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Wiggs KK, Rickert ME, Quinn PD, D'Onofrio BM, Sara Öberg A. Specific Birth Defects Following Antiseizure Medications Used By Pregnant Women With Epilepsy. Neurol Clin Pract 2024; 14:e200289. [PMID: 38720955 PMCID: PMC11073867 DOI: 10.1212/cpj.0000000000200289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/30/2024] [Indexed: 06/25/2024]
Abstract
Background and Objectives Previous research has been limited in the comprehensive study of associations between the use of individual antiseizure medications (ASMs) in pregnancy and specific groups of birth defects, and systematic reviews and meta-analyses on the topic are limited by pooled samples and study designs. This study investigated birth defects related to ASM use in pregnancy in children born to women with epilepsy in Sweden over 20 years. Methods We used data from Swedish national registers to follow a cohort of 17,996 children born to women diagnosed with epilepsy any time before conception in Sweden from 1996 to 2016, following them through 2017. We examined maternal-reported use of the 4 most commonly reported ASMs: lamotrigine (n = 2,148, 11.9%), carbamazepine (n = 1,940, 10.8%), valproic acid (n = 1,043, 5.80%), and levetiracetam (n = 587, 3.26%). We identified birth defects using diagnoses recorded at the time of discharge from the hospital and inpatient and outpatient diagnoses recorded in the first year of life. Models were estimated in a stepped fashion: unadjusted, adjusted for covariates, among a subcohort born to women diagnosed 10 years before conception (n = 14,586), and restricted to monotherapy. Results Valproic acid use in pregnancy had the strongest and most widespread associations with birth defects in children, with carbamazepine also having links to several birth defects, including respiratory system and genital organ defects. Lamotrigine use in pregnancy was associated with cleft lip/palate and chromosomal abnormalities. Levetiracetam was most often used with other ASMs and preliminarily associated with many birth defects. Discussion Our findings support avoidance of valproic acid use in pregnancy whenever possible. Lamotrigine and carbamazepine may be safer alternatives. However, these medications were also associated with certain birth defects, including some not reported previously. We are among the first to examine the possible effects of levetiracetam use in pregnancy, though more research is needed to investigate this further.
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Affiliation(s)
- Kelsey K Wiggs
- Division of Behavioral Medicine and Clinical Psychology (KKW), Cincinnati Children's Hospital, Cincinnati, OH; Department of Psychological and Brain Sciences (KKW, MER, BMDO); Department of Applied Health Science (PDQ), School of Public Health, Indiana University-Bloomington, IN; Department of Medical Epidemiology and Biostatistics (BMDO, ASO), Karolinska Institutet, Stockholm, Sweden; and Department of Epidemiology (ASO), T.H. Chan School of Public Health, Harvard, Boston
| | - Martin E Rickert
- Division of Behavioral Medicine and Clinical Psychology (KKW), Cincinnati Children's Hospital, Cincinnati, OH; Department of Psychological and Brain Sciences (KKW, MER, BMDO); Department of Applied Health Science (PDQ), School of Public Health, Indiana University-Bloomington, IN; Department of Medical Epidemiology and Biostatistics (BMDO, ASO), Karolinska Institutet, Stockholm, Sweden; and Department of Epidemiology (ASO), T.H. Chan School of Public Health, Harvard, Boston
| | - Patrick D Quinn
- Division of Behavioral Medicine and Clinical Psychology (KKW), Cincinnati Children's Hospital, Cincinnati, OH; Department of Psychological and Brain Sciences (KKW, MER, BMDO); Department of Applied Health Science (PDQ), School of Public Health, Indiana University-Bloomington, IN; Department of Medical Epidemiology and Biostatistics (BMDO, ASO), Karolinska Institutet, Stockholm, Sweden; and Department of Epidemiology (ASO), T.H. Chan School of Public Health, Harvard, Boston
| | - Brian M D'Onofrio
- Division of Behavioral Medicine and Clinical Psychology (KKW), Cincinnati Children's Hospital, Cincinnati, OH; Department of Psychological and Brain Sciences (KKW, MER, BMDO); Department of Applied Health Science (PDQ), School of Public Health, Indiana University-Bloomington, IN; Department of Medical Epidemiology and Biostatistics (BMDO, ASO), Karolinska Institutet, Stockholm, Sweden; and Department of Epidemiology (ASO), T.H. Chan School of Public Health, Harvard, Boston
| | - A Sara Öberg
- Division of Behavioral Medicine and Clinical Psychology (KKW), Cincinnati Children's Hospital, Cincinnati, OH; Department of Psychological and Brain Sciences (KKW, MER, BMDO); Department of Applied Health Science (PDQ), School of Public Health, Indiana University-Bloomington, IN; Department of Medical Epidemiology and Biostatistics (BMDO, ASO), Karolinska Institutet, Stockholm, Sweden; and Department of Epidemiology (ASO), T.H. Chan School of Public Health, Harvard, Boston
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Wolf CJ, Fitzpatrick H, Becker C, Smith J, Wood C. An improved multicellular human organoid model for the study of chemical effects on palatal fusion. Birth Defects Res 2023; 115:1513-1533. [PMID: 37530699 PMCID: PMC11253831 DOI: 10.1002/bdr2.2229] [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: 04/07/2023] [Revised: 07/11/2023] [Accepted: 07/19/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Tissue fusion is a mechanism involved in the development of the heart, iris, genital tubercle, neural tube, and palate during embryogenesis. Failed fusion of the palatal shelves could result in cleft palate (CP), a common birth defect. Organotypic models constructed of human cells offer an opportunity to investigate developmental processes in the human. Previously, our laboratory developed an organoid model of the human palate that contains human mesenchyme and epithelial progenitor cells to study the effects of chemicals on fusion. METHODS Here, we developed an organoid model more representative of the embryonic palate that includes three cell types: mesenchyme, endothelial, and epithelial cells. We measured fusion by a decrease in epithelial cells at the contact point between the organoids and compared the effects of CP teratogens on fusion and toxicity in the previous and current organoid models. We further tested additional suspect teratogens in our new model. RESULTS We found that the three-cell-type model is more sensitive to fusion inhibition by valproic acid and inhibitors of FGF, BMP, and TGFβRI/II. In this new model, we tested other suspect CP teratogens and found that nocodazole, topiramate, and Y27632 inhibit fusion at concentrations that do not induce toxicity. CONCLUSION This sensitive human three-cell-type organotypic model accurately evaluates chemicals for cleft palate teratogenicity.
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Affiliation(s)
- Cynthia J Wolf
- Center for Public Health and Environmental Assessment, Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, North Carolina, USA
| | - Hunter Fitzpatrick
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Carrie Becker
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Jessica Smith
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Carmen Wood
- Center for Public Health and Environmental Assessment, Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, North Carolina, USA
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Johnston JC, Sartwelle TP. Medical Malpractice and the Neurologist: Specific Neurological Claims. Neurol Clin 2023; 41:493-512. [PMID: 37407102 DOI: 10.1016/j.ncl.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
This chapter highlights the most frequently encountered neurological malpractice claims. The format is designed to provide a rudimentary understanding of how lawsuits arise and thereby focus discussion on adapting practice patterns to improve patient care and minimize liability risk.
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Affiliation(s)
- James C Johnston
- GlobalNeurology, 17B Farnham Street, Auckland 1052, New Zealand; GlobalNeurology®, 5290 Medical Drive, San Antonio, TX 78229, USA.
| | - Thomas P Sartwelle
- Hicks Davis Wynn, PC, 3555 Timmons Lane, Suite 1000, Houston, TX 77027, USA
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Biso L, Carli M, Kolachalam S, Monticelli G, Calabrò PF, di Paolo A, Giorgi FS, Bocci G, Scarselli M. A 5-Year Study of Antiseizure Medications (ASMs) Monitoring in Patients with Neuropsychiatric Disorders in an Italian Clinical Center. Pharmaceuticals (Basel) 2023; 16:945. [PMID: 37513857 PMCID: PMC10383891 DOI: 10.3390/ph16070945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023] Open
Abstract
Despite receiving appropriate antiseizure medications (ASMs), a relevant percentage of neuropsychiatric patients do not benefit from this approach, and one reason is subtherapeutic ASMs plasma concentration (C(p)) due to improper drug adherence, interindividual pharmacokinetic differences, or metabolic interactions among different drugs. For these reasons, therapeutic drug monitoring (TDM) by measuring ASMs C(p) is an effective tool that improves pharmacological therapies in clinical practice. Based on these premises, in the present real-world study, we analyzed the C(p) of the most used ASMs in diverse medical conditions, which were assayed during the years 2018-2022 at the University Hospital of Pisa, including about 24,000 samples. This population was largely heterogeneous, and our database did not contain clinical information about the patients. The most used ASMs were Valproate (VPA: 54.5%) and Levetiracetam (LEV: 18.6%), followed by Oxcarbazepine (OxCBZ: 8.3%) and Carbamazepine (CBZ: 7.2%), whereas the associations LEV/VPA, Ethosuximide (ESM)/VPA, and CBZ/VPA were the most frequently proposed. In about 2/3 of assays, ASMs C(p) was in range, except for VPA, which was underdosed in almost half of the samples. Importantly, toxic levels of ASMs C(p) were found very rarely. For VPA, there was a decrease of mean C(p) across ages, from adolescents to older patients, while the C(p) of LEV, CBZ, OxCBZ, and Topiramate (TPM) showed a slight tendency to increase. When we compared females and males, we found that for VPA, the average age was higher for females, whereas women taking Lamotrigine (LTG) and OxCBZ were younger than men. Then, comparing ASMs used in neurologic and psychiatric disorders, based on the request form, it emerged that the mean C(p) of CBZ, OxCBZ, and LTG on samples collected in the Psychiatric Unit was lower compared to the Neurology and Child Neuropsychiatry Units. Finally, the ASMs subjected to multiple dosing starting from an initial subtherapeutic C(p) increased their level at different time points within a year, reaching the reference range for some of them. In conclusion, the present study suggests that TDM is widely applied to monitor ASMs C(p), finding many of them within the reference range, as a demonstration of its utility in clinical practice.
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Affiliation(s)
- Letizia Biso
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Marco Carli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Shivakumar Kolachalam
- Aseptic Pharmacy, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London W6 8RF, UK
| | - Giorgio Monticelli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Pasquale Fabio Calabrò
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Antonello di Paolo
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Filippo Sean Giorgi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Guido Bocci
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Marco Scarselli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
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Ozekin YH, O’Rourke R, Bates EA. Single cell sequencing of the mouse anterior palate reveals mesenchymal heterogeneity. Dev Dyn 2023; 252:713-727. [PMID: 36734036 PMCID: PMC10238667 DOI: 10.1002/dvdy.573] [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: 11/11/2022] [Revised: 01/05/2023] [Accepted: 01/17/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Cleft palate is one of the most prevalent birth defects. Mice are useful for studying palate development because of their morphological and genetic similarities to humans. In mice, palate development occurs between embryonic days (E)11.5 to 15.5. Single cell transcriptional profiles of palate cell populations have been a valuable resource for the craniofacial research community, but we lack a single cell transcriptional profile for anterior palate at E13.5, at the transition from proliferation to shelf elevation. RESULTS A detailed single cell RNA sequencing analysis reveals heterogeneity in expression profiles of the cell populations of the E13.5 anterior palate. Hybridization chain reaction RNA fluorescent in situ hybridization (HCR RNA FISH) reveals epithelial populations segregate into layers. Mesenchymal populations spatially segregate into four domains. One of these mesenchymal populations expresses ligands and receptors distinct from the rest of the mesenchyme, suggesting that these cells have a unique function. RNA velocity analysis shows two terminal cell states that contribute to either the proximal or distal palatal regions emerge from a single progenitor pool. CONCLUSION This single cell resolution expression data and detailed analysis from E13.5 anterior palate provides a powerful resource for mechanistic insight into secondary palate morphogenesis for the craniofacial research community.
