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Pavlik R, Hecht S, Noss U, Soldin OP, Mendu RD, Soldin SJ, Lohse P, Thaler CJ. Reduced Steroid Synthesis in the Follicular Fluid of MTHFR 677TT Mutation Carriers: Effects of Increased Folic Acid Administration. Geburtshilfe Frauenheilkd 2022; 82:1074-1081. [PMID: 36186148 PMCID: PMC9525144 DOI: 10.1055/a-1791-9358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/24/2022] [Indexed: 10/27/2022] Open
Abstract
Objective To compare steroid profiles in the follicular fluid (FF) from women homozygous for the methylenetetrahydrofolate reductase (MTHFR) 677C>T mutation and wildtype controls and to correlate it with the folic acid administration scheme applied at the time of oocyte retrieval. Design Retrospective single center study. Subjects and Methods Infertile patients treated by using assisted reproductive techniques were genotyped routinely for the MTHFR 677C>T mutation. In 2006 they had received folic acid supplementation doses of 400 µg daily per os. This group was designated Group-400 (n = 10). From 2008 onwards, all of our infertility patients received a daily dose of 800 µg folic acid per os. Women from this group were designated Group-800 (n = 28). FF were collected and a panel of steroid hormones (estradiol, estrone, estriol, cortisol, progesterone, 17-OH progesterone, testosterone, androstenedione, aldosterone, DHEA, and DHEA-S) was measured by isotope dilution liquid chromatography-tandem mass spectrometry employing atmospheric pressure photo ionization (APPI). Results In Group-400, the FF hormone profile confirmed a significant reduction of estradiol in homozygous 677TT carriers (0.52 ± 0.08-fold, exact p = 0.032) and for the first time also revealed significantly reduced estriol concentrations in these individuals (0.54 ± 0.05-fold, p = 0.016), as compared to wildtype controls. In Group-800, no significant differences were found for concentrations of any of the steroid hormones between homozygous 677TT carriers and wildtype controls. Conclusions The current findings support and extend previous reports on reduced concentrations of specific steroid hormones in follicular fluids of homozygous MTHFR 677C>T mutation carriers. The restoration of the FF hormone profile by elevated-dose folic acid supplementation might impact performing ART in infertile women with the MTHFR 677TT-genotype. Further adequately powered studies are necessary to verify our finding and to demonstrate the clinical effect of enhanced folic supplementation on ovarian function.
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Affiliation(s)
- Roman Pavlik
- Department of Obstetrics and Gynecology and Center for Gynecological Endocrinology and Reproductive Medicine, University Hospital, Ludwig-Maximilians University, Munich,
Germany,TFP Fertility Wels, Wels, Austria
| | - Stephanie Hecht
- Department of Obstetrics and Gynecology and Center for Gynecological Endocrinology and Reproductive Medicine, University Hospital, Ludwig-Maximilians University, Munich,
Germany,Practice for Obstetrics and Gynecology, Erfurt, Germany
| | - Ulrich Noss
- Centre for Reproductive Medicine, Munich, Germany
| | - Offie P. Soldin
- Division of Endocrinology and Metabolism, Georgetown University Medical Center, Washington, D.C., USA
| | - Rao D. Mendu
- Division of Endocrinology and Metabolism, Georgetown University Medical Center, Washington, D.C., USA
| | - Steven J. Soldin
- Division of Endocrinology and Metabolism, Georgetown University Medical Center, Washington, D.C., USA
| | - Peter Lohse
- Department of Clinical Chemistry, University Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Christian J. Thaler
- Department of Obstetrics and Gynecology and Center for Gynecological Endocrinology and Reproductive Medicine, University Hospital, Ludwig-Maximilians University, Munich,
Germany,Korrespondenzadresse Univ.-Prof. Dr. med. Christian J. Thaler, M.I.A.C., F.C.R.I. University Hospital, Ludwig-Maximilians University, Department of Obstetrics and
Gynecology and Center for Gynecological Endocrinology and Reproductive MedicineMarchioninistraße 1581377
MunichGermany
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Noor RA, Abioye AI, Ulenga N, Msham S, Kaishozi G, Gunaratna NS, Mwiru R, Smith E, Dhillon CN, Spiegelman D, Fawzi W. Large -scale wheat flour folic acid fortification program increases plasma folate levels among women of reproductive age in urban Tanzania. PLoS One 2017; 12:e0182099. [PMID: 28797054 PMCID: PMC5552223 DOI: 10.1371/journal.pone.0182099] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 07/12/2017] [Indexed: 12/26/2022] Open
