The effect of vitamin A deficiency during pregnancy on anorectal malformations

Analysis of alcohol-metabolizing enzymes genetic variants and RAR/RXR expression in patients diagnosed with fetal alcohol syndrome: a case-control study

Understanding the mechanisms underlying alcohol metabolism and its regulation, including the effect of polymorphisms in alcohol-metabolizing enzymes, is crucial for research on Fetal Alcohol Spectrum Disorders. The aim of this study was to identify specific single nucleotide polymorphisms in key alcohol-metabolizing enzymes in a cohort of 71 children, including children with fetal alcohol syndrome, children prenatally exposed to ethanol but without fetal alcohol spectrum disorder, and controls. We hypothesized that certain genetic variants related to alcohol metabolism may be fixed in these populations, giving them a particular alcohol metabolism profile. In addition, the difference in certain isoforms of these enzymes determines their affinity for alcohol, which also affects the metabolism of retinoic acid, which is key to the proper development of the central nervous system. Our results showed that children prenatally exposed to ethanol without fetal alcohol spectrum disorder traits had a higher frequency of the ADH1B*3 and ADH1C*1 alleles, which are associated with increased alcohol metabolism and therefore a protective factor against circulating alcohol in the fetus after maternal drinking, compared to FAS children who had an allele with a lower affinity for alcohol. This study also revealed the presence of an ADH4 variant in the FAS population that binds weakly to the teratogen, allowing increased circulation of the toxic agent and direct induction of developmental abnormalities in the fetus. However, both groups showed dysregulation in the expression of genes related to the retinoic acid pathway, such as retinoic acid receptor and retinoid X receptor, which are involved in the development, regeneration, and maintenance of the nervous system. These findings highlight the importance of understanding the interplay between alcohol metabolism, the retinoic acid pathway and genetic factors in the development of fetal alcohol syndrome.

Vitamin A deficiency among pregnant women in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Vitamin A deficiency (VAD) during pregnancy is a public health challenge in low-income countries. There are inconsistent findings that can affect policy in planning appropriate intervention. This systematic review and meta-analysis were conducted to summarize the evidence in order to identify existing gaps and propose strategies to reduce VAD during pregnancy in Ethiopia.

METHODS

This study included published and unpublished observational studies searched from different databases (PubMed, CINHAL [EBSCO], Embase, Google Scholar, Directory of Open Access Journals, Web of Sciences, MEDLINE, Cochrane Library, Scopus, Google Search and MedNar). Statistical analysis was conducted using Stata version 14 software. Heterogeneity and publication bias were assessed. Forest plots were used to present the pooled prevalence using the random effects model.

RESULTS

A total of 37 618 pregnant women from 15 studies were included. The overall pooled prevalence of VAD was 29% (95% confidence interval 21 to 36) with I2=99.67% and p<0.001. Socio-economic and sociodemographic factors were identified as affecting vitamin A deficiencies among pregnant women.

CONCLUSIONS

Nearly one-third of pregnant women in Ethiopia had VAD. Strengthening intervention modalities that aimed to increase the uptake of vitamin A-rich foods can avert VAD among pregnant women in Ethiopia.

Embryology and anatomy of anorectal malformations

The etiology of anorectal malformations (ARM) is complicated because of the spectrum of anomalies seen clinically, many of which are isolated and seemingly unique. Recent studies suggest that ARMs result from abnormal cloacal membrane (CM) development that contributes to disrupt normal local muscle and nerve development. If CM maldevelopment is severe, the rectal pouch lies above the pelvic floor, resulting in asymmetric and/or deviated musculature, so a midline incision is likely to cause trauma or be detrimental. Autonomic nerve plexuses can be associated with a fistula tract in ARMs and are also at risk for damage during surgery and contribute to genitourinary complications. Understanding the anatomy and development of the perineum is crucial for treating the broad spectrum of anomalies associated with ARMs and may assist in predicting/managing other related morbidity.

Pathogenesis of Anorectal Malformations in Retinoic Acid Receptor Knockout Mice Studied by HREM

Anorectal malformations (ARMs) are relatively common congenital abnormalities, but their pathogenesis is poorly understood. Previous gene knockout studies indicated that the signalling pathway mediated by the retinoic acid receptors (RAR) is instrumental to the formation of the anorectal canal and of various urogenital structures. Here, we show that simultaneous ablation of the three RARs in the mouse embryo results in a spectrum of malformations of the pelvic organs in which anorectal and urinary bladder ageneses are consistently associated. We found that these ageneses could be accounted for by defects in the processes of growth and migration of the cloaca, the embryonic structure from which the anorectal canal and urinary bladder originate. We further show that these defects are preceded by a failure of the lateral shift of the umbilical arteries and propose vascular abnormalities as a possible cause of ARM. Through the comparisons of these phenotypes with those of other mutant mice and of human patients, we would like to suggest that morphological data may provide a solid base to test molecular as well as clinical hypotheses.

