1
|
Wang S, Mitsunami M, Ortiz-Panozo E, Leung CW, Manson JE, Rich-Edwards JW, Chvarro JE. Prepregnancy Healthy Lifestyle and Adverse Pregnancy Outcomes. Obstet Gynecol 2023; 142:1278-1290. [PMID: 37826849 PMCID: PMC10840639 DOI: 10.1097/aog.0000000000005346] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/13/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE To investigate the association of healthy lifestyle factors before pregnancy (body mass index [BMI] 18.5-24.9, nonsmoking, 150 min/wk or more of moderate-to-vigorous physical activity, healthy eating [top 40% of Dietary Approaches to Stop Hypertension score], no or low-to-moderate alcohol intake [less than 15 g/d], and use of multivitamins) with risk of adverse pregnancy outcomes. METHODS We conducted a secondary analysis of prospectively collected data for women without chronic diseases who are participating in an ongoing cohort in the United States (the NHSII [Nurses' Health Study II]). Healthy lifestyle factors preceding pregnancy were prospectively assessed every 2-4 years from 1991 to 2009 with validated measures. Reproductive history was self-reported in 2001 and 2009. A composite outcome of adverse pregnancy outcomes that included miscarriage, ectopic pregnancy, gestational diabetes, gestational hypertension, preeclampsia, preterm birth, stillbirth, or low birth weight was assessed. RESULTS Overall, 15,509 women with 27,135 pregnancies were included. The mean maternal age was 35.1±4.2 years. Approximately one in three pregnancies (n=9,702, 35.8%) was complicated by one or more adverse pregnancy outcomes. The combination of six low-risk factors was inversely associated with risk of adverse pregnancy outcomes in a dose-dependent manner ( P for trend <.001). Compared with women who had zero or one healthy lifestyle factor, those with six had a 37% lower risk of adverse pregnancy outcomes (relative risk 0.63, 95% CI 0.55-0.72), driven primarily by lower risks of gestational diabetes, gestational hypertension, and low birth weight. All prepregnancy healthy lifestyle factors, except avoiding harmful alcohol consumption and regular physical activity, were independently associated with lower risk of adverse pregnancy outcomes after mutual adjustment for each other. Healthy BMI, high-quality diet, and multivitamin supplementation showed the strongest inverse associations with adverse pregnancy outcomes. If the observed relationships were causal, 19% of adverse pregnancy outcomes could have been prevented by the adoption of all six healthy lifestyle factors (population attributable risk 19%, 95% CI 13-26%). CONCLUSION Prepregnancy healthy lifestyle is associated with a substantially lower risk of adverse pregnancy outcomes and could be an effective intervention for the prevention of adverse pregnancy outcomes.
Collapse
Affiliation(s)
- Siwen Wang
- Department of Nutrition and the Department of Epidemiology, Harvard T.H. Chan School of Public Health, the Division of Women's Health, the Division of Preventive Medicine, and the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | | |
Collapse
|
2
|
Moreira de Andrade A, Alves Ramalho A, Andrade Martins F, Rafael Valentim-Silva J, Jorge Koifman R. Use of antianemics in prenatal care: A population cohort from a capital city in the North region of Brazil. Prev Med Rep 2023; 36:102501. [PMID: 38116268 PMCID: PMC10728442 DOI: 10.1016/j.pmedr.2023.102501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 12/21/2023] Open
Abstract
Anemia during pregnancy is a significant risk factor for adverse maternal and fetal outcomes, including preterm birth, low birth weight, and maternal mortality. In Brazil, anemia prevention and treatment programs are available, but regional variations in prevalence and factors associated with antianemic drug use remain understudied. The objective was to identify the prevalence of gestational anemia and the factors associated with the use of antianemic drugs during pregnancy in a cross-sectional population-based study carried out in Rio Branco, AC. To do so, we planned a cross-sectional, population-based study with a total of 1190 postpartum women who gave birth between April 6 and July 10, 2015, were interviewed about demographic, socioeconomic, reproductive, and prenatal care factors. The prevalence of anemia during pregnancy was found to be 13.8 %, with 93.2 % of women using antianemic drugs, such as ferrous sulfate and folic acid. Factors positively associated with antianemic drug use were higher education (elementary school II RCajust = 2.46; 95 %, CI: 1.01-6.13; high school RCajust = 2.61; 95 %, CI: 1.11-6.12), primiparity (ACadjust = 1.69; 95 %, CI: 0.98-3.74), 6 to 8 prenatal consultations (ACjust = 2.16; 95, CI%: 1.15-4.05), and planned pregnancy (ARjust = 1.94; 95 %, CI: 1.05-3.74). Food security during pregnancy was inversely associated. These findings suggest that while anemia prevention and treatment programs exist, more targeted strategies are needed, particularly for women with lower socioeconomic status, to improve maternal and fetal health outcomes.
