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Arynchyna-Smith A, Arynchyn AN, Kancherla V, Anselmi K, Aban I, Hoogeveen RC, Steffen LM, Becker DJ, Kulczycki A, Carlo WA, Blount JP. Improvement of serum folate status in the US women of reproductive age with fortified iodised salt with folic acid (FISFA study). Public Health Nutr 2024; 27:e218. [PMID: 39445493 DOI: 10.1017/s1368980024001903] [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] [Indexed: 10/25/2024]
Abstract
OBJECTIVE Mandatory folic acid fortification of enriched grains has reduced neural tube defect prevalence in several countries. We examined salt as an additional vehicle for folic acid fortification. The primary objective was to examine the change in serum folate concentration after 1 month of consumption of fortified iodised salt with folic acid (FISFA) among women of reproductive age. The secondary objectives were to examine (1) the feasibility of implementing FISFA intervention and (2) the acceptability of FISFA. DESIGN We conducted a pre–post intervention study (January–April 2023). Participants received a FISFA saltshaker with the study salt (1 g of sodium chloride salt fortified with 100 mcg of folic acid) to use instead of regular table salt for 1 month. Serum folate was measured using the Elecsys Folate-III immunoassay method at baseline and 1-month endpoint. Change in serum folate was assessed using a two-tailed Wilcoxon signed rank test for paired samples. SETTING Metropolitan city, Southern USA. PARTICIPANTS Non-pregnant, 18–40-year-old women who lived alone/with a partner. RESULTS Thirty-two eligible women consented to participate, including eleven non-Hispanic-White, eleven non-Hispanic-Black and ten Hispanic. Post-intervention, there was a significant increase in median serum folate concentration of 1·40 nmol/l (IQR 0·74–2·05; P < 0·001) from 24·08 nmol/l to 25·96 nmol/l in an analytical sample of n 29. An increase was seen in 28/29 (93 %) participants. Feasibility: 100 % study consent and compliance. FISFA acceptability: 25 d average use; 1·28 g average daily intake; 96·7 % and 90 % reported taste and colour of FISFA as highly acceptable, respectively. CONCLUSIONS FISFA is an effective approach to increasing serum folate concentrations among women of reproductive age. Findings should be replicated in a larger study.
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Affiliation(s)
- Anastasia Arynchyna-Smith
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, 1600 7th Ave South, JFL 400, Birmingham, AL35233, USA
| | - Alexander N Arynchyn
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vijaya Kancherla
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kenneth Anselmi
- Department of Marketing and Supply Chain Management, College of Business, East Carolina University, Greenville, NC, USA
| | - Inmaculada Aban
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ron C Hoogeveen
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Lyn M Steffen
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - David J Becker
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrzej Kulczycki
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Waldemar A Carlo
- Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeffrey P Blount
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, 1600 7th Ave South, JFL 400, Birmingham, AL35233, USA
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Escobar VAP, Wyant WA, Debs LH, Jamshidi A, Kiehna EN, McCrea HJ. Evaluating the potential role of determinants of health on encephalocele patient outcomes - a combined retrospective study and systematic review. Childs Nerv Syst 2024; 40:1751-1763. [PMID: 38347306 DOI: 10.1007/s00381-024-06312-z] [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: 12/30/2023] [Accepted: 01/30/2024] [Indexed: 05/23/2024]
Abstract
INTRODUCTION To evaluate the outcomes and demographics of encephalocele patients who were born and received treatment in our neonatal ICU and conduct a PRISMA literature review. METHODS An Institutional Review Board (IRB)-approved retrospective cohort study was undertaken to investigate the results of treating encephalocele patients at Jackson Memorial Hospital (JMH) from 1998 to 2022. The study focused on assessing outcomes and the impact of maternal socioeconomic factors, such as religion, age, and education, along with the timing of diagnosis, in connection with a systematic review. RESULTS A total of 20 encephalocele patients were identified (13 females and 7 males), with 15 having available medical records for review. Most of these cases involved occipital encephaloceles (73.3%). Maternal ages at the time of delivery ranged from 15 