Selected Micronutrients: An Option to Boost Immunity against COVID-19 and Prevent Adverse Pregnancy Outcomes in Pregnant Women: A Narrative Review

The coronavirus disease-19 (COVID-19) negatively affects immune system. It is linked with adverse pregnancy outcomes. These complications may be linked with the infections mediated deficiency of micronutrients in pregnant women. COVID-19 cause's malabsorption of micronutrients thereby increases the risk of their deficiency. Both micronutrients deficiencies and poor micronutrients intake can compromise immune function and may increase the risk of pregnancy complications associated with COVID-19 infection. Vita-min A, C, D, E, and selected minerals iron (Fe), selenium (Se), and zinc (Zn) are the micronutrients essential for immuno-competency and play a significant role in the prevention of adverse pregnancy outcomes. Immune function and pregnancy outcomes can be improved by adequate intake of micronutrients in diet or in supplements form. Based on regulatory links between viral infection, micronutrients, immunity, and pregnancy outcomes, this review highlights the role of micronutrients in boosting immunity to reduce or prevent pregnancy complications in COVID-19 infected women.

Vitamin A Requirements in Pregnancy and Lactation

Pregnancy and lactation are critical life stages with unique nutritional requirements, including for vitamin A (VA). Current DRIs for VA were published in 2001. The objective of this review was to identify and categorize evidence related to VA requirements in pregnancy and lactation since these DRIs were formulated. We searched MEDLINE and included articles according to an analytic framework of maternal VA exposure on status and health outcomes in the mother-child dyad. Intermediate and indirect evidence supports that maternal VA intakes can impact the mother's VA status, breastmilk, and health outcomes, as well as the child's VA status and select health outcomes. Food-based approaches can lead to more sustained, sufficient VA status in mothers and children. Research needs include further study linking maternal VA intakes on maternal and child VA status, and further associations with outcomes to determine intake requirements to optimize health.

Dietary vitamin A intakes among pregnant women attending antenatal care in health facilities in Dessie Town, North East Ethiopia

BACKGROUND

Vitamin A plays an important role in vision, cellular differentiation, embryonic development, reproduction, growth and the immune system. Women who live in developing countries face a risk of undernutrition during pregnancy as a result of poverty, poor diet quality and quantity, and a high fertility rate. This poor dietary problem could reflect the high risk of vitamin A deficiency in women. The present study aimed to determine the adequacy of vitamin A among pregnant women following antenatal care in health facilities of Dessie Town, Ethiopia, January 2017.

METHODS

Health facility-based cross-sectional study was conducted among 390 women who attended antenatal care in Dessie Town. Food groups from the Food and Agriculture Organization based on 24-h dietary recall were used to measure dietary intake of vitamin A and dietary diversity of women. Adequacy of vitamin A was determined from the nutrient adequacy ratio after obtaining reports of nutrient intake from food composition tables version III and IV in terms of B carotene and retinol equivalent, respectively, based on the estimated average requirement recommendation of vitamin A, 370 retinol equivalent day^-1 for pregnant women. Multivariable logistic regression analysis was performed to identify associated factors of vitamin A adequacy.

RESULTS

Adequacy of vitamin A among pregnant women was 41.8%, with an average nutrient adequacy ratio of 0.9. The mean dietary intake of vitamin A was 290.1 µg day^-1 . The predictors for adequacy of vitamin A were high and medium women diversity scores (adjusted odds ratio = 2.92; 95% confidence interval = 1.50-5.70) and (adjusted odds ratio = 1.87; 95% confidence interval = 1.11-3.16).

CONCLUSIONS

In the present study, adequacy of vitamin A was low and was affected by the dietary diversity score. A focus on food-based approaches, especially regarding educating pregnant women to diversify their diet, is crucial for reducing the risk of vitamin A deficiency. Vitamin A is crucial micronutrient for the health of women and fetus, being essential for morphological, ocular and functional developments, as well as fetal organ and skeletal growth. Its requirement is greater during pregnancy and its deficiencies lead to maternal and child mortality and development. The dietary intake of vitamin A among pregnant women remains below the current recommendation. Inadequate intake of vitamin A Pregnant women Heath facility Dessie, Ethiopia.