Abstract
There is widespread vitamin and mineral deficiency problem in Tanzania with known deficiencies of at least vitamin A, iron, folate and zinc, resulting in lasting negative consequences especially on maternal health, cognitive development and thus the nation's economic potential. Folate deficiency is associated with significant adverse health effects among women of reproductive age, including a higher risk of neural tube defects. Several countries, including Tanzania, have implemented mandatory fortification of wheat and maize flour but evidence on the effectiveness of these programs in developing countries remains limited. We evaluated the effectiveness of Tanzania's food fortification program by examining folate levels for women of reproductive age, 18-49 years. A prospective cohort study with 600 non-pregnant women enrolled concurrent with the initiation of food fortification and followed up for 1 year thereafter. Blood samples, dietary intake and fortified foods consumption data were collected at baseline, and at 6 and 12 months. Plasma folate levels were determined using a competitive assay with folate binding protein. Using univariate and multivariate linear regression, we compared the change in plasma folate levels at six and twelve months of the program from baseline. We also assessed the relative risk of folate deficiency during follow-up using log-binomial regression. The mean (±SE) pre-fortification plasma folate level for the women was 5.44-ng/ml (±2.30) at baseline. These levels improved significantly at six months [difference: 4.57ng/ml (±2.89)] and 12 months [difference: 4.27ng/ml (±4.18)]. Based on plasma folate cut-off level of 4 ng/ml, the prevalence of folate deficiency was 26.9% at baseline, and 5% at twelve months. One ng/ml increase in plasma folate from baseline was associated with a 25% decreased risk of folate deficiency at 12 months [(RR = 0.75; 95% CI = 0.67-0.85, P<0.001]. In a setting where folate deficiency is high, food fortification program with folic acid resulted in significant improvements in folate status among women of reproductive age.
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Affiliation(s)
- Ramadhani A. Noor
- Africa Academy for Public Health (AAPH), Dar es Salaam, Tanzania
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Ajibola I. Abioye
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Nzovu Ulenga
- Africa Academy for Public Health (AAPH), Dar es Salaam, Tanzania
- Management Development for Health (MDH), Dar es Salaam, Tanzania
| | - Salum Msham
- Africa Academy for Public Health (AAPH), Dar es Salaam, Tanzania
| | | | - Nilupa S Gunaratna
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Ramadhani Mwiru
- Africa Academy for Public Health (AAPH), Dar es Salaam, Tanzania
| | - Erin Smith
- Helen Keller International, Dar es Salaam, Tanzania
| | | | - Donna Spiegelman
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Wafaie Fawzi
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Ami N, Bernstein M, Boucher F, Rieder M, Parker L. Folate and neural tube defects: The role of supplements and food fortification. Paediatr Child Health 2016; 21:145-54. [PMID: 27398055 DOI: 10.1093/pch/21.3.145] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Periconceptional folic acid significantly reduces the risk of neural tube defects. It is difficult to achieve optimal levels of folate by diet alone, even with fortification of flour, especially because flour consumption in Canada is slightly decreasing. Intermittent concerns have been raised concerning possible deleterious effects of folate supplementation, including the masking of symptoms of vitamin B12 deficiency and an association with cancer, especially colorectal cancer. Both concerns have been disproved. The Canadian Paediatric Society endorses the following steps to enhance folate intake in women of child-bearing age: encouraging the consumption of folate-rich foods such as leafy vegetables, increasing the level of folate food fortification, taking a supplement containing folate and B12, and providing free folate supplementation to disadvantaged women of child-bearing age. These recommendations are consistent with those of the Society of Obstetricians and Gynaecologists of Canada.