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Affiliation(s)
- Yunus H. Ozekin
- Section of Developmental Biology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rebecca O’Rourke
- Section of Developmental Biology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Emily Anne Bates
- Section of Developmental Biology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Platamone C, Huang X, Mazumder R, Ritz B, Olsen J, Hansen J, Saechao C, Heck JE. Danish Population Based Study of Familial Epilepsy and Childhood Cancer. RESEARCH SQUARE 2023:rs.3.rs-2500755. [PMID: 37090596 PMCID: PMC10120770 DOI: 10.21203/rs.3.rs-2500755/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Objective Results from studies investigating the association between maternal or child epilepsy, use of anticonvulsants in pregnancy, and childhood cancer are inconsistent and at times contradictory. Methods Linking Danish national databases, we obtained epilepsy and childhood cancer diagnoses, and anticonvulsant use data. We estimated adjusted odds ratios of all or specific childhood cancers in relation to maternal or child epilepsy and anticonvulsant therapies using conditional logistic regression. Results Maternal epilepsy was positively associated with all childhood cancers in offspring, specifically, with acute lymphoblastic leukemia (Odds Ratio (OR) = 1.68, 95% Confidence Interval (CI) = 1.16, 2.43) and Wilms tumor (OR = 2.13, 95%CI = 0.97, 4.68). When considering maternal ever (lifetime) ingestion of anticonvulsants, a positive association was found with all cancers (OR = 1.15, 95%CI = 1.01, 1.31), and central nervous system tumors (OR = 1.32, 95%CI = 1.03, 1.69) as well as neuroblastoma (OR = 2.05, 95%CI = 1.29, 3.28) among offspring. Maternal anticonvulsant use before or during the index pregnancy was related to CNS tumors in offspring (OR = 1.78, 95%CI = 0.99, 3.21), however the confidence interval included the null. Significance Maternal use of certain anticonvulsant medications may be a risk factor for cancer in offspring. Medical providers may need to consider what type of treatments to prescribe to pregnant mothers with epilepsy.
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Affiliation(s)
- Corbin Platamone
- UCLA School of Public Health: University of California Los Angeles Jonathan and Karin Fielding School of Public Health
| | - Xiwen Huang
- UCLA School of Public Health: University of California Los Angeles Jonathan and Karin Fielding School of Public Health
| | - Rajarshi Mazumder
- David Geffen School of Medicine: University of California Los Angeles David Geffen School of Medicine
| | - Beate Ritz
- UCLA School of Public Health: University of California Los Angeles Jonathan and Karin Fielding School of Public Health
| | - Jorn Olsen
- Aarhus University Department of Clinical Medicine: Aarhus Universitet Institut for Klinisk Medicin
| | | | - Chai Saechao
- UCLA Health System: University of California Los Angeles Health System
| | - Julia E Heck
- UCLA School of Public Health: University of California Los Angeles Jonathan and Karin Fielding School of Public Health
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Ren T, Lee PMY, Li F, Li J. Prenatal Carbamazepine Exposure and Academic Performance in Adolescents: A Population-Based Cohort Study. Neurology 2023; 100:e728-e738. [PMID: 36323520 PMCID: PMC9969917 DOI: 10.1212/wnl.0000000000201529] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/21/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To investigate whether children born to mothers who used carbamazepine during pregnancy had worse academic performance in adolescence. METHODS This population-based cohort study included all live-born singletons in Denmark between 1996 and 2002 who participated in the national ninth-grade exit examination (n = 370,859). Those born to mothers with prescription of antiseizure medications other than carbamazepine during pregnancy were excluded. We examined the association of in utero exposure to maternal carbamazepine redeemed during pregnancy (n = 290) with academic performance of offspring, defined by the scores in Danish and mathematics in ninth-grade exit examination. We estimated mean z-score difference with linear regression adjusted for socioeconomic factors and potential indications, including epilepsy and medication for other psychiatric disorders. Additional analyses addressing confounding by indication included comparison between in utero exposed vs past exposed and between past exposed and never exposed. In utero exposure to valproate monotherapy was used as a positive control and in utero exposure to lamotrigine as a negative control. RESULTS At the age of 16.1 (SD 0.4) years, adolescents in utero exposed to maternal carbamazepine monotherapy had lower scores both in Danish and mathematics in ninth-grade exit examination (adjusted z-score difference, -0.14 [95% CI -0.24 to -0.05] and -0.17 [95% CI -0.28 to -0.07], respectively). In utero exposure to carbamazepine monotherapy was associated with lower scores than past exposure only (adjusted z-score difference, -0.24 [95% CI -0.41 to -0.06] for Danish and -0.25 [95% CI -0.44 to -0.06] for mathematics), while past exposure to carbamazepine was associated with minor decrease in offspring's academic performance (adjusted z-score difference, -0.02 [95% CI -0.09 to 0.06] for Danish and -0.07 [95% CI -0.16 to 0.01] for mathematics). The association was also observed for in utero exposure to valproate monotherapy, but not for in utero exposure to lamotrigine. DISCUSSION In utero exposure to carbamazepine was associated with poorer academic performance in adolescence, as represented by lower scores in ninth-grade exit examination in Danish and mathematics. Additional studies are needed to confirm these findings because of limitations in this study and variable findings in prior studies. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that academic performance, as reflected in ninth-grade exit examinations in Danish and mathematics, was worse among those exposed to carbamazepine monotherapy in utero, compared with those without in utero exposure to antiseizure medications.
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Affiliation(s)
| | | | - Fei Li
- From the Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health (T.R., F.L.), Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China; Department of Clinical Medicine-Department of Clinical Epidemiology (P.M.Y.L., J.L.), Aarhus University and Aarhus University Hospital, Denmark; and Department of Developmental and Behavioural Paediatric & Child Primary Care (F.L.), Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China.
| | - Jiong Li
- From the Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health (T.R., F.L.), Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China; Department of Clinical Medicine-Department of Clinical Epidemiology (P.M.Y.L., J.L.), Aarhus University and Aarhus University Hospital, Denmark; and Department of Developmental and Behavioural Paediatric & Child Primary Care (F.L.), Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China.
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Castro PA, Pinto-Borguero I, Yévenes GE, Moraga-Cid G, Fuentealba J. Antiseizure medication in early nervous system development. Ion channels and synaptic proteins as principal targets. Front Pharmacol 2022; 13:948412. [PMID: 36313347 PMCID: PMC9614143 DOI: 10.3389/fphar.2022.948412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/05/2022] [Indexed: 12/04/2022] Open
Abstract
The main strategy for the treatment of epilepsy is the use of pharmacological agents known as antiseizure medication (ASM). These drugs control the seizure onset and improves the life expectancy and quality of life of patients. Several ASMs are contraindicated during pregnancy, due to a potential teratogen risk. For this reason, the pharmacological treatments of the pregnant Women with Epilepsy (WWE) need comprehensive analyses to reduce fetal risk during the first trimester of pregnancy. The mechanisms by which ASM are teratogens are still under study and scientists in the field, propose different hypotheses. One of them, which will be addressed in this review, corresponds to the potential alteration of ASM on ion channels and proteins involved in relevant signaling and cellular responses (i.e., migration, differentiation) during embryonic development. The actual information related to the action of ASM and its possible targets it is poorly understood. In this review, we will focus on describing the eventual presence of some ion channels and synaptic proteins of the neurotransmitter signaling pathways present during early neural development, which could potentially interacting as targets of ASM. This information leads to elucidate whether these drugs would have the ability to affect critical signaling during periods of neural development that in turn could explain the fetal malformations observed by the use of ASM during pregnancy.
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Affiliation(s)
- Patricio A. Castro
- Laboratory of Physiology and Pharmacology for Neural Development, LAND, Departamento de Fisiología, Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile
- *Correspondence: Patricio A. Castro,
| | - Ingrid Pinto-Borguero
- Laboratory of Physiology and Pharmacology for Neural Development, LAND, Departamento de Fisiología, Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile
| | - Gonzalo E. Yévenes
- Departamento de Fisiología, Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile
| | - Gustavo Moraga-Cid
- Departamento de Fisiología, Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile
| | - Jorge Fuentealba
- Departamento de Fisiología, Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile
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A CCR5 antagonist, maraviroc, alleviates neural circuit dysfunction and behavioral disorders induced by prenatal valproate exposure. J Neuroinflammation 2022; 19:195. [PMID: 35906621 PMCID: PMC9335995 DOI: 10.1186/s12974-022-02559-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/22/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Valproic acid (VPA) is a clinically used antiepileptic drug, but it is associated with a significant risk of a low verbal intelligence quotient (IQ) score, attention-deficit hyperactivity disorder and autism spectrum disorder in children when it is administered during pregnancy. Prenatal VPA exposure has been reported to affect neurogenesis and neuronal migration and differentiation. In addition, growing evidence has shown that microglia and brain immune cells are activated by VPA treatment. However, the role of VPA-activated microglia remains unclear. METHODS Pregnant female mice received sodium valproate on E11.5. A microglial activation inhibitor, minocycline or a CCR5 antagonist, maraviroc was dissolved in drinking water and administered to dams from P1 to P21. Measurement of microglial activity, evaluation of neural circuit function and expression analysis were performed on P10. Behavioral tests were performed in the order of open field test, Y-maze test, social affiliation test and marble burying test from the age of 6 weeks. RESULTS Prenatal exposure of mice to VPA induced microglial activation and neural circuit dysfunction in the CA1 region of the hippocampus during the early postnatal periods and post-developmental defects in working memory and social interaction and repetitive behaviors. Minocycline, a microglial activation inhibitor, clearly suppressed the above effects, suggesting that microglia elicit neural dysfunction and behavioral disorders. Next-generation sequencing analysis revealed that the expression of a chemokine, C-C motif chemokine ligand 3 (CCL3), was upregulated in the hippocampi of VPA-treated mice. CCL3 expression increased in microglia during the early postnatal periods via an epigenetic mechanism. The CCR5 antagonist maraviroc significantly suppressed neural circuit dysfunction and post-developmental behavioral disorders induced by prenatal VPA exposure. CONCLUSION These findings suggest that microglial CCL3 might act during development to contribute to VPA-induced post-developmental behavioral abnormalities. CCR5-targeting compounds such as maraviroc might alleviate behavioral disorders when administered early.
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Napolitano A, Schiavi S, La Rosa P, Rossi-Espagnet MC, Petrillo S, Bottino F, Tagliente E, Longo D, Lupi E, Casula L, Valeri G, Piemonte F, Trezza V, Vicari S. Sex Differences in Autism Spectrum Disorder: Diagnostic, Neurobiological, and Behavioral Features. Front Psychiatry 2022; 13:889636. [PMID: 35633791 PMCID: PMC9136002 DOI: 10.3389/fpsyt.2022.889636] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/25/2022] [Indexed: 12/25/2022] Open
Abstract
Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder with a worldwide prevalence of about 1%, characterized by impairments in social interaction, communication, repetitive patterns of behaviors, and can be associated with hyper- or hypo-reactivity of sensory stimulation and cognitive disability. ASD comorbid features include internalizing and externalizing symptoms such as anxiety, depression, hyperactivity, and attention problems. The precise etiology of ASD is still unknown and it is undoubted that the disorder is linked to some extent to both genetic and environmental factors. It is also well-documented and known that one of the most striking and consistent finding in ASD is the higher prevalence in males compared to females, with around 70% of ASD cases described being males. The present review looked into the most significant studies that attempted to investigate differences in ASD males and females thus trying to shade some light on the peculiar characteristics of this prevalence in terms of diagnosis, imaging, major autistic-like behavior and sex-dependent uniqueness. The study also discussed sex differences found in animal models of ASD, to provide a possible explanation of the neurological mechanisms underpinning the different presentation of autistic symptoms in males and females.