Abnormal serum vitamin A levels and retinoic acid receptor α expression patterns in children with anorectal malformation

BACKGROUND

Anorectal malformation (ARM) is known to be associated with maldevelopment of the enteric nervous system (ENS), and vitamin A (VA) and its metabolite retinoic acid (RA) play important roles in ENS development. Thus, our aim was to investigate serum VA levels in ARM newborns and RA receptor (RAR) expression in the rectum of ARM patients and animal models.

METHODS

Serum VA concentrations were detected in newly diagnosed ARM neonates (n = 32) and neonates with non-alimentary tract malformations (n = 30). Intestinal specimens were divided into three groups: rectum from ARM patients (n = 30), colon from a stoma (n = 30) and rectum from controls (n = 4). RAR mRNA expression was evaluated by RT-qPCR. Rectum specimens from ARM patients were divided into two groups by postoperative pathology: the normal and lesion ganglion cell groups. Immunohistochemistry and Western blot were employed to detect RARα protein expression in rectum specimens. In addition, the ARM mouse model was induced by all-trans retinoid acid (ATRA), and the expression levels of RARα and the neuronal marker NeuN in the rectum of mice on embryonic day 16.5-18.5 (E16.5-18.5) were investigated.

RESULTS

The serum concentration of VA in ARM neonates was lower than that in control neonates (P < 0.0001), and RARα mRNA expression was lower in the rectum specimens from ARM patients than in the colon specimens from a stoma and the rectum specimens from controls (P < 0.05); there was no significant difference between the colon from a stoma and the rectum from controls. RARα protein was expressed in the nucleus of ganglion cells and nerve fibers, and RARα protein expression in the lesion ganglion cell group was significantly lower than that in the normal ganglion cell group (P < 0.01). Compared with the control mice, ARM mice at E16.5-18.5 showed decreased fluorescence intensity of RARα and NeuN in the rectum. RARα and NeuN mRNA expression in the rectum on E16.5-18.5 was lower in ARM mice than in control mice (P < 0.05).

CONCLUSION

Serum VA concentration and the RARα expression pattern are abnormal in the rectum in ARM and may contribute to the ENS maldevelopment in ARM.

Vitamin A and Pregnancy: A Narrative Review

Vitamin A is a crucial micronutrient for pregnant women and their fetuses. In addition to being essential for morphological and functional development and for ocular integrity, vitamin A exerts systemic effects on several fetal organs and on the fetal skeleton. Vitamin A requirements during pregnancy are therefore greater. Vitamin A deficiency (VAD) remains the leading cause of preventable blindness in the world. VAD in pregnant women is a public health issue in most developing countries. In contrast, in some developed countries, excessive vitamin A intake during pregnancy can be a concern since, when in excess, this micronutrient may exert teratogenic effects in the first 60 days following conception. Routine prenatal vitamin A supplementation for the prevention of maternal and infant morbidity and mortality is not recommended; however, in regions where VAD is a public health issue, vitamin A supplementation is recommended to prevent night blindness. Given the importance of this topic and the lack of a complete, up-to-date review on vitamin A and pregnancy, an extensive review of the literature was conducted to identify conflicting or incomplete data on the topic as well as any gaps in existing data.

Maternal drug use and the risk of anorectal malformations: systematic review and meta-analysis

Background

Origin of anorectal malformations (ARM) are considered multifactorial. Several genetic and non-genetic risk factors are discussed in literature. Maternal periconceptional medical drug use as possible risk factor, however, has not been reviewed systematically.

Methods

Studies published between 1977 and April 2017 were reviewed through systematic search in PubMed, ISI Web of Knowledge and Scopus databases. Furthermore, related and cross-referencing publications were reviewed. Pooled odds ratios (95% confidence intervals) were determined to quantify associations of maternal periconceptional use of folic acid, multivitamins, anti-asthma medication (separated in any anti-asthma medication, inhaled corticosteroids and salbutamol), thyroid hormone supplements, psychiatric drugs (separated in antidepressants, any selective serotonin reuptake inhibitors [SSRI], sertraline, citalopram, fluoxetine, paroxetine, hypnotics and benzodiazepine) and aspirin with ARM using meta-analyses.