to 42 years, with a mean age of 27.3 years. The average gestational age at birth was 37 weeks. Ten cases had a prenatal diagnosis documented, occurring between 12 and 24.5 weeks of gestation. Three of the surviving patients had records of prenatal counseling that included discussions about termination. No infections were reported. Among the 15 cases, 11 patients (73.3%) were alive at the last follow-up, with a mean age at follow-up of 4.12 years, ranging from 6 weeks to 15 years post-birth. Hydrocephalus was noted in 26.7%. Only 1 mother had completed high school. Most mothers were either on Medicaid (9 patients) or uninsured (3 patients), with only 3 having commercial insurance. Religious affiliations varied among the mothers, with 14 out of 15 identifying with a particular religion. The systematic review identified 22 articles from various countries, with 11 articles meeting the inclusion criteria for qualitative analysis. These articles revealed potential maternal risk factors for encephaloceles, including low-nutrient diets, inadequate folic acid intake, young maternal age, advanced maternal age, low socioeconomic status, and limited educational attainment. CONCLUSIONS In the twenty-first century, there is a positive trend in the survival rates of children born with encephalocele. However, maternal factors such as low socioeconomic status and limited educational attainment remain prominent, affecting their ability to access timely prenatal care and impacting follow-up medical care for these children.
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Affiliation(s)
- Victoria A Pinilla Escobar
- Department of Neurological Surgery, University of Miami Miller School of Medicine/Jackson Health System, 1095 NW 14th Terrace, Miami, FL, 33136, USA
| | - W Austin Wyant
- Department of Neurological Surgery, University of Miami Miller School of Medicine/Jackson Health System, 1095 NW 14th Terrace, Miami, FL, 33136, USA
| | - Luca H Debs
- Department of Neurological Surgery, Augusta University Medical Center, Augusta, GA, USA
| | - Aria Jamshidi
- Department of Neurological Surgery, University of Miami Miller School of Medicine/Jackson Health System, 1095 NW 14th Terrace, Miami, FL, 33136, USA
| | - Erin N Kiehna
- Department of Neurological Surgery, Novant Health, Charlotte, NC, USA
| | - Heather J McCrea
- Department of Neurological Surgery, University of Miami Miller School of Medicine/Jackson Health System, 1095 NW 14th Terrace, Miami, FL, 33136, USA.
- Department of Pediatrics, University of Miami Miller School of Medicine/Jackson Health System, Miami, FL, USA.
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Agrawal S, Hobson EV, Hart AR. Family experiences of antenatal counselling of spina bifida: a systematic review. Arch Dis Child Fetal Neonatal Ed 2023; 109:59-64. [PMID: 37433589 DOI: 10.1136/archdischild-2023-325391] [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: 01/26/2023] [Accepted: 06/28/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE To describe families' experiences of antenatal counselling of spina bifida. DESIGN Systematic review. METHODS MEDLINE, CINAHL, PsycINFO and Embase databases were searched using a combination of Medical Subject Headings and text/abstract terms. Case reports, survey results and qualitative interview data were included. The quality of research was evaluated using the Critical Appraisal Skills Programme checklist. RESULTS 8 papers were included. Families described shock and grief at diagnosis, with some immediately offered termination of pregnancy (TOP) even though they knew little about the condition. Positive and negative aspects of care were found. Teams that were gentle, kind and empathetic, who did not use jargon, and highlighted positive and negative aspects of the baby's life were seen favourably. Callous language, and overly negative or incorrect counselling was not, particularly if there was pressure to agree to TOP. Families based their decisions on how they would cope, the effect on siblings and the baby's likely quality of life. Prenatal surgery was viewed positively. The views of families who chose TOP, were happy with their care, partners, families, and the LGBTQ+ community were under-represented in the literature. CONCLUSIONS Unlike other conditions where limited data on outcome exist or the spectrum is genuinely broad, the outcomes of children with spina bifida is well described. Poor aspects of antenatal counselling were described frequently by families, and further work is needed to capture the full spectrum of views on antenatal counselling, how it can be improved, and what training and resources healthcare professionals need to perform it better.