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Affiliation(s)
- Antonio Napolitano
- Medical Physics Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sara Schiavi
- Section of Biomedical Sciences and Technologies, Science Department, Roma Tre University, Rome, Italy
| | - Piergiorgio La Rosa
- Division of Neuroscience, Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Maria Camilla Rossi-Espagnet
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- NESMOS, Neuroradiology Department, S. Andrea Hospital Sapienza University, Rome, Italy
| | - Sara Petrillo
- Head Child and Adolescent Psychiatry Unit, Neuroscience Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesca Bottino
- Medical Physics Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Emanuela Tagliente
- Medical Physics Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Daniela Longo
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Elisabetta Lupi
- Head Child and Adolescent Psychiatry Unit, Neuroscience Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Laura Casula
- Head Child and Adolescent Psychiatry Unit, Neuroscience Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giovanni Valeri
- Head Child and Adolescent Psychiatry Unit, Neuroscience Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fiorella Piemonte
- Neuromuscular and Neurodegenerative Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Viviana Trezza
- Section of Biomedical Sciences and Technologies, Science Department, Roma Tre University, Rome, Italy
| | - Stefano Vicari
- Child Neuropsychiatry Unit, Neuroscience Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Life Sciences and Public Health Department, Catholic University, Rome, Italy
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Parekh K, Kravets HD, Spiegel R. Special Considerations in the Management of Women with Epilepsy in Reproductive Years. J Pers Med 2022; 12:jpm12010088. [PMID: 35055403 PMCID: PMC8781280 DOI: 10.3390/jpm12010088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/23/2021] [Accepted: 01/05/2022] [Indexed: 12/07/2022] Open
Abstract
Anti-seizure medications (ASMs) fail to prevent seizure recurrence in more than 30% of patients with epilepsy. The treatment is more difficult in premenopausal women with epilepsy (WWE) because changes in plasma estrogen and progesterone concentrations during the menstrual cycle often affect seizure frequency and intensity. Interactions between enzyme-inducin ASMs and hormonal contraceptives can lead to both a loss of seizure control and failure of contraception. Significant changes in the function of the liver and kidneys during pregnancy can accelerate metabolism and elimination of ASMs, causing breakthrough seizures. In addition, the teratogenic, cognitive, and psychological effects of ASMs on potential offspring have to be considered when choosing the best ASM regimen. Therefore, aspecialized approach is necessary for the treatment of premenopausal WWE.
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12
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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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13
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Yu K, Xie W, Wang L, Li W. ILRC: a hybrid biomarker discovery algorithm based on improved L1 regularization and clustering in microarray data. BMC Bioinformatics 2021; 22:514. [PMID: 34686127 PMCID: PMC8532312 DOI: 10.1186/s12859-021-04443-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Finding significant genes or proteins from gene chip data for disease diagnosis and drug development is an important task. However, the challenge comes from the curse of the data dimension. It is of great significance to use machine learning methods to find important features from the data and build an accurate classification model. RESULTS The proposed method has proved superior to the published advanced hybrid feature selection method and traditional feature selection method on different public microarray data sets. In addition, the biomarkers selected using our method show a match to those provided by the cooperative hospital in a set of clinical cleft lip and palate data. METHOD In this paper, a feature selection algorithm ILRC based on clustering and improved L1 regularization is proposed. The features are firstly clustered, and the redundant features in the sub-clusters are deleted. Then all the remaining features are iteratively evaluated using ILR. The final result is given according to the cumulative weight reordering. CONCLUSION The proposed method can effectively remove redundant features. The algorithm's output has high stability and classification accuracy, which can potentially select potential biomarkers.
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Affiliation(s)
- Kun Yu
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Weidong Xie
- School of Computer Science and Engineering, Northeastern University, Shenyang, China
| | - Linjie Wang
- School of Computer Science and Engineering, Northeastern University, Shenyang, China
| | - Wei Li
- Key Laboratory of Intelligent Computing in Medical Image (MIIC), Northeastern University, Ministry of Education, Shenyang, China
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14
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Petersen JM, Yazdy MM, Getz KD, Anderka MT, Werler MM. Short interpregnancy intervals and risks for birth defects: support for the nutritional depletion hypothesis. Am J Clin Nutr 2021; 113:1688-1699. [PMID: 33668063 PMCID: PMC8168364 DOI: 10.1093/ajcn/nqaa436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 12/17/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Research suggests short interpregnancy intervals increase risks for adverse perinatal outcomes, including some birth defects. A hypothesized cause is nutritional depletion, including folic acid (FA). OBJECTIVES We evaluated associations between short interpregnancy intervals, alone and in combination with FA intake, and the occurrence of select malformations. METHODS Data were from the National Birth Defects Prevention Study (US case-control, 1997-2011). Participants included multiparous women whose prior pregnancy resulted in live birth. Cases included 8 noncardiac and 6 cardiac defect groups (n = 3219); controls were nonmalformed live-borns (n = 2508). We categorized interpregnancy interval (<6, 6-11, 12-17, and 18-23 mo) and periconceptional FA intake [no FA supplement use and dietary folate equivalents (DFE) <400 µg/d, no FA supplement use and DFE ≥400 µg/d, or any FA supplement use]. We controlled for age, race/ethnicity, income, pregnancy intention, and study center. ORs <0.8 or >1.2 were considered to represent potentially meaningful associations. RESULTS ORs for <6 compared with 18-23 mo were >1.2 for 4/8 noncardiac and 3/6 cardiac malformations. Among participants with any FA supplement use, ORs comparing <6 with 6-23 mo were <1.2 for most defects. Conversely, most ORs were >1.2 for <6 mo + no FA supplement use and DFE <400 µg/d compared with 6-23 mo + any FA supplement use. Magnitude and precision varied by defect. CONCLUSIONS Short interpregnancy intervals were associated with a trend of higher risks for several defects, notably in the absence of FA supplement use. To our knowledge, our study is the first to provide preliminary empirical support that these etiologies may be related to shorter interpregnancy intervals and possible nutritional deficiencies. Because FA intake is highly correlated with other nutrients, and because our estimates were generally imprecise, more research with larger sample sizes is needed to better understand the role of FA compared with other nutrients in each defect-specific etiology.
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Affiliation(s)
- Julie M Petersen
- Department of Epidemiology, Boston University School of Public Health, Boston, MA USA
| | - Mahsa M Yazdy
- Center for Birth Defects Research and Prevention, Massachusetts Department of Public Health, Boston, MA USA
| | - Kelly D Getz
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA USA.,Departments of Biostatistics, Epidemiology and Informatics, and Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Marlene T Anderka
- Center for Birth Defects Research and Prevention, Massachusetts Department of Public Health, Boston, MA USA
| | - Martha M Werler
- Department of Epidemiology, Boston University School of Public Health, Boston, MA USA
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15
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Fuangtharnthip P, Chonnapasatid W, Thiradilok S, Manopatanakul S, Jaruratanasirikul S. Registry-Based Study of Prevalence of Cleft Lip/Palate in Thailand from 2012 to 2015. Cleft Palate Craniofac J 2021; 58:1430-1437. [PMID: 33486980 DOI: 10.1177/1055665620987677] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Two main objectives were established. First objective was to determine the prevalence of the cleft lip and/or cleft palate (CL/P) in Thailand from 2012 to 2015 using the orofacial clefts (OFCs) registry and civil registration. Second objective was to conduct a quality control of this OFC registry especially for the Birth Defects Registration (BDR). DESIGN Registry-based survey. SETTING Analyzing data from the Thailand National Health Security Office. PARTICIPANTS Registered patients with CL/P in Thailand from 2012 to 2015. INTERVENTION None. MAIN OUTCOME MEASURE Duplicated records were verified using National Identity Number (Thai ID#) and date of birth. The prevalence of CL/P and specific phenotypes was then calculated. From this prevalence estimate method, quality assurance of the OFCs registry was possible. RESULTS For the main outcome, the population-weighted pool prevalence of CL/P was 2.14 per 1000 live births (95% confidence interval of 2.08-2.20). Thai ID# and expense reimbursement systems were the main factors driving this cases capturing. However, this OFCs registration still requires active case finding with clinical verification, improvement of staff training and databases networking. CONCLUSIONS This study reported a very high CL/P prevalence of Thailand. Strengths and limitations of these OFCs registry and BDR were described.
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Affiliation(s)
- Pornpoj Fuangtharnthip
- Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Wannapong Chonnapasatid
- Master of Science in Advanced General Dentistry, Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University, Thailand
| | - Sasipa Thiradilok
- Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Somchai Manopatanakul
- Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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16
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Qi Z, Lyu M, Yang L, Yuan H, Cao Y, Zhai L, Dang W, Liu J, Yang F, Li Y. A Novel and Reliable Rat Model of Autism. Front Psychiatry 2021; 12:549810. [PMID: 33776811 PMCID: PMC7994364 DOI: 10.3389/fpsyt.2021.549810] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/17/2021] [Indexed: 12/21/2022] Open
Abstract
Background: Autism spectrum disorders (ASD) is a complex neurodevelopmental disorder that lacks an ideal animal model to recapitulate the disease state of ASD. Previous studies have reported that transplanting gut microbiota of ASD patients into pregnant mice is sufficient to promote the changes of autism-like behavior in offspring. This study aims to explore whether fecal microbiota transplantation (FMT) can be used as a new method to establish the ASD animal model. Methods: We transplanted the fecal sample extract of ASD children into pregnant rats (rFMT) repeatedly to establish an ASD rat model (oFMT) and compare it with the classical valproic acid (VPA) model (oVPA). Results: First, we reveal that oFMT shows hypoevolutism and typical behavioral characteristics of ASD, consistent with the previous study. Second, the gut microbiota of oFMT mainly consists of Firmicutes and Bacteroidetes, recapitulating the abnormal gut microbiota of ASD. In oFMT, the abundance of Lactobacillus and Collinsella increased (Lactobacillus: oFMT 60.16%, oVPA 64.13%, oCON 40.11%; Collinsella: oFMT 3.73%, oVPA 1.39%, oCON 1.28%), compared with oVPA, gut microbiota also showed high consistency. Third, the expression of 5-hydroxytryptamine (5-HT) in oFMT serum increased, γ-aminobutyric acid (GABA) and norepinephrine (NE) in oFMT serum decreased. Fourth, the gut microbiota of oFMT also has some ASD characteristic gut microbiota not found in oVPA. Fifth, pregnant rat with VPA showed significant immune activation, while those with FMT showed relatively minor immune activation. Limitations: Although the mechanism of establishing FMT autism rat model (oFMT) has not clearly defined, the data show that the model has high structural validity, and FMT model is likely to be a new and reliable potential animal model of ASD, and will have potential value in studying gut microbiota of ASD. Conclusions: The FMT autism rat model has high structural validity, and the FMT model is likely to be a new and reliable potential animal model of ASD.
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Affiliation(s)
- Zhaoyao Qi
- Basic Medical College, Henan University of Chinese Medicine, Zhengzhou, China
| | - Mengke Lyu
- Second Clinical Medical College, Henan University of Chinese Medicine, Zhengzhou, China
| | - Liping Yang
- Basic Medical College, Henan University of Chinese Medicine, Zhengzhou, China
| | - Haiyan Yuan
- Basic Medical College, Henan University of Chinese Medicine, Zhengzhou, China
| | - Yun Cao
- Basic Medical College, Henan University of Chinese Medicine, Zhengzhou, China
| | - Linlin Zhai
- Basic Medical College, Henan University of Chinese Medicine, Zhengzhou, China
| | - Weili Dang
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Juan Liu
- Basic Medical College, Henan University of Chinese Medicine, Zhengzhou, China
| | - Fan Yang
- First Clinical Medical College, Henan University of Chinese Medicine, Zhengzhou, China
| | - Ying Li
- Basic Medical College, Henan University of Chinese Medicine, Zhengzhou, China
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17
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Heinke D, Rich-Edwards JW, Williams PL, Hernandez-Diaz S, Anderka M, Fisher SC, Desrosiers TA, Shaw GM, Romitti PA, Canfield M, Yazdy MM. Quantification of selection bias in studies of risk factors for birth defects among livebirths. Paediatr Perinat Epidemiol 2020; 34:655-664. [PMID: 32249969 PMCID: PMC7541428 DOI: 10.1111/ppe.12650] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 12/20/2019] [Accepted: 01/05/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Risk factors for birth defects are frequently investigated using data limited to liveborn infants. By conditioning on survival, results of such studies may be distorted by selection bias, also described as "livebirth bias." However, the implications of livebirth bias on risk estimation remain poorly understood. OBJECTIVES We sought to quantify livebirth bias and to investigate the conditions under which it arose. METHODS We used data on 3994 birth defects cases and 11 829 controls enrolled in the National Birth Defects Prevention Study to compare odds ratio (OR) estimates of the relationship between three established risk factors (antiepileptic drug use, smoking, and multifetal pregnancy) and four birth defects (anencephaly, spina bifida, omphalocele, and cleft palate) when restricted to livebirths as compared to among livebirths, stillbirths, and elective terminations. Exposures and birth defects represented varying strengths of association with livebirth; all controls were liveborn. We performed a quantitative bias analysis to evaluate the sensitivity of our results to excluding terminated and stillborn controls. RESULTS Cases ranged from 33% liveborn (anencephaly) to 99% (cleft palate). Smoking and multifetal pregnancy were associated with livebirth among anencephaly (crude OR [cOR] 0.61 and cOR 3.15, respectively) and omphalocele cases (cOR 2.22 and cOR 5.22, respectively). For analyses of the association between exposures and birth defects, restricting to livebirths produced negligible differences in estimates except for anencephaly and multifetal pregnancy, which was twofold higher among livebirths (adjusted OR [aOR] 4.93) as among all pregnancy outcomes (aOR 2.44). Within tested scenarios, bias analyses suggested that results were not sensitive to the restriction to liveborn controls. CONCLUSIONS Selection bias was generally limited except for high mortality defects in the context of exposures strongly associated with livebirth. Findings indicate that substantial livebirth bias is unlikely to affect studies of risk factors for most birth defects.
