Folic acid. Preconception knowledge and use by infertile women.

OBJECTIVE: To assess knowledge of preconception folic acid intake (PFAI) and its use by infertile women and to compare it to results from a national survey of reproductive-age women. STUDY DESIGN: New patients presenting to a reproductive medicine practice were surveyed regarding their knowledge and use of PFAI. Results were compared to those of a national survey of reproductive age women. RESULTS: Eighty-six women were surveyed. Infertile women were more aware of the benefits of PFAI than the control population (65% vs. 13%) and used it more frequently (52% vs. 29%). Although infertile women knowledgeable about PFAI were more likely to take folic acid (chi 2 = 24.90, P < .001), 30% of women who were aware of the benefits of PFAI did not take it. CONCLUSION: Preconception folic acid knowledge and use were higher among infertility patients presenting to a reproductive medicine practice than in the general population. Nonetheless, in this highly motivated population, only half were taking folic acid, and knowledge alone did not ensure usage. To effectively decrease the incidence of neural tube defects, food fortification may be more effective than education focusing on vitamin supplementation.     

Folic acid supplementation use among women who contact a teratology information service

OBJECTIVE: The purpose of this study was to determine the percentage of the women who call a teratology information service who take folic acid before conception. STUDY DESIGN: A pilot-tested questionnaire was used to survey women who called a teratology information service about their use of folic acid supplementation. Frequencies were generated by pregnancy status, age, race, and parity. RESULTS: Of the 693 pregnant callers, 42% of the women initiated folic acid use 6 weeks before pregnancy, 35% of the women initiated folic acid use during pregnancy. Thirty-seven percent of the total caller population reported taking folic acid. Forty-seven percent of pregnant white women versus 27% of pregnant black women reported preconceptional folic acid use (P =.005). Thirty-nine percent of pregnant women who were <30 years old reported preconceptional folic acid use versus 48% of women who were >30 years old (P =.018). CONCLUSION: Most pregnant women take folic acid; however, only a minority of them start before conception. The use of preconceptional folic acid, although higher than the national average of 30%, was still low. Many women start taking folic acid in their pregnancy after the neural tube is closed.     

Alcohol abuse in women seeking gynecologic care

In several retrospective studies, alcoholic women have reported menstrual problems significantly more often than nonalcoholic women. There is no information, however, comparing the prevalence of alcohol abuse in women who receive periodic gynecologic care and those who seek care for menstrual disorders such as the premenstrual syndromes. This question was studied in two private practice settings. Women seeking periodic care were obtained from a suburban, general gynecology practice. Women seeking treatment for premenstrual syndrome (PMS) were obtained from a practice that specialized in the care of PMS. Ninety-five patients with PMS and 147 patients seeking periodic care were screened with the CAGE questions--a mnemonic for attempts to Cut back on drinking, being Annoyed at criticism about drinking, feeling Guilty about drinking, and using alcohol as an Eye-opener. Women who gave affirmative responses to one or more of the CAGE questions were evaluated for the presence of alcohol abuse. In the women seeking periodic care, 33% were CAGE positive and 12% were alcohol abusers. In the PMS practice, 51% were CAGE positive and 21% were alcohol abusers. Alcohol abuse is a common problem in gynecologic practice. Women who seek medical care for PMS are at much greater risk to be alcohol abusers.     

Is intraperitoneal dextran 70 safe for routine gynecologic use?

The routine use of intraperitoneal 32% dextran 70 has been suggested as an adjuvant to prevent postsurgical pelvic adhesions. Two hundred thirty-four women received an antiadhesion regimen consisting of intraperitoneal 32% dextran 70, dexamethasone, and promethazine. Ten women (4%) experienced spontaneous leakage of the dextran-peritoneal fluid mixture through their abdominal incisions. Painless bilateral swelling of the labia was noted in 18 women (8%). Mild abdominal bloating and weight gain of from 2.5 to 11 pounds were common. No anaphylactic reactions, peritonitis, or wound infections were experienced by any woman. Intraperitoneal dextran 70 appears to be a safe, well-tolerated antiadhesion adjuvant for routine use in gynecologic operations.     

Genital aerobic bacterial flora of women receiving radiotherapy for gynecologic malignancy

In the present study, genital aerobic bacterial flora was prospectively studied in 12 women receiving radiotherapy for gynecologic malignancy. Gram-positive cocci accounted for 59% and gram-negative bacilli for 27% of the 26 cervical or vaginal isolates preradiation. A similar pattern of recovery was found during external beam, 60CO whole pelvis radiotherapy. The gram-positive cocci and gram-negative bacilli accounted for 42 and 46% of the preradiotherapy rectal isolates, respectively. There was no significant change in the pattern of rectal flora during external beam radiotherapy. Thus, results from this preliminary study would indicate that external beam radiotherapy has little or no influence on the major aerobic pathogens in either the cervix, vagina, or rectum.     

Folic acid use in pregnancy and embryo selection

Objective  Folic acid supplement use is recommended in pregnancy to reduce the risk of neural tube defect but concerns have been raised that increasing folic acid intake may select for embryos with genotypes that increase disease risk in the offspring. Our aim was to test for this effect.
Design  Observational prospective cohort study.
Setting  Aberdeen Maternity Hospital.
Population or Sample  Women born before the introduction of folic acid advice (1970–80) and carrying singleton pregnancies ( n = 1234) and their offspring ( n = 1083) born after (2001–03).
Methods  We measured the genotype ( MTHFR C677T and A1298C, MTR A2756G, MTRR A66G and TCN G776C ) of mothers and their offspring, maternal supplement intake, intake of folate and vitamin B12 from natural foods and maternal blood folate and B12 status at 19 weeks of gestation.
Main outcome measures  B vitamin related genotype of the offspring.
Results  There were no significant differences in any of the five genotype frequencies between mothers and their babies. There was no deviation from Hardy–Weinberg equilibrium in either generation and no change in the frequency of doubly homozygous
MTHFR variants (677 TT/1298 CC). The genotype of the offspring was not related to maternal periconceptual supplement use, folate intake from foods or plasma and red cell folate measured at 19 weeks of gestation.
Conclusions  We found no evidence to support the concern that folic acid fortification or supplement use in pregnancy results in selection of deleterious genotypes.     