Collapse
Affiliation(s)
| | - Alanderson Alves Ramalho
- Collective Health Post-Graduation Program at Federal University of Acre, Rio Branco, Acre, Brazil
| | - Fernanda Andrade Martins
- Collective Health Post-Graduation Program at Federal University of Acre, Rio Branco, Acre, Brazil
| | - João Rafael Valentim-Silva
- University of Vassouras, and Research Associated at Federal University of State of Rio de Janeiro, Rio de Janeiro, and Federal University of Santa Catarina, Santa Catarina, Brazil
- College of Education and Technology of Amazônia, Pará, Brazil
| | - Rosalina Jorge Koifman
- Public Health Program of Oswaldo Cruz Foundation, and Public Health and Environment Program, Rio de Janeiro, Brazil
| |
Collapse
|
3
|
Grzelczyk J, Gałązka-Czarnecka I, Oracz J. Potentiality Assessment of the Acetylcholinesterase-Inhibitory Activity of Olive Oil with an Additive Edible Insect Powder. Molecules 2023; 28:5535. [PMID: 37513405 PMCID: PMC10386343 DOI: 10.3390/molecules28145535] [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: 06/29/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
Edible insects (Alphitobius diaperinus Panzer, Gryllus campestris, Tenebrio molitor, Chorthippus biguttulus) are rich in nutrients that potentially inhibit acetylcholinesterase (AChE), but also improve cognition. The aim of this study was to evaluate four varied species of freeze-dried edible insects (purchased from a store); their nutrient composition, including fat, total phenolic compounds, vitamins, and antioxidant properties; and the potential inhibitory effect of AChE. An additional goal was to obtain olive oil with the addition of edible insects. Such oil was characterized by high oxidizing properties and showed high affinity to AChE. The results showed that mealworms and grasshoppers had the highest content of fats (PUFA/SFA) and phenolic compounds. These insects also showed a high content of vitamins, which correlated with the highest affinity for AChE. Therefore, they were added as a functional additive to olive oil. Olive oil with the addition of edible insects showed a higher affinity for AChE and enriched the olive oil with vitamin C and B vitamins.