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Affiliation(s)
- Dominique Heinke
- Center for Birth Defects Research and Prevention, Massachusetts Department of Public Health, Boston, Massachusetts
- Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Janet W. Rich-Edwards
- Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
- Brigham and Women’s Hospital, Boston, Massachusetts
| | - Paige L. Williams
- Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Sonia Hernandez-Diaz
- Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Marlene Anderka
- Center for Birth Defects Research and Prevention, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Sarah C. Fisher
- Congenital Malformations Registry, New York State Department of Health, Albany, New York
| | - Tania A. Desrosiers
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Gary M. Shaw
- Stanford University School of Medicine, Stanford University, Stanford, California
| | - Paul A. Romitti
- College of Public Health, The University of Iowa, Iowa City, Iowa
| | - Mark Canfield
- Texas Department of State Health Services, Austin, Texas
| | - Mahsa M. Yazdy
- Center for Birth Defects Research and Prevention, Massachusetts Department of Public Health, Boston, Massachusetts
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18
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Kerr SM, Parker SE, Mitchell AA, Tinker SC, Werler MM. Folic acid antagonist use before and during pregnancy and risk for selected birth defects. Birth Defects Res 2020; 112:1526-1540. [PMID: 32875745 PMCID: PMC10938459 DOI: 10.1002/bdr2.1789] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Maternal folic acid (FA) intake before and during early pregnancy reduces the risk for neural tube defects (NTDs); evidence suggests it may also reduce the risk for oral clefts, urinary defects, and cardiac defects. We sought to re-examine the use of drugs, which affect folate metabolism, dihydrofolate reductase inhibiting (DHFRI) medications, and anti-epileptic drugs (AEDs), in data collected in the post-FA fortification era (1998+) in the Slone Birth Defects Study. METHODS We assessed maternal DHFRI and AED use and risk for NTDs, oral clefts, and urinary and cardiac defects. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) using logistic regression. We assessed daily average FA intake of ≥400 mcg as a potential effect modifier. RESULTS We analyzed data from 10,209 control and 9,625 case mothers. Among controls, the prevalence of exposure to DHFRI medications was 0.3% and to AEDs was 0.5%. Maternal use of AEDs was associated with increased risks for NTDs (OR: 3.4; 95% CI: 1.5, 7.5), oral clefts (OR: 2.3; 95% CI: 1.3, 4.0), urinary defects (OR: 1.6; 95% CI: 1.0, 2.7), and cardiac defects (OR: 1.6; 95% CI: 1.1, 2.3); similar or further increased risks were found among those with FA intake ≥400 mcg per day. DHFRI use was rare and relative risk estimates were imprecise and consistent with the null. CONCLUSIONS Similar to our previous analyses, we observed associations between AED use and these defects. For DHFRI exposure, we found no evidence for increased risk of these defects. Though statistical power to examine FA effect modification was low, we found no evidence of further protection among those with FA intake ≥400 mcg, with some associations somewhat stronger in this group.
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Affiliation(s)
- Stephen M. Kerr
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | | | - Allen A. Mitchell
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | - Sarah C. Tinker
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia
| | - Martha M. Werler
- Department of Epidemiology, Boston University, Boston, Massachusetts
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Ovayolu A, Ovayolu G, Karaman E, Yuce T, Ozek MA, Turksoy VA. Amniotic fluid levels of selected trace elements and heavy metals in pregnancies complicated with neural tube defects. Congenit Anom (Kyoto) 2020; 60:136-141. [PMID: 31743503 DOI: 10.1111/cga.12363] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 11/07/2019] [Accepted: 11/08/2019] [Indexed: 02/06/2023]
Abstract
The aims of this study were to determine the levels of trace elements and heavy metals, namely aluminum (Al), chromium (Cr), manganese (Mn), cobalt (Co), nickel (Ni), copper (Cu), zinc (Zn), arsenic (As), molybdenum (Mo), cadmium (Cd), tin (Sn), antimony (Sb), mercury (Hg), and lead (Pb), in the amniotic fluid of pregnant women, and to investigate their relationship with neural tube defects (NTDs). The study included 36 pregnant women whose fetuses were complicated with NTDs (study group) and 39 pregnant women with unaffected healthy fetuses (control group), who were matched for body mass index and gestational weeks. The amniotic fluid levels of trace elements and heavy metals were measured using inductively coupled plasma-mass spectrometry and compared between the two groups. Significantly lower mean levels of Zn and Mo and significantly higher levels of Al, Sn, Sb, and Hg in the study group than in the healthy control group were observed, which implied that these elements are possibly correlated with risk factors for the occurrence of NTDs. In contrast, there were no significant differences in the levels of Cr, Mn, Co, Ni, Cu, As, Cd, and Pb between the groups (P ≥ .05).
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Affiliation(s)
- Ali Ovayolu
- Department of Obstetrics and Gynecology, Cengiz Gokcek Women's and Children's Hospital, Gaziantep, Turkey
| | - Gamze Ovayolu
- Department of Biostatistics, Umay IVF Center, Gaziantep, Turkey
| | - Erbil Karaman
- Department of Gynecology and Obstetrics, Faculty of Medicine, Yuzuncu Yıl University, Van, Turkey
| | - Tuncay Yuce
- Department of Obstetrics and Gynecology, Cengiz Gokcek Women's and Children's Hospital, Gaziantep, Turkey
| | - Murat A Ozek
- Department of Obstetrics and Gynecology, Cengiz Gokcek Women's and Children's Hospital, Gaziantep, Turkey
| | - Vugar A Turksoy
- Department of Public Health, Faculty of Medicine, Bozok University, Yozgat, Turkey
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20
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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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Abstract
Aerodigestive disorders, those affecting the upper and lower airway or upper gastrointestinal tract, are interrelated anatomically during fetal development and functionally after birth. Successful respiration and feeding requires careful coordination to promote effective swallowing and prevent aspiration. I describe the epidemiology, including the prevalence of the most common aerodigestive disorders. The ability of an infant to feed by mouth at discharge, without a surgically placed feeding tube, is an important neurodevelopmental marker. Therefore, aerodigestive disorders have a high potential for lifelong morbidities and health care expenditures. When available, published research on related medical costs for these disorders is provided.
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22
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Care of the Asian American Child With Cleft Lip or Palate. Plast Surg Nurs 2020; 39:142-147. [PMID: 31790043 DOI: 10.1097/psn.0000000000000286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Orofacial clefts are one of the most common global birth defects. Orofacial clefts may be part of a syndrome or an isolated birth defect, and affect approximately 1-1.5 per 1,000 live births worldwide with noted inequalities across geographical areas and cultures. In the United States, Asian American populations have a substantially higher incidence of cleft lip with or without cleft palate (2/1,000 live births). Orofacial clefts are a key health issue with substantial health care costs, and associated medical, psychological, and social ramifications. It has been estimated that the health care costs within the United States are approximately $697 million over a child's lifetime. In disorders like orofacial clefts, because of the complexity of the condition and subsequent medical interventions, as well as the cultural intricacies of the Asian culture, it requires significant knowledge and understanding by the health care providers. In order to provide optimal and safe cleft care, reduce health care costs, and improve the outcomes for the Asian American population, a culturally sensitive, multidisciplinary, and coordinated approach is needed. Increased culturally specific education, early access to prenatal care, and ongoing infant and pediatric health care are essential.
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Shafi N, Bukhari F, Iqbal W, Almustafa KM, Asif M, Nawaz Z. Cleft prediction before birth using deep neural network. Health Informatics J 2020; 26:2568-2585. [PMID: 32283987 DOI: 10.1177/1460458220911789] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In developing countries like Pakistan, cleft surgery is expensive for families, and the child also experiences much pain. In this article, we propose a machine learning-based solution to avoid cleft in the mother's womb. The possibility of cleft lip and palate in embryos can be predicted before birth by using the proposed solution. We collected 1000 pregnant female samples from three different hospitals in Lahore, Punjab. A questionnaire has been designed to obtain a variety of data, such as gender, parenting, family history of cleft, the order of birth, the number of children, midwives counseling, miscarriage history, parent smoking, and physician visits. Different cleaning, scaling, and feature selection methods have been applied to the data collected. After selecting the best features from the cleft data, various machine learning algorithms were used, including random forest, k-nearest neighbor, decision tree, support vector machine, and multilayer perceptron. In our implementation, multilayer perceptron is a deep neural network, which yields excellent results for the cleft dataset compared to the other methods. We achieved 92.6% accuracy on test data based on the multilayer perceptron model. Our promising results of predictions would help to fight future clefts for children who would have cleft.
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24
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Lieberman OJ, Cartocci V, Pigulevskiy I, Molinari M, Carbonell J, Broseta MB, Post MR, Sulzer D, Borgkvist A, Santini E. mTOR Suppresses Macroautophagy During Striatal Postnatal Development and Is Hyperactive in Mouse Models of Autism Spectrum Disorders. Front Cell Neurosci 2020; 14:70. [PMID: 32296308 PMCID: PMC7136750 DOI: 10.3389/fncel.2020.00070] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 03/11/2020] [Indexed: 01/06/2023] Open
Abstract
Macroautophagy (hereafter referred to as autophagy) plays a critical role in neuronal function related to development and degeneration. Here, we investigated whether autophagy is developmentally regulated in the striatum, a brain region implicated in neurodevelopmental disease. We demonstrate that autophagic flux is suppressed during striatal postnatal development, reaching adult levels around postnatal day 28 (P28). We also find that mTOR signaling, a key regulator of autophagy, increases during the same developmental period. We further show that mTOR signaling is responsible for suppressing autophagy, via regulation of Beclin-1 and VPS34 activity. Finally, we discover that autophagy is downregulated during late striatal postnatal development (P28) in mice with in utero exposure to valproic acid (VPA), an established mouse model of autism spectrum disorder (ASD). VPA-exposed mice also display deficits in striatal neurotransmission and social behavior. Correction of hyperactive mTOR signaling in VPA-exposed mice restores social behavior. These results demonstrate that neurons coopt metabolic signaling cascades to developmentally regulate autophagy and provide additional evidence that mTOR-dependent signaling pathways represent pathogenic signaling cascades in ASD mouse models that are active during specific postnatal windows.
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Affiliation(s)
- Ori J. Lieberman
- Division of Molecular Therapeutics, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
- Division of Movement Disorders, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | | | - Irena Pigulevskiy
- Division of Movement Disorders, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Maya Molinari
- Department of Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Josep Carbonell
- Department of Neuroscience, Karolinska Institute, Stockholm, Sweden
| | | | - Michael R. Post
- Division of Molecular Therapeutics, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - David Sulzer
- Division of Molecular Therapeutics, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Anders Borgkvist
- Department of Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Emanuela Santini
- Division of Movement Disorders, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
- Department of Neuroscience, Karolinska Institute, Stockholm, Sweden
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25
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Wang Z, Ho PWH, Choy MTH, Wong ICK, Brauer R, Man KKC. Advances in Epidemiological Methods and Utilisation of Large Databases: A Methodological Review of Observational Studies on Central Nervous System Drug Use in Pregnancy and Central Nervous System Outcomes in Children. Drug Saf 2020; 42:499-513. [PMID: 30421346 DOI: 10.1007/s40264-018-0755-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Studies have used various epidemiological approaches to study associations between central nervous system (CNS) drug use in pregnancy and CNS outcomes in children. Studies have generally focused on clinical adverse effects, whereas variations in methodologies have not received sufficient attention. OBJECTIVE Our objective was to review the methodological characteristics of existing studies to identify any limitations and recommend further research. METHODS A systematic literature search was conducted on observational studies listed in PubMed from 1 January 1946 to 21 September 2017. Following independent screening and data extraction, we conducted a review addressing the trends of relevant studies, differences between various data sources, and methods used to address bias and confounders; we also conducted statistical analyses. RESULTS In total, 111 observational studies, 25 case-control studies, and 86 cohort studies were included in the review. Publications dating from 1978 to 2006 mainly focused on antiepileptic drugs, but research on antidepressants increased from 2007 onwards. Only one study focused on antipsychotic use during pregnancy. A total of 46 studies obtained data from an administrative database/registry, 20 from ad hoc disease registries, and 41 from ad hoc clinical samples. Most studies (58%) adjusted the confounding factors using general adjustment, whereas only a few studies used advanced methods such as sibling-matched models and propensity score methods; 42 articles used univariate analyses and 69 conducted multivariable regression analyses. CONCLUSION Multiple factors, including different study designs and data sources, have led to inconsistent findings in associations between CNS drug use in pregnancy and CNS outcomes in children. Researchers should allow for study designs with clearly defined exposure periods, at the very least in trimesters, and use advanced confounding adjustment methodology to increase the accuracy of the findings.
