelomeningocele is a relatively rare condition, cervical myelomeningocele is extremely uncommon. The condition can lead to various neurological problems and atrophies and is typically diagnosed in the first trimester of pregnancy using an ultrasound examination. Surgical intervention is typically recommended to repair the affected vertebral column. In this report, we describe the case of a four-month-old baby boy who was diagnosed with a cervical myelocystocele and successfully treated surgically. The patient had an excellent postoperative status, and this case highlights the importance of early diagnosis and intervention in the management of this rare condition.
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Affiliation(s)
- Ali Msheik
- Neurological Surgery, Zahraa Hospital University Medical Center, Beirut, LBN
- Neurological Surgery, Lebanese University Faculty of Medical Sciences, Hadath, LBN
| | - Daniel Abbass
- Neurological Surgery, Al Rassoul Al-Aazam Hospital, Beirut, LBN
| | - Mohamad Bayram
- Neurological Surgery, Al Rassoul Al-Aazam Hospital, Beirut, LBN
| | - Ahmad Awde
- Neurosurgery, Endovascular Neurosurgery, Al Rassoul Al-Aazam Hospital, Beirut, LBN
| | - Zeinab Al Mokdad
- Medical Sciences, Public Health, Lebanese University Faculty of Medical Sciences, Hadath, LBN
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Negrato CA, Marques PR, Leite HB, Torigoe CN, Silva BF, Costa K, Kamei JM, Zampa CL, Toni ACRG, Pereira ICGS, Heinzelmann GL, Zajdenverg L. Glycemic and nonglycemic mechanisms of congenital malformations in hyperglycemic pregnancies: a narrative review. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:908-918. [PMID: 36191262 PMCID: PMC10118772 DOI: 10.20945/2359-3997000000521] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Congenital malformations are more frequently found among children born to mothers with diabetes than in the background population. There are several complex mechanisms involved in the development of congenital malformations in the offspring of mothers with hyperglycemia, such as the overexpression of glucose transporters (GLUTs) 1 and 2, the increased activity of the hexosamine biosynthetic pathway and the reduced expression of the PAX3 gene with a consequent increase in p53 protein expression. These alterations can lead to increased glucose and free radical concentrations in the embryo, thus promoting the process of apoptosis and causing malformation. The most frequent malformations found in the offspring of mothers with diabetes are heart and neural tube defects, urinary tract and kidney malformations, and cleft lip with or without cleft palate. Strict glycemic control should be obtained before and during pregnancy, aiming to avoid or minimize the risk of congenital malformations in the offspring. Beyond hyperglycemia, several factors may also be associated with increased risks of malformations in the offspring of these women, such as obesity, multiple pregnancies, advanced maternal age, folic acid deficiency, use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers, assisted reproduction techniques, and exposure to different types of environmental pollutants.
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Wilson R, O'Connor D. Maternal folic acid and multivitamin supplementation: International clinical evidence with considerations for the prevention of folate-sensitive birth defects. Prev Med Rep 2021; 24:101617. [PMID: 34976673 PMCID: PMC8684027 DOI: 10.1016/j.pmedr.2021.101617] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 10/18/2021] [Accepted: 10/22/2021] [Indexed: 12/17/2022] Open
Abstract
More evidence is available for maternal intake, absorption, distribution, tissue specific concentrations, and pregnancy outcomes with folic acid (fortification/supplementation) during preconception - first trimester. This Quality Improvement prevention review used expert guidelines/opinions, systematic reviews, randomized control trials/controlled clinical trials, and observational case control/case series studies, published in English, from 1990 to August 2021. Optimization for an oral maternal folic acid supplementation is difficult because it relies on folic acid dose, type of folate supplement, bio-availability of the folate from foods, timing of supplementation initiation, maternal metabolism/genetic factors, and many other factors. There is continued use of high dose pre-food fortification 'RCT evidenced-based' folic acid supplementation for NTD recurrence pregnancy prevention. Innovation requires preconception and pregnancy use of 'carbon one nutrient' supplements (folic acid, vitamin B12, B6, choline), using the appropriate evidence, need to be considered. The consideration and adoption of directed personalized approaches for maternal complex risk could use serum folate testing for supplementation dosing choice. Routine daily folic acid dosing for low-risk women should consider a multivitamin with 0.4 mg of folic acid starting 3 months prior to conception until completion of breastfeeding. Routine folic acid dosing or preconception measurement of maternal serum folate (after 4-6 weeks of folate supplementation) could be considered for maternal complex risk group with genetic/medical/surgical co-morbidities. These new approaches for folic acid oral supplementation are required to optimize benefit (decreasing folate sensitive congenital anomalies; childhood morbidity) and minimizing potential maternal and childhood risk.