Collapse
Affiliation(s)
- Joanna Grzelczyk
- Institute of Food Technology and Analysis, Faculty of Biotechnology and Food Sciences, Lodz University of Technology, 90-537 Lodz, Poland
| | - Ilona Gałązka-Czarnecka
- Institute of Food Technology and Analysis, Faculty of Biotechnology and Food Sciences, Lodz University of Technology, 90-537 Lodz, Poland
| | - Joanna Oracz
- Institute of Food Technology and Analysis, Faculty of Biotechnology and Food Sciences, Lodz University of Technology, 90-537 Lodz, Poland
| |
Collapse
|
4
|
Wang S, Minguez-Alarcon L, Capotosto MP, Mitsunami M, Gaskins AJ, Charlton BM, Hart JE, Rich-Edwards JW, Chavarro JE. Pregnancy Intention, Changes in Pregnancy Intention, and Pregnancy Incidence Among Female Nurses in North America. JAMA Netw Open 2023; 6:e2311301. [PMID: 37133861 PMCID: PMC10157424 DOI: 10.1001/jamanetworkopen.2023.11301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/20/2023] [Indexed: 05/04/2023] Open
Abstract
Importance Pregnancy intention assessment is a key element of preconception and contraceptive care. The association between a single screening question and the incidence of pregnancy is unknown. Objective To prospectively evaluate the dynamics of pregnancy intention and pregnancy incidence. Design, Setting, and Participants This prospective cohort study (the Nurses' Health Study 3) was conducted from June 1, 2010, to April 1, 2022, in 18 376 premenopausal, nonpregnant female nurses aged 19 to 44 years. Main Outcomes and Measures Pregnancy intention and pregnancy status were assessed at baseline and approximately every 3 to 6 months thereafter. Cox proportional hazards regression models were used to estimate the association between pregnancy intention and pregnancy incidence. Results A total of 18 376 premenopausal, nonpregnant women (mean [SD] age, 32.4 [6.5] years) participated in the study. At baseline, 1008 women (5.5%) were trying to conceive, 2452 (13.3%) were contemplating pregnancy within 1 year, and the remaining 14 916 (81.2%) were neither trying to conceive nor thought they would be pregnant within 1 year. A total of 1314 pregnancies were documented within 12 months of pregnancy intention assessment. The cumulative incidence of pregnancy was 38.8% in women actively trying to conceive (median [IQR] time to pregnancy, 3.3 [1.5-6.7] months), 27.6% in women contemplating pregnancy (median [IQR] time to pregnancy, 6.7 [4.2-9.3] months), and 1.7% in women neither trying to conceive nor contemplating pregnancy (median [IQR] time to pregnancy, 7.8 [5.2-10.5] months) among those who became pregnant. Women who were actively trying to conceive were 23.1 times (95% CI, 19.5-27.4 times) and women who were contemplating pregnancy were 13.0 times (95% CI, 11.1-15.2 times) more likely to conceive within 12 months than women who were neither attempting nor contemplating pregnancy. Among women contemplating pregnancy at baseline who did not get pregnant during follow up, 18.8% were actively trying and 27.6% were not trying by 12 months. Conversely, only 4.9% of women neither trying to conceive nor contemplating pregnancy within 1 year at baseline changed pregnancy intention during follow up. Conclusions and Relevance In this cohort study of reproductive-aged nurses in North America, pregnancy intention was highly fluid among women who were contemplating pregnancy but relatively stable among women trying to conceive and women who were neither trying to conceive nor contemplating pregnancy. Pregnancy intention was strongly associated with pregnancy incidence, but the median time to pregnancy points to a relatively short time window to initiate preconception care.
Collapse
Affiliation(s)
- Siwen Wang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Lidia Minguez-Alarcon
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Makiko Mitsunami
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Audrey J. Gaskins
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Brittany M. Charlton
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jaime E. Hart
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Janet W. Rich-Edwards
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of Women’s Health, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jorge E. Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| |
Collapse
|
5
|
Steane SE, Cuffe JSM, Moritz KM. The role of maternal choline, folate and one-carbon metabolism in mediating the impact of prenatal alcohol exposure on placental and fetal development. J Physiol 2023; 601:1061-1075. [PMID: 36755527 PMCID: PMC10952912 DOI: 10.1113/jp283556] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/30/2023] [Indexed: 02/10/2023] Open
Abstract
Prenatal alcohol consumption (PAE) may be associated with a broad spectrum of impacts, ranging from no overt effects, to miscarriage, fetal growth restriction and fetal alcohol spectrum disorder. A major mechanism underlying the effects of PAE is considered to be altered DNA methylation and gene expression. Maternal nutritional status may be an important factor in determining the extent to which PAE impacts pregnancy outcomes, particularly the dietary micronutrients folate and choline because they provide methyl groups for DNA methylation via one carbon metabolism. This review summarises the roles of folate and choline in development of the blastocyst, the placenta and the fetal brain, and examines the evidence that maternal intake of these micronutrients can modify the effects of PAE on development. Studies of folate or choline deficiency have found reduced blastocyst development and implantation, reduced placental invasion, vascularisation and nutrient transport capability, impaired fetal brain development, and abnormal neurodevelopmental outcomes. PAE has been shown to reduce absorption and/or metabolism of folate and choline and to produce similar outcomes to maternal choline/folate deficiency. A few studies have demonstrated that the effects of PAE on brain development can be ameliorated by folate or choline supplementation; however, there is very limited evidence on the effects of supplementation in early pregnancy on the blastocyst and placenta. Further studies are required to support these findings and to determine optimal supplementation parameters.