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Affiliation(s)
- Zixuan Wang
- Research Department of Practice and Policy, UCL School of Pharmacy, Mezzanine Floor, BMA House, Entrance A, Tavistock Square, London, WC1H 9JP, UK
| | - Phoebe W H Ho
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Michael T H Choy
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Ian C K Wong
- Research Department of Practice and Policy, UCL School of Pharmacy, Mezzanine Floor, BMA House, Entrance A, Tavistock Square, London, WC1H 9JP, UK.,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Ruth Brauer
- Research Department of Practice and Policy, UCL School of Pharmacy, Mezzanine Floor, BMA House, Entrance A, Tavistock Square, London, WC1H 9JP, UK
| | - Kenneth K C Man
- Research Department of Practice and Policy, UCL School of Pharmacy, Mezzanine Floor, BMA House, Entrance A, Tavistock Square, London, WC1H 9JP, UK. .,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong. .,Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands.
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26
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Anderson KN, Ailes EC, Lind JN, Broussard CS, Bitsko RH, Friedman JM, Bobo WV, Reefhuis J, Tinker SC. Atypical antipsychotic use during pregnancy and birth defect risk: National Birth Defects Prevention Study, 1997-2011. Schizophr Res 2020; 215:81-88. [PMID: 31761471 PMCID: PMC7036025 DOI: 10.1016/j.schres.2019.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 07/09/2019] [Accepted: 11/12/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE To examine the prevalence of, and factors associated with, atypical antipsychotic use among U.S. pregnant women, and potential associations between early pregnancy atypical antipsychotic use and risk for 14 birth defects. METHODS We analyzed data from the National Birth Defects Prevention Study (1997-2011), a U.S. population-based case-control study examining risk factors for major structural birth defects. RESULTS Atypical antipsychotic use during pregnancy was more common among women with pre-pregnancy obesity, and women who reported illicit drug use before and during pregnancy, smoking during pregnancy, alcohol use during pregnancy, or use of other psychiatric medications during pregnancy. We observed elevated associations (defined as a crude odds ratio [cOR] ≥2.0) between early pregnancy atypical antipsychotic use and conotruncal heart defects (6 exposed cases; cOR: 2.3, 95% confidence interval [CI]: 0.9-6.1), and more specifically Tetralogy of Fallot (3 exposed cases; cOR: 2.5, 95% CI: 0.7-8.8), cleft palate (4 exposed cases, cOR: 2.5, 95% CI: 0.8-7.6), anorectal atresia/stenosis (3 exposed cases, cOR: 2.8, 95% CI: 0.8-9.9), and gastroschisis (3 exposed cases, cOR: 2.1, 95% CI: 0.6-7.3). CONCLUSIONS Our findings support the close clinical monitoring of pregnant women using atypical antipsychotics. Women treated with atypical antipsychotics generally access healthcare services before pregnancy; efforts to reduce correlates of atypical antipsychotic use might improve maternal and infant health in this population.
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Affiliation(s)
- Kayla N Anderson
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, MS S-106, Atlanta, GA 30341, USA.
| | - Elizabeth C Ailes
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, MS S-106, Atlanta, GA 30341, USA
| | - Jennifer N Lind
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, MS S-106, Atlanta, GA 30341, USA; United States Public Health Service, 4770 Buford Highway, MS S-106, Atlanta, GA 30341, USA
| | - Cheryl S Broussard
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, MS S-106, Atlanta, GA 30341, USA
| | - Rebecca H Bitsko
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, MS S-106, Atlanta, GA 30341, USA
| | - Jan M Friedman
- Department of Medical Genetics, University of British Columbia, 4500 Oak Street, Vancouver V6H 3N1, Canada
| | - William V Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, 4500 San Pablo Road S #378, Jacksonville, FL 32224, USA
| | - Jennita Reefhuis
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, MS S-106, Atlanta, GA 30341, USA
| | - Sarah C Tinker
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, MS S-106, Atlanta, GA 30341, USA
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27
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Eléfant E, Hanin C, Cohen D. Pregnant women, prescription, and fetal risk. HANDBOOK OF CLINICAL NEUROLOGY 2020; 173:377-389. [PMID: 32958185 DOI: 10.1016/b978-0-444-64150-2.00027-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Since the historical scandal of thalidomide in the 1960s, practitioners and future mothers are fearful of drugs during pregnancy. In-uterine exposure to drugs can induce major malformation of the fetus or even intrauterine fetal death. Prescribing drugs to a pregnant woman requires particular attention, and it is necessary to consider both the maternal needs and the proven and potential fetal risks. In this chapter, we review the mechanisms for medication transfer from mother to fetus, fetal risk according to pregnancy timeline, and the main dangerous drugs during pregnancy. We also focus on three prescription debates, which are relevant for neurodevelopmental disorder, because they each point to a paradigmatic situation-diethylstilbestrol, which shows transgenerational adversary effects; valproate, which impacts neurodevelopment as a whole; and antidepressants for which the adverse impact on neurodevelopment is still controversial given the impact of depression itself. Finally, we consider the implications for practice and toxicologic research to promote risk prevention.
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Affiliation(s)
- Elisabeth Eléfant
- Centre de Référence sur les Agents Tératogènes, Hôpital Armand-Trousseau, Paris, France.
| | - Cyril Hanin
- Service de Psychiatrie de l'Enfant et de l'Adolescent, APHP.Sorbonne Université, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - David Cohen
- Service de Psychiatrie de l'Enfant et de l'Adolescent, APHP.Sorbonne Université, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; Institut des Systèmes Intelligents et Robotiques, Sorbonne Université, Paris, France
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28
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Lieberman OJ, Cartocci V, Pigulevskiy I, Molinari M, Carbonell J, Broseta MB, Post MR, Sulzer D, Borgkvist A, Santini E. mTOR Suppresses Macroautophagy During Striatal Postnatal Development and Is Hyperactive in Mouse Models of Autism Spectrum Disorders. Front Cell Neurosci 2020; 14:70. [PMID: 32296308 DOI: 10.3389/fncel.2020.00070/bibtex] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 03/11/2020] [Indexed: 05/20/2023] Open
Abstract
Macroautophagy (hereafter referred to as autophagy) plays a critical role in neuronal function related to development and degeneration. Here, we investigated whether autophagy is developmentally regulated in the striatum, a brain region implicated in neurodevelopmental disease. We demonstrate that autophagic flux is suppressed during striatal postnatal development, reaching adult levels around postnatal day 28 (P28). We also find that mTOR signaling, a key regulator of autophagy, increases during the same developmental period. We further show that mTOR signaling is responsible for suppressing autophagy, via regulation of Beclin-1 and VPS34 activity. Finally, we discover that autophagy is downregulated during late striatal postnatal development (P28) in mice with in utero exposure to valproic acid (VPA), an established mouse model of autism spectrum disorder (ASD). VPA-exposed mice also display deficits in striatal neurotransmission and social behavior. Correction of hyperactive mTOR signaling in VPA-exposed mice restores social behavior. These results demonstrate that neurons coopt metabolic signaling cascades to developmentally regulate autophagy and provide additional evidence that mTOR-dependent signaling pathways represent pathogenic signaling cascades in ASD mouse models that are active during specific postnatal windows.
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Affiliation(s)
- Ori J Lieberman
- Division of Molecular Therapeutics, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
- Division of Movement Disorders, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | | | - Irena Pigulevskiy
- Division of Movement Disorders, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Maya Molinari
- Department of Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Josep Carbonell
- Department of Neuroscience, Karolinska Institute, Stockholm, Sweden
| | | | - Michael R Post
- Division of Molecular Therapeutics, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - David Sulzer
- Division of Molecular Therapeutics, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Anders Borgkvist
- Department of Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Emanuela Santini
- Division of Movement Disorders, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
- Department of Neuroscience, Karolinska Institute, Stockholm, Sweden
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29
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Prenatal valproate in rodents as a tool to understand the neural underpinnings of social dysfunctions in autism spectrum disorder. Neuropharmacology 2019; 159:107477. [DOI: 10.1016/j.neuropharm.2018.12.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/11/2018] [Accepted: 12/20/2018] [Indexed: 12/22/2022]
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30
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Abstract
Orofacial clefts are one of the most common global birth defects. Orofacial clefts may be part of a syndrome or an isolated birth defect, and affect approximately 1-1.5 per 1,000 live births worldwide with noted inequalities across geographical areas and cultures. In the United States, Asian American populations have a substantially higher incidence of cleft lip with or without cleft palate (2/1,000 live births). Orofacial clefts are a key health issue with substantial health care costs, and associated medical, psychological, and social ramifications. It has been estimated that the health care costs within the United States are approximately $697 million over a child's lifetime. In disorders like orofacial clefts, because of the complexity of the condition and subsequent medical interventions, as well as the cultural intricacies of the Asian culture, it requires significant knowledge and understanding by the health care providers. In order to provide optimal and safe cleft care, reduce health care costs, and improve the outcomes for the Asian American population, a culturally sensitive, multidisciplinary, and coordinated approach is needed. Increased culturally specific education, early access to prenatal care, and ongoing infant and pediatric health care are essential.
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31
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Forestieri NE, Desrosiers TA, Freedman SF, Aylsworth AS, Voltzke K, Olshan AF, Meyer RE. Risk factors for primary congenital glaucoma in the National Birth Defects Prevention Study. Am J Med Genet A 2019; 179:1846-1856. [DOI: 10.1002/ajmg.a.61296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 02/05/2019] [Accepted: 07/03/2019] [Indexed: 02/04/2023]
Affiliation(s)
- Nina E. Forestieri
- North Carolina Birth Defects Monitoring Program, State Center for Health Statistics Raleigh North Carolina
| | - Tania A. Desrosiers
- Department of EpidemiologyGillings School of Global Public Health, University of North Carolina at Chapel Hill Chapel Hill North Carolina
| | - Sharon F. Freedman
- Department of Ophthalmology and PediatricsDuke University Medical Center Durham North Carolina
| | - Arthur S. Aylsworth
- Department of Pediatrics and GeneticsUniversity of North Carolina at Chapel Hill Chapel Hill North Carolina
| | - Kristin Voltzke
- Department of EpidemiologyGillings School of Global Public Health, University of North Carolina at Chapel Hill Chapel Hill North Carolina
| | - Andrew F. Olshan
- Department of EpidemiologyGillings School of Global Public Health, University of North Carolina at Chapel Hill Chapel Hill North Carolina
| | - Robert E. Meyer
- North Carolina Birth Defects Monitoring Program, State Center for Health Statistics Raleigh North Carolina
- Department of Maternal and Child HealthGillings School of Global Public Health, University of North Carolina at Chapel Hill Chapel Hill North Carolina
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32
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Abstract
The management of bipolar disorder during reproductive years is a challenge to both patient and clinician. The rapidly changing landscape of medical literature, newly available medications, and implementation of the Pregnancy and Lactation Labeling Final Rule by the Food and Drug Administration can be dizzying. This article serves as a brief, practical guide on the use of medications for the treatment of bipolar disorder before, during, and immediately after pregnancy. Special focus is devoted to the risk-benefit analysis of using potentially teratogenic medications during pregnancy. Availability and appropriateness of various contraceptive methods and folic acid supplementation in combination with mood stabilizers is also addressed. Every clinician managing bipolar disorder in adult women should be knowledgeable of family planning resources and what to do in the setting of unintended pregnancy.