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Affiliation(s)
- R.D. Wilson
- Cumming School of Medicine, Department of Obstetrics and Gynecology, University of Calgary, FMC NT 435, 1403 29 St NW, Calgary, Alberta, Canada
| | - D.L. O'Connor
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
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12
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Jain RB. Impact of the increasing concentrations of selected perfluoroalkyl acids on the observed concentrations of red blood cell folate among US adults aged ≥20 years. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:52357-52369. [PMID: 34009570 DOI: 10.1007/s11356-021-14454-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/13/2021] [Indexed: 06/12/2023]
Abstract
For the first time (N = 6291), a study was undertaken to estimate associations between the concentratio ns of red blood cell folate (RBCF) and concentration of six perfluoroalkyl acids (PFAAs), namely, perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), perfluorodecanoic acid (PFDA), perfluorononanoic acid (PFNA), and perfluoroundecanoic acid (PFUnDA) for US adults aged ≥20 years by fitting regression models for the data from National Health and Nutrition Examination Survey for 2007-2014. In almost consistent fashion, increasing concentrations of PFAAs were associated with decreasing concentrations of RBCF. For the total population, for a 10% increase in the concentrations of PFOA, PFOS, PFDA, PFHxS, PFNA, and PFUnDA, percent decreases in RBCF concentrations were found to be 0.33%, 0.66%, 0.83%, 0.16%, 0.89%, and 0.43%, respectively. RBCF concentrations of PFAAs were found to be 1104, 1042, 100, and 936 nmol/L across the four quartiles of PFOS; 112, 1068, 1009, and 948 nmol/L across the four quartiles of PFDA; 1125, 1054, 1005, and 967 nmol/L across the four quartiles of PFNA; and 1099, 1094, 989, and 952 nmol/L across the four quartiles of PFUnDA. Perfluorinated carboxylic acids with carbon chain length > 8 decreased concentrations of RBCF to a greater degree than those carbon chain length ≤ 8. Perfluorinated chemicals with a sulfonic group with carbon chain length > 6 decreased concentrations of RBCF to a greater degree than those carbon chain length ≤ 6. The degree to which concentrations of RBCF decrease varied by age, gender, and race/ethnicity. Non-Hispanic blacks as compared to non-Hispanic whites and Hispanics had the lowest decreases in RBCF concentrations. Mechanisms responsible for negative associations between RBCF and PFAA concentrations are not known and will need to be researched further.
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Petersen JM, Ranker LR, Barnard-Mayers R, MacLehose RF, Fox MP. A systematic review of quantitative bias analysis applied to epidemiological research. Int J Epidemiol 2021; 50:1708-1730. [PMID: 33880532 DOI: 10.1093/ije/dyab061] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Quantitative bias analysis (QBA) measures study errors in terms of direction, magnitude and uncertainty. This systematic review aimed to describe how QBA has been applied in epidemiological research in 2006-19. METHODS We searched PubMed for English peer-reviewed studies applying QBA to real-data applications. We also included studies citing selected sources or which were identified in a previous QBA review in pharmacoepidemiology. For each study, we extracted the rationale, methodology, bias-adjusted results and interpretation and assessed factors associated with reproducibility. RESULTS Of the 238 studies, the majority were embedded within papers whose main inferences were drawn from conventional approaches as secondary (sensitivity) analyses to quantity-specific biases (52%) or to assess the extent of bias required to shift the point estimate to the null (25%); 10% were standalone papers. The most common approach was probabilistic (57%). Misclassification was modelled in 57%, uncontrolled confounder(s) in 40% and selection bias in 17%. Most did not consider multiple biases or correlations between errors. When specified, bias parameters came from the literature (48%) more often than internal validation studies (29%). The majority (60%) of analyses resulted in >10% change from the conventional point estimate; however, most investigators (63%) did not alter their original interpretation. Degree of reproducibility related to inclusion of code, formulas, sensitivity analyses and supplementary materials, as well as the QBA rationale. CONCLUSIONS QBA applications were rare though increased over time. Future investigators should reference good practices and include details to promote transparency and to serve as a reference for other researchers.