Collapse
Affiliation(s)
- Sarah E. Steane
- School of Biomedical SciencesThe University of QueenslandSt LuciaQLDAustralia
| | - James S. M. Cuffe
- School of Biomedical SciencesThe University of QueenslandSt LuciaQLDAustralia
| | - Karen M. Moritz
- School of Biomedical SciencesThe University of QueenslandSt LuciaQLDAustralia
| |
Collapse
|
6
|
Lian Z, Wu Z, Gu R, Wang Y, Wu C, Cheng Z, He M, Wang Y, Cheng Y, Gu HF. Evaluation of Cardiovascular Toxicity of Folic Acid and 6S-5-Methyltetrahydrofolate-Calcium in Early Embryonic Development. Cells 2022; 11:cells11243946. [PMID: 36552710 PMCID: PMC9777352 DOI: 10.3390/cells11243946] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/02/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022] Open
Abstract
Folic acid (FA) is a synthetic and highly stable version of folate, while 6S-5-methyltetrahydrofolate is the predominant form of dietary folate in circulation and is used as a crystalline form of calcium salt (MTHF-Ca). The current study aims to evaluate the toxicity and safety of FA and MTHF-Ca on embryonic development, with a focus on cardiovascular defects. We began to analyze the toxicity of FA and MTHF-Ca in zebrafish from four to seventy-two hours postfertilization and assessed the efficacy of FA and MTHF-Ca in a zebrafish angiogenesis model. We then analyzed the differently expressed genes in in vitro fertilized murine blastocysts cultured with FA and MTHF-Ca. By using gene-expression profiling, we identified a novel gene in mice that encodes an essential eukaryotic translation initiation factor (Eif1ad7). We further applied the morpholino-mediated gene-knockdown approach to explore whether the FA inhibition of this gene (eif1axb in zebrafish) caused cardiac development disorders, which we confirmed with qRT-PCR. We found that FA, but not MTHF-Ca, could inhibit angiogenesis in zebrafish and result in abnormal cardiovascular development, leading to embryonic death owing to the downregulation of eif1axb. MTHF-Ca, however, had no such cardiotoxicity, unlike FA. The current study thereby provides experimental evidence that FA, rather than MTHF-Ca, has cardiovascular toxicity in early embryonic development and suggests that excessive supplementation of FA in perinatal women may be related to the potential risk of cardiovascular disorders, such as congenital heart disease.
Collapse
Affiliation(s)
- Zenglin Lian
- Institute of Biological Chinese Medicine, Beijing Yichuang Institute of Biotechnology Industry, Beijing 100023, China
| | - Zhuanbin Wu
- Shanghai Model Organisms Center, Inc., Shanghai 201203, China
| | - Rui Gu
- Institute of Biological Chinese Medicine, Beijing Yichuang Institute of Biotechnology Industry, Beijing 100023, China
| | - Yurong Wang
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 210009, China
| | - Chenhua Wu
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 210009, China
- School of Life Science and Technology, China Pharmaceutical University, Nanjing 211198, China
| | - Zhengpei Cheng
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 210009, China
| | - Mingfang He
- College of Biotechnology and Pharmaceutical Engineering, Nanjing Tech University, Nanjing 211816, China
| | - Yanli Wang
- National Health Commission Key Laboratory of Birth Defect Prevention, Henan Institute of Reproductive Health Science and Technology, Zhengzhou 450002, China
| | - Yongzhi Cheng
- College of Biotechnology and Pharmaceutical Engineering, Nanjing Tech University, Nanjing 211816, China
- Correspondence: (Y.C.); (H.F.G.)
| | - Harvest F. Gu
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 210009, China
- Correspondence: (Y.C.); (H.F.G.)