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Affiliation(s)
- Shreya Agrawal
- The University of Sheffield Medical School, Sheffield, UK
| | - Esther V Hobson
- Department of Neurology, The University of Sheffield Institute for Translational Neuroscience, Sheffield, UK
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Jeffery M, Tai-MacArthur S, Shangaris P, Duggan M, Spencer J, Sankaran S. Trends in Termination of Pregnancy for Foetal Urological Abnormalities in England and Wales: a Cross-Sectional Study. Reprod Sci 2023; 30:1350-1358. [PMID: 36175615 PMCID: PMC10159963 DOI: 10.1007/s43032-022-01094-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/16/2022] [Indexed: 11/30/2022]
Abstract
The detection of developmental abnormalities in the foetus is considered an essential component of antenatal screening. Among the most frequently identified sonographically, and possibly one of the easiest recognised, are those affecting the urinary tract, with an incidence of 1-4 in 1000 pregnancies. As such, foetal urological abnormalities represent up to 30% of all prenatally diagnosed congenital anomalies. We analysed information recorded on the Health and Social Act 4 (HSA4) forms submitted to the Department of Health and Social Care (DHSC) for 2015 to 2019. There were 915 cases of termination of pregnancy for foetal urological anomaly between 2015 and 2019 in England and Wales, representing 0.09% of total abortions. There has been a steady increase in cases, from 186 in 2015 to 222 in 2018, followed by a more recent decline in 2019 to 172. All 915 cases were justified under Ground E of The Abortion Act 1967. Most terminations of pregnancy for foetal urological anomaly were carried out at 20 weeks gestation. Isolated urinary tract single diagnoses were the commonest, with megacystis being the most prevalent, followed by bilateral renal agenesis and bilateral cystic kidneys. Nearly a third of cases (32.2%) were performed in women aged 30-34 years, and almost 4/5 of women (78.7%) were of White ethnicity. Foetal urological abnormality is a complex issue affecting a significant minority of pregnant women. When severe abnormalities are detected by prenatal diagnosis, most women choose to terminate the pregnancy.
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Affiliation(s)
- Megan Jeffery
- GKT School of Biomedical Sciences, King's College London, Guy's Campus, Great Maze Pond, London, UK
| | - Sarah Tai-MacArthur
- School of Bioscience Education, King's College London, Guy's Campus, Great Maze Pond, London, UK
| | - Panicos Shangaris
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine King's College London, 10th Floor North Wing St Thomas' Hospital, London, SE1 7EH, UK.
- Department of Women and Children, Guy's and St Thomas' NHS Foundation Trust, London, UK.
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
| | | | | | - Srividhya Sankaran
- Department of Women and Children, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Department of Health and Social Care, London, UK
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Abstract
Neural tube defects (NTDs) are a group of relatively common fatal or severely disabling birth defects that result in about 300,000 cases a year world-wide. The search for a cause was elusive, but in 1991 it was shown that about 8 out of 10 cases are due to a lack of vitamin B9 (folate) and are therefore preventable. This article (i) describes the challenge in finding the cause; (ii) examines the reasons for the failure of many countries to introduce folic acid fortification of staple foods such as flour and rice; (iii) shows that countries that have introduced fortification failed to do so in a fully effective way; (iv) shows how current preventive polices are confusing, inconsistent and sub-optimal; (v) shows that the proposed UK folic acid fortification policy is expected to prevent about 1 out of 10 NTD cases only; and (vi) proposes a simple, fully effective fortification policy that would prevent about 8 out of 10 NTDs and avoid the need for women to start taking folic acid supplements before pregnancy, a policy that has been shown to fail because only a small percentage of women adopt this practice.
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Affiliation(s)
- Nicholas J Wald
- Professor of Preventive Medicine, Institute of Health Informatics, 4919University College London, London, UK
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