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33
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Nicolini C, Fahnestock M. The valproic acid-induced rodent model of autism. Exp Neurol 2018; 299:217-227. [DOI: 10.1016/j.expneurol.2017.04.017] [Citation(s) in RCA: 235] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 04/26/2017] [Accepted: 04/28/2017] [Indexed: 01/12/2023]
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34
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Gallagher ER, Siebold B, Collett BR, Cox TC, Aziz V, Cunningham ML. Associations between laterality of orofacial clefts and medical and academic outcomes. Am J Med Genet A 2017; 176:267-276. [PMID: 29232056 DOI: 10.1002/ajmg.a.38567] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 11/09/2017] [Accepted: 11/13/2017] [Indexed: 01/07/2023]
Abstract
Patients with oral clefts have an increased risk of other malformations, syndromes, and lower academic performance in school. Few studies have investigated if laterality of clefts is associated with medical and academic outcomes. Oral clefts have nonrandom laterality, with left-sided clefts occurring approximately twice as often as right-sided clefts. Using a retrospective study design, we examined potential associations of cleft attributes and outcomes in patients with cleft lip with or without cleft palate (CL/P) born in 2003-2010 who were treated at the Seattle Children's Craniofacial Center. The following variables were extracted from medical records: cleft type, medical history, maternal hyperglycemia, other malformations, and the need for academic support at school. We used logistic regression to examine risk of associations with outcomes of interest. Relative to patients with left-sided clefts, patients with bilateral CL/P were more likely to have a syndrome. Patients with nonsyndromic right-sided CL/P had a higher risk (OR and 95%CI: 3.5, 1.3-9.5, and 5.5, 1.9-16.0, respectively) of having other malformations and requiring academic support at school, when compared to patients with left-sided CL/P. Understanding the etiology of oral clefts is complicated, in part because both genetic and environmental factors contribute to the risk of developing a cleft. However, the different outcomes associated with cleft laterality suggest that right-sided clefts may have a distinct etiology. Using laterality to study cleft subgroups may advance our understanding of the etiology of this common birth defect.
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Affiliation(s)
- Emily R Gallagher
- Division of Craniofacial Medicine, Department of Pediatrics, University of Washington, Seattle, Washington.,Seattle Children's Craniofacial Center, University of Washington, Seattle, Washington.,Seattle Children's Research Institute, Seattle, Washington
| | - Babette Siebold
- Seattle Children's Craniofacial Center, University of Washington, Seattle, Washington.,Seattle Children's Research Institute, Seattle, Washington
| | - Brent R Collett
- Seattle Children's Craniofacial Center, University of Washington, Seattle, Washington.,Seattle Children's Research Institute, Seattle, Washington.,Child Psychiatry at Seattle Children's Hospital and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Timothy C Cox
- Division of Craniofacial Medicine, Department of Pediatrics, University of Washington, Seattle, Washington.,Seattle Children's Research Institute, Seattle, Washington
| | - Verena Aziz
- Seattle Children's Research Institute, Seattle, Washington
| | - Michael L Cunningham
- Division of Craniofacial Medicine, Department of Pediatrics, University of Washington, Seattle, Washington.,Seattle Children's Craniofacial Center, University of Washington, Seattle, Washington.,Seattle Children's Research Institute, Seattle, Washington
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35
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Nikolopoulou E, Galea GL, Rolo A, Greene NDE, Copp AJ. Neural tube closure: cellular, molecular and biomechanical mechanisms. Development 2017; 144:552-566. [PMID: 28196803 DOI: 10.1242/dev.145904] [Citation(s) in RCA: 310] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Neural tube closure has been studied for many decades, across a range of vertebrates, as a paradigm of embryonic morphogenesis. Neurulation is of particular interest in view of the severe congenital malformations - 'neural tube defects' - that result when closure fails. The process of neural tube closure is complex and involves cellular events such as convergent extension, apical constriction and interkinetic nuclear migration, as well as precise molecular control via the non-canonical Wnt/planar cell polarity pathway, Shh/BMP signalling, and the transcription factors Grhl2/3, Pax3, Cdx2 and Zic2. More recently, biomechanical inputs into neural tube morphogenesis have also been identified. Here, we review these cellular, molecular and biomechanical mechanisms involved in neural tube closure, based on studies of various vertebrate species, focusing on the most recent advances in the field.
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Affiliation(s)
- Evanthia Nikolopoulou
- Newlife Birth Defects Research Centre, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - Gabriel L Galea
- Newlife Birth Defects Research Centre, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - Ana Rolo
- Newlife Birth Defects Research Centre, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - Nicholas D E Greene
- Newlife Birth Defects Research Centre, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - Andrew J Copp
- Newlife Birth Defects Research Centre, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
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36
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Ornoy A, Weinstein-Fudim L, Ergaz Z. Antidepressants, Antipsychotics, and Mood Stabilizers in Pregnancy: What Do We Know and How Should We Treat Pregnant Women with Depression. Birth Defects Res 2017; 109:933-956. [DOI: 10.1002/bdr2.1079] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/02/2017] [Accepted: 06/06/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Asher Ornoy
- Laboratory of Teratology, Department of Medical Neurobiology; Hebrew University Hadassah Medical School; Jerusalem Israel
| | - Liza Weinstein-Fudim
- Laboratory of Teratology, Department of Medical Neurobiology; Hebrew University Hadassah Medical School; Jerusalem Israel
| | - Zivanit Ergaz
- Laboratory of Teratology, Department of Medical Neurobiology; Hebrew University Hadassah Medical School; Jerusalem Israel
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37
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Mohd-Zin SW, Marwan AI, Abou Chaar MK, Ahmad-Annuar A, Abdul-Aziz NM. Spina Bifida: Pathogenesis, Mechanisms, and Genes in Mice and Humans. SCIENTIFICA 2017; 2017:5364827. [PMID: 28286691 PMCID: PMC5327787 DOI: 10.1155/2017/5364827] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 11/14/2016] [Accepted: 12/01/2016] [Indexed: 05/26/2023]
Abstract
Spina bifida is among the phenotypes of the larger condition known as neural tube defects (NTDs). It is the most common central nervous system malformation compatible with life and the second leading cause of birth defects after congenital heart defects. In this review paper, we define spina bifida and discuss the phenotypes seen in humans as described by both surgeons and embryologists in order to compare and ultimately contrast it to the leading animal model, the mouse. Our understanding of spina bifida is currently limited to the observations we make in mouse models, which reflect complete or targeted knockouts of genes, which perturb the whole gene(s) without taking into account the issue of haploinsufficiency, which is most prominent in the human spina bifida condition. We thus conclude that the need to study spina bifida in all its forms, both aperta and occulta, is more indicative of the spina bifida in surviving humans and that the measure of deterioration arising from caudal neural tube defects, more commonly known as spina bifida, must be determined by the level of the lesion both in mouse and in man.
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Affiliation(s)
- Siti W. Mohd-Zin
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Ahmed I. Marwan
- Laboratory for Fetal and Regenerative Biology, Colorado Fetal Care Center, Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, 12700 E 17th Ave, Aurora, CO 80045, USA
| | | | - Azlina Ahmad-Annuar
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Noraishah M. Abdul-Aziz
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Wilson RD. Supplémentation préconceptionnelle en acide folique / multivitamines pour la prévention primaire et secondaire des anomalies du tube neural et d'autres anomalies congénitales sensibles à l'acide folique. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 38:S646-S664. [PMID: 28063572 DOI: 10.1016/j.jogc.2016.09.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIF Offrir des renseignements à jour sur l'utilisation pré et postconceptionnelle d'acide folique par voie orale, avec ou sans supplément de multivitamines / micronutriments, aux fins de la prévention des anomalies du tube neural et d'autres anomalies congénitales. Ces renseignements aideront les médecins, les sages-femmes, les infirmières et les autres professionnels de la santé à contribuer aux efforts de sensibilisation des femmes quant à l'utilisation et aux posologies adéquates de la supplémentation en acide folique / multivitamines, avant et pendant la grossesse. RéSULTATS: La littérature publiée a été récupérée par l'intermédiaire de recherches menées dans PubMed, Medline, CINAHL et la Cochrane Library en janvier 2011 au moyen d'un vocabulaire contrôlé et de mots clés appropriés (p. ex. « folic acid », « prenatal multivitamins », « folate sensitive birth defects », « congenital anomaly risk reduction », « pre-conception counselling »). Les résultats ont été restreints aux analyses systématiques, aux études observationnelles et aux essais comparatifs randomisés / essais cliniques comparatifs publiés en anglais entre 1985 et juin 2014. Les recherches ont été mises à jour de façon régulière et intégrées à la directive clinique jusqu'en juin 2014. La littérature grise (non publiée) a été identifiée par l'intermédiaire de recherches menées dans les sites Web d'organismes s'intéressant à l'évaluation des technologies dans le domaine de la santé et d'organismes connexes, dans des collections de directives cliniques, dans des registres d'essais cliniques, et auprès de sociétés de spécialité médicale nationales et internationales. COûTS, RISQUES ET AVANTAGES: Les coûts financiers sont ceux de la supplémentation quotidienne en vitamines et de la consommation d'un régime alimentaire santé enrichi en folate. Les risques sont ceux qui sont liés à une association signalée entre la supplémentation alimentaire en acide folique et des modifications épigénétiques fœtales / la probabilité accrue d'obtenir une grossesse gémellaire. Ces associations pourraient devoir être prises en considération avant la mise en œuvre d'une supplémentation en acide folique. La supplémentation en acide folique par voie orale (ou l'apport alimentaire en folate combiné à un supplément de multivitamines / micronutriments) a pour avantage de mener à une baisse connexe du taux d'anomalies du tube neural et peut-être même des taux d'autres complications obstétricales et anomalies congénitales particulières. VALEURS La qualité des résultats est évaluée au moyen des critères décrits par le Groupe d'étude canadien sur les soins de santé préventifs (Tableau 1). DéCLARATION SOMMAIRE: RECOMMANDATIONS.
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Borgelt LM, Hart FM, Bainbridge JL. Epilepsy during pregnancy: focus on management strategies. Int J Womens Health 2016; 8:505-517. [PMID: 27703396 PMCID: PMC5036546 DOI: 10.2147/ijwh.s98973] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
In the US, more than one million women with epilepsy are of childbearing age and have over 20,000 babies each year. Patients with epilepsy who become pregnant are at risk of complications, including changes in seizure frequency, maternal morbidity and mortality, and congenital anomalies due to antiepileptic drug exposure. Appropriate management of epilepsy during pregnancy may involve frequent monitoring of antiepileptic drug serum concentrations, potential preconception switching of antiepileptic medications, making dose adjustments, minimizing peak drug concentration with more frequent dosing, and avoiding potentially teratogenic medications. Ideally, preconception planning will be done to minimize risks to both the mother and fetus during pregnancy. It is important to recognize benefits and risks of current and emerging therapies, especially with revised pregnancy labeling in prescription drug product information. This review will outline risks for epilepsy during pregnancy, review various recommendations from leading organizations, and provide an evidence-based approach for managing patients with epilepsy before, during, and after pregnancy.
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Affiliation(s)
| | - Felecia M Hart
- Departments of Clinical Pharmacy and Neurology, University of Colorado Anschutz Medical Campus, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Jacquelyn L Bainbridge
- Departments of Clinical Pharmacy and Neurology, University of Colorado Anschutz Medical Campus, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
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Campos Neves ATDS, Volpato LER, Espinosa MM, Aranha AMF, Borges AH. Environmental factors related to the occurrence of oral clefts in a Brazilian subpopulation. Niger Med J 2016; 57:167-72. [PMID: 27397957 PMCID: PMC4924399 DOI: 10.4103/0300-1652.184064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: A cross-sectional study was conducted at the Craniofacial Rehabilitation Center in the General Hospital of the University of Cuiabá, Cuiabá city, Mato Grosso, Brazil. Materials and Methods: Poisson regression model was used to analyze the relationship between antenatal factors and the occurrence of oral clefts in 116 patients. Results: Oral clefts were more common in males (64.66%) and White race (46.02%). The mean age of the children was 21.91 months. The most common type of cleft was cleft lip and palate (CLP, 55.17%). Maternal and paternal smoking in the first trimester of pregnancy and parity were significantly associated with the occurrence of CLP. Parent's age, educational level, and occupation did not interfere in the occurrence of oral clefts. There was also no significant association between maternal illness, medication use, alcohol consumption, and maternal exposure to chemicals in the first trimester of pregnancy and the occurrence of clefts in this population. Conclusion: The analysis of the environmental factors present during the pregnancy of children with oral clefts revealed a significant association between parity (second onward), maternal smoking, and paternal smoking and the occurrence of CL and/or palate in this population.