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Affiliation(s)
- Julie M Petersen
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Lynsie R Ranker
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Ruby Barnard-Mayers
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Richard F MacLehose
- Division of Epidemiology and Community Health, University of Minnesota, School of Public Health, Minneapolis, MN, USA
| | - Matthew P Fox
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.,Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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Buschur EO, Polsky S. Type 1 Diabetes: Management in Women From Preconception to Postpartum. J Clin Endocrinol Metab 2021; 106:952-967. [PMID: 33331893 DOI: 10.1210/clinem/dgaa931] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Indexed: 01/11/2023]
Abstract
CONTEXT This review presents an up-to-date summary on management of type 1 diabetes mellitus (T1DM) among women of reproductive age and covers the following time periods: preconception, gestation, and postpartum. EVIDENCE ACQUISITION A systematic search and review of the literature for randomized controlled trials and other studies evaluating management of T1DM before pregnancy, during pregnancy, and postpartum was performed. EVIDENCE SYNTHESIS Preconception planning should begin early in the reproductive years for young women with T1DM. Preconception and during pregnancy, it is recommended to have near-normal glucose values to prevent adverse maternal and neonatal outcomes, including fetal demise, congenital anomaly, pre-eclampsia, macrosomia, neonatal respiratory distress, neonatal hyperbilirubinemia, and neonatal hypoglycemia. CONCLUSION Women with T1DM can have healthy, safe pregnancies with preconception planning, optimal glycemic control, and multidisciplinary care.
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Affiliation(s)
| | - Sarit Polsky
- The University of Colorado Barbara Davis Center, Denver, CO, USA
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15
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Vladutiu CJ, Kandasamy V, Ahrens KA. Folate Levels by Time Since Last Live Birth Among U.S. Women, 2007-2016. J Womens Health (Larchmt) 2020; 30:1204-1212. [PMID: 33236942 DOI: 10.1089/jwh.2020.8428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: Folate depletion in the postpartum period may increase the risk of adverse pregnancy outcomes for women with a short interpregnancy interval following a live birth. We sought to examine folate levels by time since last live birth among U.S. women. Materials and Methods: Data were from 4,809 U.S. women, 20-44 years of age, participating in the National Health and Nutrition Examination Survey, 2007-2016. Red blood cell (RBC) folate was measured using microbiological assay on whole blood samples. Dietary folate intake and folic acid supplementation were measured during a 24-hour dietary recall. Prevalence of supplementation by time since last live birth was estimated from logistic regression models; mean levels of RBC folate and mean intake of dietary folate equivalent were estimated from linear regression models. Models were adjusted for maternal sociodemographic characteristics. Results: In adjusted models, supplementation (±standard error) was highest among women in the first year postpartum (31.7% ± 3.2) compared with nulliparous women (23.7% ± 1.9) and those 2-3 years (15.6% ± 1.9) and ≥3 years (18.4% ± 1.6) after last live birth. Mean RBC folate was highest among women in the first year postpartum, regardless of supplementation, with overall mean levels of 606 ± 15 ng/mL, compared with 484 ± 9, 477 ± 11, and 474 ± 7 among women in the aforementioned groups, respectively. Mean dietary folate intake was also highest among postpartum women: 542 ± 23 mcg/day, compared with 474 ± 12, 486 ± 21, and 467 ± 12. Conclusions: Folate levels are highest in the first year postpartum compared with other time periods within a woman's reproductive lifespan. These findings do not support the idea that postpartum U.S. women are depleted in folate, on average.