| |
Collapse
|
7
|
Thornburgh S, Gaskins AJ. B vitamins, polycystic ovary syndrome, and fertility. Curr Opin Endocrinol Diabetes Obes 2022; 29:554-559. [PMID: 36165609 DOI: 10.1097/med.0000000000000773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW This review provides a general overview of the literature on B vitamins and fertility, as well as summarizes the evidence concerning B vitamin supplementation and fertility among polycystic ovary syndrome (PCOS) women. RECENT FINDINGS Studies among women conceiving with and without medical assistance provide strong evidence for a beneficial effect of B vitamins, particularly folate and vitamin B12, on fecundability and fertility. Moreover, recent work suggests that effects may be even more pronounced among women with menstrual cycle dysfunction (a common symptom of PCOS). Among PCOS women, intervention studies have demonstrated that folic acid supplementation may reduce homocysteine levels, potentially improve women's metabolic profiles, and possibly ameliorate some hallmark features of PCOS. Although none of these intervention studies have included fertility endpoints, it is possible that by reducing homocysteine levels (or other clinical/biochemical features) in PCOS women, there may be a downstream improvement in fertility outcomes. SUMMARY There is growing evidence folate (and possibly vitamin B12) supplementation may be beneficial to fertility in women. Although most studies have not exclusively focused on women with PCOS, there is biological plausibility and some evidence that B vitamin supplementation may be even more important for improving reproductive health outcomes in PCOS women.
Collapse
Affiliation(s)
- Sarah Thornburgh
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | | |
Collapse
|
8
|
Wilson RD, O'Connor DL. Guideline No. 427: Folic Acid and Multivitamin Supplementation for Prevention of Folic Acid-Sensitive Congenital Anomalies. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:707-719.e1. [PMID: 35691683 DOI: 10.1016/j.jogc.2022.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To provide updated guidance on pre-conception folic acid and multivitamin supplementation for primary and secondary (recurrence) prevention of neural tube defects and other folate-sensitive congenital anomalies. TARGET POPULATION Women aged 12-45 years who could become pregnant should be aware of the risk of serious birth defects without adequate pre-conception and first-trimester folic acid supplementation. OPTIONS Optimizing folic acid supplementation is complex and depends on factors including dosage; type of supplement; bioavailability of folate from food, timing of initiating supplementation; and metabolic and genetic factors. For all women who could become pregnant, a low daily dosage of folic acid is recommended before conception and throughout pregnancy and breastfeeding. High-dosage folic acid supplementation is recommended only for women who can become pregnant and have had a previous pregnancy affected by a neural tube defect or other folate-sensitive congenital anomaly. Directed personalized approaches could be considered and adopted for women who can become pregnant and have complex risks (genetic, medical, or surgical risk factors), using new knowledge of co-factor metabolism and synergy, as well as red blood cell or serum folate testing. Such approaches would require changes to current provincial health care maternal serum folate screening/testing. OUTCOMES New approaches to oral folic acid supplementation, including triage tools, need to be considered to optimize the benefits of decreasing risk of neural tube defects and folate-sensitive congenital anomalies. BENEFITS, HARMS, AND COSTS Oral folic acid supplementation, or dietary folate intake combined with a multivitamin/micronutrient supplement, is associated with lower rates of neural tube defects, other folate-sensitive birth defects, and obstetrical complications. The costs are those attributable to daily vitamin supplementation and a healthy, folate-rich diet. EVIDENCE A literature search was designed and carried in PubMed and the Cochrane Library databases from 1990 to 2021 using following MeSH terms and keywords (and variants): folic acid supplementation; folate food fortification; primary neural tube defect prevention; prevention of recurrence of neural tube defects; folate-sensitive birth defects; folate supplementation benefit; folate supplementation risk; folate pregnant woman physiology; pregnant woman RBC folate level; pregnant woman serum folate levels; folate and epilepsy; folate and obesity. This guideline was based upon expert guidelines or opinions, systematic reviews, randomized controlled clinical trials, and observational case-control studies and case series retrieved, published in English from 1990 to 2021. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE Maternity health care providers (physicians, midwives, nurses) and other providers of pregnancy-related wellness and health counselling. SUMMARY STATEMENTS RECOMMENDATIONS.