Trichomonas vaginalis infection: risk indicators among women attending for routine gynecologic examination

OBJECTIVES: Trichomonas vaginalis is one of the most common agents of sexually transmitted disease, but trichomoniasis is still considered as an infection of minor importance. The aim of this study was to investigate the risk indicators for trichomoniasis in women attending for routine gynecologic examination. METHODS: The study was conducted comparing demographic and behavioral characteristics in two groups of 122 women with T. vaginalis infection and 853 uninfected women. RESULTS: Univariate analysis showed a significant increase of T. vaginalis infection among women with older age and multiple sexual partners. In multiple logistic regression analysis, the higher number of lifetime partners and older age remained significantly associated with T. vaginalis infection. CONCLUSIONS: This study suggests that T. vaginalis infection might be mainly related to lifestyle risk factors. Therefore, in our opinion, the diagnosis and treatment of this disease should be encouraged on routine gynecologic examination.     

Folic acid supplementation

Neural tube defects represent one of a limited number of congenital conditions for which primary prevention strategies are available. Despite strong clinical evidence to support the preventive effect of supplementary folic acid given prior to conception and continued throughout the first 12 weeks of pregnancy, there is limited recent epidemiological data to support the effectiveness of national folic acid supplementation programs. Whether folic acid fortification of staple foods will provide a more effective means of achieving further reductions in the prevalence rates for this condition remains open to question. Recent advances associating folic acid supplementation, hyperhomocysteinaemia and neural tube defects provide a new insight into the possible pathological mechanism of this and possibly other related congenital conditions.     

Prevalence of sexual abuse among women seeking gynecologic care in Germany

OBJECTIVE: To estimate the prevalence of sexual abuse among patients seen for gynecologic care in Germany. METHODS: A short anonymous questionnaire was distributed to 1157 women attending a gynecologic outpatient clinic at a large urban teaching hospital. Data collected using the questionnaire included patient characteristics, sexual abuse history, and screening practices. Women who reported that they had been abused were asked if they had ever discussed the issue with their gynecologist. RESULTS: A total of 1075 questionnaires were returned, for a response rate of 92.9%. Almost half (n = 479 [44.6%]) of the women surveyed reported that they had been the subject of unwanted sexual attention. One fifth (n = 216 [20.1%]) had been forced to engage in sexual activities: 6.8% in childhood, 10.3% during adolescence, 6.4% as an adult, and 3.5% across more than one stage. Thirteen women (6%) reported having discussed the abuse with their gynecologist. Sixty-six (30.5%) were too afraid to raise the issue, and 119 (55.1%) stated it was not relevant to their care. Only one woman (0.5%) reported that her gynecologist had asked about sexual abuse. CONCLUSION: Despite the high prevalence of sexual abuse among women seeking gynecologic care, routine screening does not appear to be part of standardized practice.     

Folic acid in pregnancy

For more than two decades, folic acid supplementation has been an essential component of pre-pregnancy and early pregnancy care across the world. Folic acid supplements reduce the risk of fetal neural tube defects, and a decline in incidence of such defects following food fortification with folic acid has been a public health success story in many countries. Recent evidence has shown that some group of women, such as those who are obese or taking certain medications, are at an increased risk of fetal neural tube anomalies and require a higher dose of periconceptional folic acid supplementation. Although concerns have been raised over the possible risk of cancer with increased folic acid intake, most data from large studies appear reassuring.     

Folic acid supplementation: The new dawn for postmenopausal women with hot flushes

Hot flushes, experienced by 75% of menopausal women, are associated with estrogen deprivation. Estrogen was shown to ameliorate hot flushes by interacting with monoamine neurotransmitters in the brain; reducing noradrenaline and increasing serotonin. Hormone replacement therapy (HRT), the first treatment option, causes concerns over possible increased risks particularly breast cancer. Folic acid is involved in the biosynthesis of serotonin and nordrenaline, which is responsible for its effects on mood and cognition, and degrees of folate inadequacy, not severe enough to produce megaloblastic anaemia, were found to be associated with depression and cognitive malfunctioning. Also, increased age was observed to relate to reduced serum and cerebrospinal fluid folic acid levels. There is emerging evidence that folic acid supplementation ameliorates hot flushes by the same mechanism as estrogen. To explore this hypothesis, a multi-centre, double-blind, placebo-controlled randomized is being set up to compare the effect of 5 mg folic acid vs placebo in reducing the frequency and severity of hot flushes in postmenopausal women, and on the blood level of serotonin and noradrenaline. If folic acid supplementation is demonstrated to be effective, this will be a turning point in the clinical practice since it represents a cheap, safe and well-tolerated alternative to HRT.     

Experiences with gynecologic laparoscopy as a routine method

Report on 631 gynecological laparoscopies performed from January 1978 till March 1982. The main indications are ectopic pregnancy, acute and chronic pelvic inflammatory diseases and tumours of the ovaries. It is necessary to be critical against the palpation findings and the clinical diagnosis acute or chronic salpingooophoritis. There was a concordance of 51% with laparoscopic diagnosis. The importance and necessity of laparoscopic tubal sterilization is commented.