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Affiliation(s)
- Catherine J Vladutiu
- Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland, USA
| | - Veni Kandasamy
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Katherine A Ahrens
- Muskie School of Public Service, University of Southern Maine, Portland, Maine, USA
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16
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McAuliffe FM, Killeen SL, Jacob CM, Hanson MA, Hadar E, McIntyre HD, Kapur A, Kihara AB, Ma RC, Divakar H, Hod M. Management of prepregnancy, pregnancy, and postpartum obesity from the FIGO Pregnancy and Non-Communicable Diseases Committee: A FIGO (International Federation of Gynecology and Obstetrics) guideline. Int J Gynaecol Obstet 2020; 151 Suppl 1:16-36. [PMID: 32894590 PMCID: PMC7590083 DOI: 10.1002/ijgo.13334] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, National Maternity Hospital, University College Dublin, Dublin, Ireland
| | - Sarah Louise Killeen
- UCD Perinatal Research Centre, School of Medicine, National Maternity Hospital, University College Dublin, Dublin, Ireland
| | - Chandni Maria Jacob
- Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Mark A Hanson
- Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Eran Hadar
- Maternal-Fetal Medicine Unit, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - H David McIntyre
- Mater Research, The University of Queensland, South Brisbane, Qld, Australia
| | - Anil Kapur
- World Diabetes Foundation, Bagsvaerd, Denmark
| | - Anne B Kihara
- African Federation of Obstetricians and Gynaecologists, Khartoum, Sudan.,Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Ronald C Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - Moshe Hod
- Mor Comprehensive Women's Health Care Center, Tel Aviv, Israel.,FIGO Pregnancy and Non-Communicable Diseases Committee, International Federation of Gynecology and Obstetrics, London, UK
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17
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Ishikawa T, Obara T, Jin K, Nishigori H, Miyakoda K, Akazawa M, Nakasato N, Yaegashi N, Kuriyama S, Mano N. Folic acid prescribed to prenatal and postpartum women who are also prescribed antiepileptic drugs in Japan: Data from a health administrative database. Birth Defects Res 2020; 112:1224-1233. [PMID: 32613756 DOI: 10.1002/bdr2.1748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/04/2020] [Accepted: 06/07/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the prevalence of folic acid (FA) prescription to prenatal and postpartum women who have also been prescribed antiepileptic drugs (AED) in Japan. METHODS The data set used in this study included women covered by health insurance between 2005 and 2016. The prevalence of FA prescriptions between 180 days before pregnancy and 180 days postpartum was determined from a large administrative database, with the FA prescription classified according to dose and timing. RESULTS For 33,941 women meeting our eligibility criteria, the mean maternal age at delivery was 32.3 years. At least one AED was prescribed to 225 of 33,941 women between 180 days before pregnancy and 180 days postpartum. FA was prescribed to 32 of 225 women (14.2%) during the same period. FA was prescribed to 8.8% of women with AED within 90 days before pregnancy and to 19.8% during the first trimester. FA was prescribed to 10.9% during the first 30 days after conception, all of whom were prescribed FA before the pregnancy. The maximum FA dose prescribed within 90 days before pregnancy was 5 mg/day for 5 of 12 women (41.7%) and >5 mg/day for 4 of 12 women (33.3%). The maximum FA dose prescribed during the first trimester was 5 mg/day for 14 of 22 women (63.6%) and >5 mg/day for 8 of 22 women (36.4%). CONCLUSIONS The concurrent prescription of FA with AEDs in Japan was an uncommon therapeutic approach both before and during pregnancy.
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Affiliation(s)
- Tomofumi Ishikawa
- Laboratory of Clinical Pharmacy, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Miyagi, Japan
| | - Taku Obara
- Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Miyagi, Japan.,Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan.,Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hidekazu Nishigori
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
| | - Keiko Miyakoda
- Clinical & Translational Research Center, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Manabu Akazawa
- Department of Public Health and Epidemiology, Meiji Pharmaceutical University, Tokyo, Japan
| | - Nobukazu Nakasato
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Nobuo Yaegashi
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan.,Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Department of Gynecology and Obstetrics, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shinichi Kuriyama
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan.,Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,International Research Institute of Disaster Science, Tohoku University, Sendai, Miyagi, Japan
| | - Nariyasu Mano
- Laboratory of Clinical Pharmacy, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Miyagi, Japan.,Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Miyagi, Japan
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