Collapse
|
9
|
Wilson RD, O'Connor DL. Directive clinique n o427 : Suppléments d'acide folique et multivitamines en prévention des anomalies congénitales sensibles à l'acide folique. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:720-732.e1. [PMID: 35691684 DOI: 10.1016/j.jogc.2022.04.003] [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: 10/18/2022]
Abstract
OBJECTIF Offrir des recommandations à jour sur l'utilisation de multivitamines et de suppléments d'acide folique avant la conception pour la prévention primaire et secondaire (récidive) des anomalies du tube neural et des autres anomalies congénitales sensibles à l'acide folique. POPULATION CIBLE Les femmes de 12 à 45 ans qui pourraient devenir enceintes doivent être informées des risques importants d'anomalies congénitales en l'absence d'une supplémentation adéquate en acide folique avant la conception et pendant le premier trimestre. OPTIONS La supplémentation optimale en acide folique est complexe et repose sur divers facteurs tels que la dose, le type de suppléments, la biodisponibilité du folate dans l'alimentation, le moment du début de la supplémentation ainsi que sur les facteurs métaboliques et génétiques. Pour toutes les femmes qui peuvent devenir enceintes, une faible dose quotidienne d'acide folique est recommandée avant la conception et pendant la grossesse et l'allaitement. La supplémentation à forte dose d'acide folique est recommandée uniquement chez les femmes qui peuvent devenir enceintes et qui ont un antécédent de grossesse avec anomalie du tube neural ou toute autre anomalie congénitale sensible à l'acide folique. Il est possible d'envisager et d'adopter une approche personnalisée chez les femmes qui peuvent devenir enceintes et qui présentent des risques complexes (facteurs de risque génétiques, médicaux ou chirurgicaux) en se fondant sur les nouvelles connaissances en matière de métabolisme et synergie des cofacteurs et sur l'analyse du taux sérique et érythrocytaire d'acide folique. Ce genre d'approche exige une modification des protocoles provinciaux actuels de santé publique concernant le dépistage et l'analyse du taux sérique maternel d'acide folique. RéSULTATS: Les nouvelles stratégies de supplémentation en acide folique par voie orale, y compris dans les outils de triage, doivent être prises en compte pour diminuer de façon optimale le risque d'anomalies du tube neural et d'anomalies congénitales sensibles à l'acide folique. BéNéFICES, RISQUES ET COûTS: On observe une diminution du taux d'anomalies du tube neural, des autres anomalies congénitales sensibles à l'acide folique et des complications obstétricales chez les femmes qui prennent des suppléments oraux d'acide folique ou qui complémentent leur apport alimentaire en folate au moyen de multivitamines ou de suppléments de micronutriments. Les coûts relatifs sont liés à la prise quotidienne de suppléments vitaminiques et à l'adoption d'un régime alimentaire sain et riche en folate. DONNéES PROBANTES: Une recherche a été effectuée dans les bases de données PubMed et Cochrane Library pour trouver des articles publiés entre 1990 et 2021, en utilisant les termes MeSH et mots-clés (et leurs variantes) suivants : folate food fortification; primary neural tube defect prevention; prevention of recurrence of neural tube defects; folate-sensitive birth defects; folate supplementation benefit; folate supplementation risk; folate pregnant woman physiology; pregnant woman RBC folate level; pregnant woman serum folate levels; folate and epilepsy; folate and obesity. Cette directive clinique repose sur des lignes directrices et opinions de spécialistes, des revues systématiques, des essais cliniques randomisés et des études observationnelles de cas-témoin et de séries de cas qui ont été publiés en anglais entre 1990 et 2021. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et faibles). PROFESSIONNELS CONCERNéS: Fournisseurs de soins de maternité (médecins, sages-femmes et infirmières) et autres fournisseurs d'accompagnement en santé et bien-être lié à la grossesse. DÉCLARATIONS SOMMAIRES: RECOMMANDATIONS.
Collapse
|