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Affiliation(s)
| | - Luiz Evaristo Ricci Volpato
- Department of Pediatric Dentistry and Endodontics, Faculty of Dentistry, University of Cuiabá, Cuiabá, MT, Brazil
| | | | - Andreza Maria Fabio Aranha
- Department of Pediatric Dentistry and Endodontics, Faculty of Dentistry, University of Cuiabá, Cuiabá, MT, Brazil
| | - Alvaro Henrique Borges
- Department of Pediatric Dentistry and Endodontics, Faculty of Dentistry, University of Cuiabá, Cuiabá, MT, Brazil
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Ornoy A, Weinstein-Fudim L, Ergaz Z. Genetic Syndromes, Maternal Diseases and Antenatal Factors Associated with Autism Spectrum Disorders (ASD). Front Neurosci 2016; 10:316. [PMID: 27458336 PMCID: PMC4933715 DOI: 10.3389/fnins.2016.00316] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 06/22/2016] [Indexed: 01/29/2023] Open
Abstract
Autism spectrum disorder (ASD) affecting about 1% of all children is associated, in addition to complex genetic factors, with a variety of prenatal, perinatal, and postnatal etiologies. In addition, ASD is often an important clinical presentation of some well-known genetic syndromes in human. We discuss these syndromes as well as the role of the more important prenatal factors affecting the fetus throughout pregnancy which may also be associated with ASD. Among the genetic disorders we find Fragile X, Rett syndrome, tuberous sclerosis, Timothy syndrome, Phelan-McDermid syndrome, Hamartoma tumor syndrome, Prader-Willi and Angelman syndromes, and a few others. Among the maternal diseases in pregnancy associated with ASD are diabetes mellitus (PGDM and/or GDM), some maternal autoimmune diseases like antiphospholipid syndrome (APLS) with anti-β2GP1 IgG antibodies and thyroid disease with anti-thyroid peroxidase (TPO) antibodies, preeclampsia and some other autoimmune diseases with IgG antibodies that might affect fetal brain development. Other related factors are maternal infections (rubella and CMV with fetal brain injuries, and possibly Influenza with fever), prolonged fever and maternal inflammation, especially with changes in a variety of inflammatory cytokines and antibodies that cross the placenta and affect the fetal brain. Among the drugs are valproic acid, thalidomide, misoprostol, and possibly SSRIs. β2-adrenergic receptor agonists and paracetamol have also lately been associated with increased rate of ASD but the data is too preliminary and inconclusive. Associations were also described with ethanol, cocaine, and possibly heavy metals, heavy smoking, and folic acid deficiency. Recent studies show that heavy exposure to pesticides and air pollution, especially particulate matter < 2.5 and 10 μm in diameter (PM2.5 and PM10) during pregnancy is also associated with ASD. Finally, we have to remember that many of the associations mentioned in this review are only partially proven, and not all are "clean" of different confounding factors. The associations described in this review emphasize again how little we know about the etiology and pathogenesis of ASD. It is obvious that we need more epidemiologic data to establish many of these associations, but if proven, they might be promising avenues for prevention.
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Affiliation(s)
- Asher Ornoy
- Laboratory of Teratology, Department of Medical Neurobiology, Hadassah Medical School, Hebrew University Jerusalem, Israel
| | - Liza Weinstein-Fudim
- Laboratory of Teratology, Department of Medical Neurobiology, Hadassah Medical School, Hebrew University Jerusalem, Israel
| | - Zivanit Ergaz
- Laboratory of Teratology, Department of Medical Neurobiology, Hadassah Medical School, Hebrew UniversityJerusalem, Israel; Department of Neonatology, Hadassah-Hebrew University Medical CenterJerusalem, Israel
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de Jong J, Garne E, de Jong-van den Berg LTW, Wang H. The Risk of Specific Congenital Anomalies in Relation to Newer Antiepileptic Drugs: A Literature Review. Drugs Real World Outcomes 2016; 3:131-143. [PMID: 27398292 PMCID: PMC4914544 DOI: 10.1007/s40801-016-0078-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND More information is needed about possible associations between the newer anti-epileptic drugs (AEDs) in the first trimester of pregnancy and specific congenital anomalies of the fetus. OBJECTIVES We performed a literature review to find signals for potential associations between newer AEDs (lamotrigine, topiramate, levetiracetam, gabapentin, oxcarbazepine, eslicarbazepine, felbamate, lacosamide, pregabalin, retigabine, rufinamide, stiripentol, tiagabine, vigabatrin, and zonisamide) and specific congenital anomalies. METHODS We searched PubMed and EMBASE to find observational studies with pregnancies exposed to newer AEDs and detailed information on congenital anomalies. The congenital anomalies in the studies were classified according to the congenital anomaly subgroups of European Surveillance of Congenital Anomalies (EUROCAT). We compared the prevalence of specific congenital anomalies in fetuses exposed to individual AEDs in the combined studies with that of the general population in a reference database. A significantly higher prevalence based on three or more fetuses with anomalies was considered a signal. RESULTS Topiramate showed a higher rate of congenital anomalies than the other newer AEDs. Four signals were found. The signals for associations between topiramate and cleft lip with/without cleft palate and hypospadias were considered strong. Associations between lamotrigine and anencephaly and transposition of great vessels were found within one study and were not supported by other studies. No signals were found for the other newer AEDs, or the information was too limited to provide such a signal. CONCLUSION In terms of associations between monotherapy with a newer AED in the first trimester of pregnancy and a specific congenital anomaly, the signals for topiramate and cleft lip with/without cleft palate and hypospadias should be investigated further.
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Affiliation(s)
- Josta de Jong
- Department of Pharmacoepidemiology and Pharmacoeconomics, University of Groningen, A. Deusinglaan 1, 9713AV Groningen, The Netherlands
| | - Ester Garne
- Paediatric Department, Hospital Lillebaelt, Kolding, Denmark
| | - Lolkje T. W. de Jong-van den Berg
- Department of Pharmacoepidemiology and Pharmacoeconomics, University of Groningen, A. Deusinglaan 1, 9713AV Groningen, The Netherlands
| | - Hao Wang
- Department of Pharmacoepidemiology and Pharmacoeconomics, University of Groningen, A. Deusinglaan 1, 9713AV Groningen, The Netherlands
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Howley MM, Carter TC, Browne ML, Romitti PA, Cunniff CM, Druschel CM. Fluconazole use and birth defects in the National Birth Defects Prevention Study. Am J Obstet Gynecol 2016; 214:657.e1-9. [PMID: 26640069 PMCID: PMC10041360 DOI: 10.1016/j.ajog.2015.11.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/13/2015] [Accepted: 11/23/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Low-dose fluconazole is used commonly to treat vulvovaginal candidiasis, a condition occurring frequently during pregnancy. Conflicting information exists on the association between low-dose fluconazole use among pregnant women and the risk of major birth defects. OBJECTIVE We used data from the National Birth Defects Prevention Study to examine this association. STUDY DESIGN The National Birth Defects Prevention Study is a multisite, population-based, case-control study that includes pregnancies with estimated delivery dates from 1997 to 2011. Information on fluconazole use in early pregnancy was collected by self-report from 31,645 mothers of birth defect cases and 11,612 mothers of unaffected controls. Adjusted odds ratios and 95% confidence intervals were estimated for birth defects with 5 or more exposed cases; crude odds ratios and exact 95% confidence intervals were estimated for birth defects with 3-4 exposed cases. RESULTS Of the 43,257 mothers analyzed, 44 case mothers and 6 control mothers reported using fluconazole. Six exposed infants had cleft lip with cleft palate, 4 had an atrial septal defect, and each of the following defects had 3 exposed cases: hypospadias, tetralogy of Fallot, d-transposition of the great arteries, and pulmonary valve stenosis. Fluconazole use was associated with cleft lip with cleft palate (odds ratio = 5.53; confidence interval = 1.68-18.24) and d-transposition of the great arteries (odds ratio = 7.56; confidence interval = 1.22-35.45). CONCLUSIONS The associations between fluconazole and both cleft lip with cleft palate and d-transposition of the great arteries are consistent with earlier published case reports but not recent epidemiologic studies. Despite the larger sample size of the National Birth Defects Prevention Study, fluconazole use was rare. Further investigation is needed in large studies, with particular emphasis on oral clefts and conotruncal heart defects.
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Affiliation(s)
- Meredith M Howley
- Congenital Malformations Registry, New York State Department of Health, Albany, NY.
| | - Tonia C Carter
- Center for Human Genetics, Marshfield Clinic, Marshfield, WI
| | - Marilyn L Browne
- Congenital Malformations Registry, New York State Department of Health, Albany, NY; Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, NY
| | - Paul A Romitti
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
| | | | - Charlotte M Druschel
- Congenital Malformations Registry, New York State Department of Health, Albany, NY; Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, NY
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Goldman AM, LaFrance WC, Benke T, Asato M, Drane D, Pack A, Syed T, Doss R, Lhatoo S, Fureman B, Dingledine R. 2014 Epilepsy Benchmarks Area IV: Limit or Prevent Adverse Consequence of Seizures and Their Treatment Across The Lifespan. Epilepsy Curr 2016; 16:198-205. [PMID: 27330453 PMCID: PMC4913859 DOI: 10.5698/1535-7511-16.3.198] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Alica M. Goldman
- Associate Professor, Department of Neurology, Baylor College of Medicine, One Baylor Plaza, NB222, Houston, TX, USA
| | - W. Curt LaFrance
- Associate Professor, Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Providence RI 02903-4923 USA
| | - Tim Benke
- Associate Professor, Departments of Pediatrics, Neurology, Pharmacology and Otolaryngology, University of Colorado School of Medicine, Aurora, CO
| | - Miya Asato
- Associate Professor, Pediatrics and Psychiatry, Divisionof Child Neurology, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Dan Drane
- Assistant Professor, Departments of Neurology and Pediatrics, Emory University School of Medicine and Department of Neurology, University of Washington School of Medicine
| | - Alison Pack
- Associate Professor of Neurology, Department of Neurology, Columbia University Medical Center, New York, NY
| | - Tanvir Syed
- Assistant Professor of Neurology, University Hospitals Case Medical Center, Cleveland, OH
| | - Robert Doss
- Clinical Neuropsychologist, Minnesota Epilepsy Group, P.A., St. Paul, MN and Department of Neurology, University of Minnesota-Twin Cities, MN
| | - Samden Lhatoo
- Professor and Chair, Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Brandy Fureman
- Program Director, Channels Synapses and Circuits Cluster, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Ray Dingledine
- Professor and Chair, Department of Pharmacology, Emory University, Atlanta GA
| | - for the American Epilepsy Society (AES)/National Institute of Neurological Disorders and Stroke (NINDS) Epilepsy Benchmark Stewards.