Results

Thirty-seven studies that reported on the association between maternal periconceptional drug intake and infants born with ARM were included in this review. These were conducted in the United States of America (n = 14), Sweden (n = 6), Hungary (n = 5), Germany (n = 3), the Netherlands (n = 3), Denmark (n = 2), France (n = 2), Norway (n = 1) and the UK (n = 1). However, only few of these studies reported on the same risk factors. Studies were heterogeneous with respect to case numbers, period ingestion of medical drug use, control selection and adjustment for covariates. Consistently increased risks were observed for any anti-asthma medication, and hypnotics and benzodiazepine, but not for folic acid, multivitamins, inhaled corticosteroids, salbutamol, thyroid hormone supplements, antidepressants, any SSRI, sertraline, citalopram, fluoxetine, paroxetine and aspirin. In meta-analyses, pooled odds ratios (95% confidence intervals) for any anti-asthma medication, and hypnotics and benzodiazepine were 1.64 (1.22–2.21), and 2.43 (1.03–5.73), respectively.

Conclusion

Evidence on maternal drug use before conception and during pregnancy as risk factor for ARM from epidemiological studies is still very limited. Nevertheless, the few available studies indicate any anti-asthma medication, and hypnotics and benzodiazepine to be associated with increased risks. Further, ideally large-scale multicenter and register-based studies are needed to clarify the role of maternal drug intake for the development of ARM.

Serum Retinol Levels in Pregnant Adolescents and Their Relationship with Habitual Food Intake, Infection and Obstetric, Nutritional and Socioeconomic Variables

Globally, vitamin A deficiency (VAD) affects about 19.1 million pregnant women. Its occurrence is classically associated with inadequate food intake and may also be associated with socioeconomic factors and the presence of infection. The aim of this study was to determine the factors related to serum retinol levels among pregnant teenagers. The sample consisted of 89 pregnant adolescents, from whom socioeconomic, obstetric, anthropometric, and food consumption data were collected. Serum concentrations of retinol and the supposed presence of infection were determined by high-performance liquid chromatography and C-reactive protein quantification, respectively. The serum retinol concentrations were classified according to the criteria of the World Health Organization. We adopted a 5% significance level for all statistical tests. Serum retinol levels were significantly and positively associated with sanitation (p = 0.008) and pre-gestational nutritional status (p = 0.002), and negatively with the trimester (p = 0.001). The appropriate sanitation conditions and pre-pregnancy body mass index (BMI) were shown to have a protective effect against VAD. Conversely, serum retinol levels were reduced with trimester progression, favoring VAD occurrence.

Prevalence and influence factors of vitamin A deficiency of Chinese pregnant women

Background

Vitamin A plays an important role in the periods of rapid cellular growth and differentiation, especially during pregnancy, which is supplied by the mother to the fetus. The aim of this study is to assess the prevalence and potential influence factors of prenatal VAD of Chinese pregnant women.

Methods

China National Nutrition and Health Survey 2010–2013(CHNNS2010–2013) is a nationally representative cross-sectional study. It involved the random selection of 150 districts (urban) or counties (rural). Each site randomly selected 30 pregnant women. Because volume of blood and incomplete data was taken into consideration,the final sample was formed by 1209 participants. Serum retinol concentrations were measured by high performance liquid chromatography. Characteristics of the pregnant women were collected by a questionnaire. Comparing retinol level across categories of independent variables was tested by the Mann-Whitney U test. Logistic and linear regression analyses were used to identify influence factors of Chinese pregnant women.

Results

The mean serum retinol level of the pregnant women was 1.63 μmol/L (95 % CI 1.60–1.67) and 64[5.3 % (95 % CI 4.03–6.56)] had VAD. The odds of VAD were significantly higher among the pregnant women in the poor rural areas and without college or university education and low- income. Pregnant women in the second and third trimester had 2.40 (95 % CI 1.05–5.46) and 2.82 (95 % CI 1.34–5.93) times increased odds of VAD compared with those in the first trimester respectively. Pregnant women of drinker had 3.10(1.65–5.81) times increased odds of VAD compared with those no drinker. Pregnant smokers had 5.68 (95 % CI 2.23–14.49) times higher odds of VAD compared with pregnant with non-smoker without passive smoking.

Conclusions

VAD is of mild public-health issue in Chinese pregnant women. Such as : in the poor rural areas and without received college or university education and low- income and advanced gestational age and unhealthy lifestyles of pregnant women such as smoking and drinking. These were pertinent influence factors of VAD.

Is it possible folic acid reduce anorectal malformations ethylenethiourea induced in rats?