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Ami N, Bernstein M, Boucher F, Rieder M, Parker L. Le folate et les anomalies du tube neural : le rôle des suppléments et des aliments enrichis. Paediatr Child Health 2016. [DOI: 10.1093/pch/21.3.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Colapinto CK, O'Connor DL, Sampson M, Williams B, Tremblay MS. Systematic review of adverse health outcomes associated with high serum or red blood cell folate concentrations. J Public Health (Oxf) 2015; 38:e84-97. [PMID: 26160024 DOI: 10.1093/pubmed/fdv087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND To examine the relationship between reported high serum or red blood cell (RBC) folate status and adverse health outcomes. METHODS We systematically searched PubMed/Medline and EMBASE (to May 2013), with no limits by study type, country or population, to identify studies reporting high folate concentrations in association with adverse health outcomes. Two reviewers screened studies and extracted data. Study quality was assessed. RESULTS We included 51 articles, representing 46 studies and 71 847 participants. Quantiles were used by 96% of studies to identify high folate concentrations. Eighty-three percent of serum folate and 50% of RBC folate studies reported a high folate cutoff that corresponded with a clinically normal concentration. Increasing values of reported high folate concentration did not demonstrate a consistent association with risk of adverse health outcomes. Overall, reported high folate concentrations appeared to be associated with a decreased risk of adverse health outcomes, though substantial methodological heterogeneity precluded complex analyses. CONCLUSIONS Our interpretation was complicated by methodological variability. High folate cutoffs varied and often corresponded with normal or desirable blood concentrations. In general, a negative association appeared to exist between reported high folate status and adverse health outcomes. Consistent methods and definitions are needed to examine high folate status and ultimately inform public health interventions.
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Affiliation(s)
- Cynthia K Colapinto
- Healthy Active Living and Obesity Research, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario K1H 8L1, Canada University of Ottawa, Ottawa, Ontario, Canada
| | - Deborah L O'Connor
- The Hospital for Sick Children, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada
| | - Margaret Sampson
- Healthy Active Living and Obesity Research, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario K1H 8L1, Canada
| | - Brock Williams
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mark S Tremblay
- Healthy Active Living and Obesity Research, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario K1H 8L1, Canada University of Ottawa, Ottawa, Ontario, Canada
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Czeizel AE, Dudás I, Vereczkey A, Bánhidy F. Folate deficiency and folic acid supplementation: the prevention of neural-tube defects and congenital heart defects. Nutrients 2013; 5:4760-75. [PMID: 24284617 PMCID: PMC3847759 DOI: 10.3390/nu5114760] [Citation(s) in RCA: 190] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 11/02/2013] [Accepted: 11/05/2013] [Indexed: 12/24/2022] Open
Abstract
Diet, particularly vitamin deficiency, is associated with the risk of birth defects. The aim of this review paper is to show the characteristics of common and severe neural-tube defects together with congenital heart defects (CHD) as vitamin deficiencies play a role in their origin. The findings of the Hungarian intervention (randomized double-blind and cohort controlled) trials indicated that periconceptional folic acid (FA)-containing multivitamin supplementation prevented the major proportion (about 90%) of neural-tube defects (NTD) as well as a certain proportion (about 40%) of congenital heart defects. Finally the benefits and drawbacks of three main practical applications of folic acid/multivitamin treatment such as (i) dietary intake; (ii) periconceptional supplementation; and (iii) flour fortification are discussed. The conclusion arrived at is indeed confirmation of Benjamin Franklin's statement: "An ounce of prevention is better than a pound of care".