- Associate Professor, Department of Neurology, Baylor College of Medicine, One Baylor Plaza, NB222, Houston, TX, USA
- Associate Professor, Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Providence RI 02903-4923 USA
- Associate Professor, Departments of Pediatrics, Neurology, Pharmacology and Otolaryngology, University of Colorado School of Medicine, Aurora, CO
- Associate Professor, Pediatrics and Psychiatry, Divisionof Child Neurology, Children's Hospital of Pittsburgh, Pittsburgh, PA
- Assistant Professor, Departments of Neurology and Pediatrics, Emory University School of Medicine and Department of Neurology, University of Washington School of Medicine
- Associate Professor of Neurology, Department of Neurology, Columbia University Medical Center, New York, NY
- Assistant Professor of Neurology, University Hospitals Case Medical Center, Cleveland, OH
- Clinical Neuropsychologist, Minnesota Epilepsy Group, P.A., St. Paul, MN and Department of Neurology, University of Minnesota-Twin Cities, MN
- Professor and Chair, Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH
- Program Director, Channels Synapses and Circuits Cluster, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
- Professor and Chair, Department of Pharmacology, Emory University, Atlanta GA
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Abstract
Pregnancy and postpartum represent times of increased vulnerability for women with bipolar disorder, yet this condition remains under-diagnosed and under-treated. As 50 % of pregnancies are unplanned, the risks associated with the illness and the potential risks associated with treatment should be considered when a woman of reproductive age first presents for evaluation. This article reviews the epidemiology of perinatal bipolar disorder, screening recommendations, and treatment with pharmacotherapy and electroconvulsive therapy (ECT). An overview of the data in pregnancy and lactation is presented for lithium, lamotrigine, valproic acid, newer antipsychotics, and ECT. General principles of management include close monitoring in pregnancy and postpartum, careful adjustment of the treatment regimen to attenuate the risk of relapse, and avoidance of valproic acid when possible. Thoughtful consideration of these issues will minimize the risks to the mother and baby.
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Gadzhanova S, Roughead E. Use of prescription medicines in Australian women of child-bearing age. BMC Pharmacol Toxicol 2015; 16:33. [PMID: 26643036 PMCID: PMC4672510 DOI: 10.1186/s40360-015-0033-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 11/18/2015] [Indexed: 11/29/2022] Open
Abstract
Background This study aimed to examine current utilisation of prescribed medicines amongst Australian women of child-bearing age, with a particular focus on the extent of use of medicines in Category D and X risk groups, which are moderate and high risk teratogens, respectively. The use of those medicines may pose risk of birth defects in pregnant women. Methods A retrospective cross-sectional study was undertaken involving all women of child-bearing age (15 to 44 years) who were dispensed medicines in 2013 using the 10 % random sample of dispensing data from the Australian Government Department of Human Services. Dispensing patterns were reported by medicine, therapeutic class, pregnancy risk category and women’s age. Results Over one-third of women aged 15 to 44 years received at least one prescribed medicine in 2013. Psychoanaleptics, antibiotics and analgesics were the top three classes. Around 9 % of all dispensings were for medicines from risk category D, with statins, agents acting on renin-angiotensin system, and some anti-epileptic agents being the most commonly used. Both statins and agents acting on renin-angiotensin system showed increasing use with age, estimated to be 35,600 women nationally for each group. Collectively between 2 % and 4 % of women used anti-epileptics from risk category D in each year of age, with overall use estimated to be 51,000 women nationally. Below 1 % of all dispensings were for category X medicines, mainly isotretinoin. Conclusions It is important for medical practitioners to offer counselling around pregnancy planning and the risk of birth defects when prescribing moderate or high risk teratogens to women in child-bearing age. For the antihypertensives and some anti-epileptics, alternative medicines with lower risk categorization are available.
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Affiliation(s)
- Svetla Gadzhanova
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.
| | - Elizabeth Roughead
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.
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Wilson RD, Wilson RD, Audibert F, Brock JA, Carroll J, Cartier L, Gagnon A, Johnson JA, Langlois S, Murphy-Kaulbeck L, Okun N, Pastuck M, Deb-Rinker P, Dodds L, Leon JA, Lowel HL, Luo W, MacFarlane A, McMillan R, Moore A, Mundle W, O'Connor D, Ray J, Van den Hof M. Pre-conception Folic Acid and Multivitamin Supplementation for the Primary and Secondary Prevention of Neural Tube Defects and Other Folic Acid-Sensitive Congenital Anomalies. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:534-52. [PMID: 26334606 DOI: 10.1016/s1701-2163(15)30230-9] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To provide updated information on the pre- and post-conception use of oral folic acid with or without a multivitamin/micronutrient supplement for the prevention of neural tube defects and other congenital anomalies. This will help physicians, midwives, nurses, and other health care workers to assist in the education of women about the proper use and dosage of folic acid/multivitamin supplementation before and during pregnancy. EVIDENCE Published literature was retrieved through searches of PubMed, Medline, CINAHL, and the Cochrane Library in January 2011 using appropriate controlled vocabulary and key words (e.g., folic acid, prenatal multivitamins, folate sensitive birth defects, congenital anomaly risk reduction, pre-conception counselling). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies published in English from 1985 and June 2014. Searches were updated on a regular basis and incorporated in the guideline to June 2014 Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. Costs, risks, and benefits: The financial costs are those of daily vitamin supplementation and eating a healthy folate-enriched diet. The risks are of a reported association of dietary folic acid supplementation with fetal epigenetic modifications and with an increased likelihood of a twin pregnancy. These associations may require consideration before initiating folic acid supplementation. The benefit of folic acid oral supplementation or dietary folate intake combined with a multivitamin/micronutrient supplement is an associated decrease in neural tube defects and perhaps in other specific birth defects and obstetrical complications. VALUES The quality of evidence in the document was rated using the criteria described in the Report of the Canadian Task Force on Preventative Health Care (Table 1). Summary Statement In Canada multivitamin tablets with folic acid are usually available in 3 formats: regular over-the-counter multivitamins with 0.4 to 0.6 mg folic acid, prenatal over-the-counter multivitamins with 1.0 mg folic acid, and prescription multivitamins with 5.0 mg folic acid. (III) Recommendations 1. Women should be advised to maintain a healthy folate-rich diet; however, folic acid/multivitamin supplementation is needed to achieve the red blood cell folate levels associated with maximal protection against neural tube defect. (III-A) 2. All women in the reproductive age group (12-45 years of age) who have preserved fertility (a pregnancy is possible) should be advised about the benefits of folic acid in a multivitamin supplementation during medical wellness visits (birth control renewal, Pap testing, yearly gynaecological examination) whether or not a pregnancy is contemplated. Because so many pregnancies are unplanned, this applies to all women who may become pregnant. (III-A) 3. Folic acid supplementation is unlikely to mask vitamin B12 deficiency (pernicious anemia). Investigations (examination or laboratory) are not required prior to initiating folic acid supplementation for women with a risk for primary or recurrent neural tube or other folic acid-sensitive congenital anomalies who are considering a pregnancy. It is recommended that folic acid be taken in a multivitamin including 2.6 ug/day of vitamin B12 to mitigate even theoretical concerns. (II-2A) 4. Women at HIGH RISK, for whom a folic acid dose greater than 1 mg is indicated, taking a multivitamin tablet containing folic acid, should be advised to follow the product label and not to take more than 1 daily dose of the multivitamin supplement. Additional tablets containing only folic acid should be taken to achieve the desired dose. (II-2A) 5. Women with a LOW RISK for a neural tube defect or other folic acid-sensitive congenital anomaly and a male partner with low risk require a diet of folate-rich foods and a daily oral multivitamin supplement containing 0.4 mg folic acid for at least 2 to 3 months before conception, throughout the pregnancy, and for 4 to 6 weeks postpartum or as long as breast-feeding continues. (II-2A) 6. Women with a MODERATE RISK for a neural tube defect or other folic acid-sensitive congenital anomaly or a male partner with moderate risk require a diet of folate-rich foods and daily oral supplementation with a multivitamin containing 1.0 mg folic acid, beginning at least 3 months before conception. Women should continue this regime until 12 weeks' gestational age. (1-A) From 12 weeks' gestational age, continuing through the pregnancy, and for 4 to 6 weeks postpartum or as long as breast-feeding continues, continued daily supplementation should consist of a multivitamin with 0.4 to 1.0 mg folic acid. (II-2A) 7. Women with an increased or HIGH RISK for a neural tube defect, a male partner with a personal history of neural tube defect, or history of a previous neural tube defect pregnancy in either partner require a diet of folate-rich foods and a daily oral supplement with 4.0 mg folic acid for at least 3 months before conception and until 12 weeks' gestational age. From 12 weeks' gestational age, continuing throughout the pregnancy, and for 4 to 6 weeks postpartum or as long as breast-feeding continues, continued daily supplementation should consist of a multivitamin with 0.4 to 1.0 mg folic acid. (I-A). The same dietary and supplementation regime should be followed if either partner has had a previous pregnancy with a neural tube defect. (II-2A).
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Rempel E, Hoelting L, Waldmann T, Balmer NV, Schildknecht S, Grinberg M, Das Gaspar JA, Shinde V, Stöber R, Marchan R, van Thriel C, Liebing J, Meisig J, Blüthgen N, Sachinidis A, Rahnenführer J, Hengstler JG, Leist M. A transcriptome-based classifier to identify developmental toxicants by stem cell testing: design, validation and optimization for histone deacetylase inhibitors. Arch Toxicol 2015; 89:1599-618. [PMID: 26272509 PMCID: PMC4551554 DOI: 10.1007/s00204-015-1573-y] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 07/22/2015] [Indexed: 12/17/2022]
Abstract
Test systems to identify developmental toxicants are urgently needed. A combination of human stem cell technology and transcriptome analysis was to provide a proof of concept that toxicants with a related mode of action can be identified and grouped for read-across. We chose a test system of developmental toxicity, related to the generation of neuroectoderm from pluripotent stem cells (UKN1), and exposed cells for 6 days to the histone deacetylase inhibitors (HDACi) valproic acid, trichostatin A, vorinostat, belinostat, panobinostat and entinostat. To provide insight into their toxic action, we identified HDACi consensus genes, assigned them to superordinate biological processes and mapped them to a human transcription factor network constructed from hundreds of transcriptome data sets. We also tested a heterogeneous group of ‘mercurials’ (methylmercury, thimerosal, mercury(II)chloride, mercury(II)bromide, 4-chloromercuribenzoic acid, phenylmercuric acid). Microarray data were compared at the highest non-cytotoxic concentration for all 12 toxicants. A support vector machine (SVM)-based classifier predicted all HDACi correctly. For validation, the classifier was applied to legacy data sets of HDACi, and for each exposure situation, the SVM predictions correlated with the developmental toxicity. Finally, optimization of the classifier based on 100 probe sets showed that eight genes (F2RL2, TFAP2B, EDNRA, FOXD3, SIX3, MT1E, ETS1 and LHX2) are sufficient to separate HDACi from mercurials. Our data demonstrate how human stem cells and transcriptome analysis can be combined for mechanistic grouping and prediction of toxicants. Extension of this concept to mechanisms beyond HDACi would allow prediction of human developmental toxicity hazard of unknown compounds with the UKN1 test system.
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Affiliation(s)
- Eugen Rempel
- Department of Statistics, TU Dortmund University, 44139, Dortmund, Germany
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Alsaad AM, Chaudhry SA, Koren G. First trimester exposure to topiramate and the risk of oral clefts in the offspring: A systematic review and meta-analysis. Reprod Toxicol 2015; 53:45-50. [DOI: 10.1016/j.reprotox.2015.03.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 02/16/2015] [Accepted: 03/11/2015] [Indexed: 11/16/2022]
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Ornoy A, Weinstein-Fudim L, Ergaz Z. Prenatal factors associated with autism spectrum disorder (ASD). Reprod Toxicol 2015; 56:155-69. [PMID: 26021712 DOI: 10.1016/j.reprotox.2015.05.007] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 05/14/2015] [Accepted: 05/14/2015] [Indexed: 12/31/2022]
Abstract
Autism spectrum disorder (ASD) affecting about 1% of all children is associated, in addition to complex genetic factors, with a variety of prenatal, perinatal and postnatal etiologies. We discuss the known associated prenatal factors affecting the fetus throughout pregnancy; whenever relevant, also summarize some animal data. Among the maternal diseases in pregnancy associated with ASD are pregestational and/or gestational diabetes mellitus (PGDM, GDM), maternal infections (i.e. rubella, cytomegalovirus (CMV)), prolonged fever and maternal inflammation, which cause changes in a variety of inflammatory cytokines. Among the drugs are valproic acid, thalidomide, and possibly misoprostol and serotonin reuptake inhibitors (SSRIs). Associations were described with ethanol, and possibly cocaine, heavy metals heavy smoking and Folic acid deficiency. Heavy exposure to pesticides and air pollution during pregnancy was recently associated with ASD. We need more epidemiologic data to establish many of these associations; if proven, they might be promising avenues for prevention.
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Affiliation(s)
- A Ornoy
- Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem, Israel.
| | - L Weinstein-Fudim
- Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Z Ergaz
- Department of Neonatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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