PURPOSE

To investigate the effect of folic acid (FA) in an experimental model of anorectal malformations (ARMs) ethylenethiourea (ETU) induced.

METHODS

Eight female Wistar rats were divided randomly in two groups. Group A - ETU; Group B - FA+ETU; Dams from group B received daily, since two weeks before pregnancy to the end of pregnancy, FA (50mg/kg) by gavage. Dams from groups A and B, received 1% ETU (125 mk/kg) by gavage on gestational day (GD) 11. Their fetuses were harvested by cesarean section on GD21 and were examined looking for ARMs. The thickness of anal stratified squamous epithelium (ASSE) and intestinal epithelium (IE) were analyzed. p < 0.05*.

RESULTS

One hundred and one embryos were harvested. The number of embryos; number of ARMs; mean statistical % (± SD) were determined to be, respectively: ETU - 49 [30;65% (± 24%)] versus FA+ETU - 52 [1;02% (± 3%)] (p = 0.025). AMRs were significantly lower in FA+ETU group than in ETU group (p = 0.025). The thickness (µm) of ASSE (± SD) and IE (± SD) were measured, respectively: ETU - [27.75 (± 0.56) and 18.88 (± 0.93)] versus FA+ETU - [28.88 (± 0.61) and 21.11 (± 0.16)] (p = 0.001). The thickness of IE was significantly enlarged when FA was given (p=0.001).

CONCLUSION

Folic acid reduces the number and enlarged the IE of ARMs ETU-induced.

Parental risk factors of anorectal malformations: Analysis with a regional population-based control group

BACKGROUND

Adequate evidence on environmental risk factors for anorectal malformations (ARMs) is very limited. We assessed maternal body weight and several prenatal exposures of the parents to tobacco, pregestational diabetes, chronic cardiovascular and respiratory diseases, periconceptional folic acid and multivitamin intake.

METHODS

Data from the German Network for Congenital Uro-REctal malformations (CURE-Net) were compared with data from the Malformation Monitoring Centre Saxony-Anhalt of the Otto-von-Guericke University in Magdeburg, Germany. Controls were matched to cases by gender and birth year of the child. Crude and adjusted odds ratios (95% confidence intervals) were calculated for potential risk factors using multivariable logistic regression.

RESULTS

In total, 158 ARM patients and 474 healthy infants born between 1993 and 2008 in Germany were included. Maternal age at birth of ARM cases and birth plurality were significantly higher and gestational age and weight significantly lower compared with controls (p < 0.0001). We observed significantly increased risks for ARMs associated with maternal smoking before conception and the first trimester of pregnancy (odds ratio = 2.23, 95% confidence interval 1.04-4.79, p = 0.039) and maternal chronic respiratory diseases (odds ratio = 29.25, 95% confidence interval 8.22-104.14, p < 0.0001). No statistically significant increased risk or protective effect was found for the other investigated factors.

CONCLUSION

This study suggests an association between the occurrence of ARMs in the offspring and periconceptional maternal smoking as well as maternal chronic respiratory diseases. In addition, there might be a sign of an association for maternal diabetes, although not statistically significant. It can be assumed that the power is far too low to provide reliable estimates.

Anorectal malformation: the etiological factors

Anorectal malformation (ARM) is a congenital anomaly commonly encountered in pediatric surgery practice. Although surgical procedures correct the anatomical anomalies, the post-operative bowel function is not universally satisfactory. The etiology of ARM remains unclear. In this review, we summarize the current understanding of the genetic and epigenetic factors contributing to the pathogenesis of ARM, based on published animal models, human genetics and epidemiological researches. Appreciation of these factors may be helpful in the management of ARM in the future.

Environmental aspects of congenital scoliosis

Growing evidence has proved that many aspects of our lifestyle and the environment contribute to the development of congenital disease. Congenital spinal deformities are due to anomalous development of the vertebrae including failure of formation and segmentation during embryogenesis. The causes of congenital scoliosis have not been fully identified. A variety of factors are implicated in the development of vertebral abnormalities. Previous studies have demonstrated that both genetics and environmental factors are implicated in the development of vertebral abnormalities. However, no specific cause for congenital scoliosis has been identified. In our review, we focus on the environmental factors for the development of congenital scoliosis. Various maternal exposures during pregnancy including hypoxia, alcohol use, vitamin deficiency, valproic acid, boric acid, and hyperthermia have been observed to be associated with the occurrence of congenital scoliosis. This review describes the major environmental contributors of congenital scoliosis with an emphasis on treatment aspects associated with environmental disposition in congenital scoliosis.