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Affiliation(s)
- Andrew E. Czeizel
- Foundation for the Community Control of Hereditary Diseases, Torokvesz lejto 32, Budapest 1026, Hungary; E-Mail:
| | - Istvan Dudás
- Foundation for the Community Control of Hereditary Diseases, Torokvesz lejto 32, Budapest 1026, Hungary; E-Mail:
| | - Attila Vereczkey
- Versys Clinics, Human Reproduction Institute, Madarasz utca 47-49, Budapest 1138, Hungary; E-Mail:
| | - Ferenc Bánhidy
- Second Department of Obstetrics and Gynecology, School of Medicine, Semmelweis University, Ulloi ut 78/a, Budapest 1082, Hungary; E-Mail:
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Conceição RCD, Barbosa MAH, Dornela LL, Ramos PS, Castellano Filho DS, Ricardo DR, Calado AA, Netto JMB. Conhecimento de médicos e enfermeiros obstetras sobre a prevenção dos defeitos no tubo neural. CIENCIA & SAUDE COLETIVA 2012; 17:2795-803. [DOI: 10.1590/s1413-81232012001000027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 08/30/2011] [Indexed: 11/22/2022] Open
Abstract
Foi avaliado o nível de conhecimento de médicos e enfermeiros obstetras sobre a utilização de ácido fólico (AF) para a prevenção dos defeitos do fechamento do tubo neural (DFTN). Estudo descritivo transversal no qual 118 voluntários (95 médicos e 23 enfermeiros), responderam um questionário com 21 perguntas sobre a prevenção dos DFTN. Os dados foram analisados em função do conhecimento relatado, das recomendações preconizadas pelo Ministério da Saúde (MS) e das evidências científicas (EC) disponíveis sobre o assunto investigado. O nível de conhecimento baseado nas EC e nas recomendações do MS foi diferente (4,64 ± 0,20 vs 5,55 ± 0,15; p < 0,001; Média ± EPM). Não houve diferença entre o nível de conhecimento quando comparado à formação dos mesmos, ao tempo que realizam atendimento pré-natal e entre as duas classes de profissionais avaliados. Houve diferença entre o nível de conhecimento relatado e o baseado nas EC (6,76 ± 0,18 vs 4,64 ± 0,15; p < 0,001) e o baseado nas recomendações do MS (6,76 ± 0,18 vs 5,55 ± 0,20; p < 0,001), 94,1% dos profissionais conhecem o papel do ácido fólico, contudo, 64,2% relataram não saber quando iniciar a suplementação no pré-natal. Frente ao exposto foi verificado que a grande maioria dos avaliados relatou conhecer a importância do AF na prevenção do DFTN, porém, existe ainda desconhecimento sobre o assunto investigado.
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Czeizel AE. Primary prevention of neural-tube defects and some other congenital abnormalities by folic acid and multivitamins: history, missed opportunity and tasks. Ther Adv Drug Saf 2011; 2:173-88. [PMID: 25083211 PMCID: PMC4110861 DOI: 10.1177/2042098611411358] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The history of intervention trials of periconception folic acid with multivitamin and folic acid supplementation in women has shown a recent breakthrough in the primary prevention of structural birth defects, namely neural-tube defects and some other congenital abnormalities. Recently, some studies have demonstrated the efficacy of this new method in reducing congenital abnormalities with specific origin; for example, in the offspring of diabetic and epileptic mothers, and in pregnancy with high fever. The benefits and drawbacks of four possible uses of periconception folate/folic acid and multivitamin supplementation are discussed: we believe there has been a missed opportunity to implement this preventive approach in medical practice. The four methods are as follows: (i) dietary intake of folate and other vitamins, (ii) periconception folic acid/multivitamin supplementation, (iii) food fortification with folic acid, and (iv) the combination of oral contraceptives with 6S-5-methytetrahydrofolate ('folate').
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Wilson RD, Koren G. In Response. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2008. [DOI: 10.1016/s1701-2163(16)32912-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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