Inadequate compliance with periconceptional folic acid supplementation in South Australia

BACKGROUND: Despite recommendations for women to take folic acid supplements, there has been little reduction in the number of neural tube defect cases occurring each year. AIMS: To assess the level of compliance of pregnant women to recommendations for folic acid supplementation in South Australia, and audit the labelled content in reported supplements used. METHODS: A survey was conducted from May to September 2005 with 304 pregnant women recruited from antenatal clinics at the Lyell McEwin Health Service, the Women's and Children's Hospital and the Modbury Hospital in Adelaide. RESULTS: Full compliance with supplementation recommendations for both timing and dose was achieved by 30% of women. Partial compliance was achieved by 43%, while 27% took no folic acid supplements. CONCLUSIONS: There is currently poor compliance with folic acid supplementation around conception. Additional food fortification may better achieve an adequate daily level of folic acid.     

Periconceptional folic acid use among women giving birth at Queen Mary Maternity Hospital in Dunedin

BACKGROUND: The New Zealand Ministry of Health advises that all women planning a pregnancy take a folic acid supplement to reduce the risk of having a neural tube defect (NTD)-affected pregnancy. There is little information available to determine if women are following this advice. OBJECTIVE: The purpose of this study was to determine periconceptional folic acid use among women in the postnatal ward of Queen Mary Maternity Hospital in Dunedin. METHODS: A questionnaire was administered to women in the postnatal ward between 14 November and 22 December 2004. RESULTS: One hundred and six women were interviewed during the study period. Forty women (39%) used folic acid supplements before conception. Sixty-seven women (64%) planned their pregnancy. The proportion of women (P<0.001) who planned their pregnancy (53%) and used folic acid before conception was higher than those who did not (11%). The proportion of women 30 years of age (55%) who took folic acid supplements before conception was higher than women aged 17 to <25 years (10%). CONCLUSION: Despite a lack of a public health campaign in New Zealand, a high proportion of participants, especially those who planned their pregnancy, took folic acid during the periconceptional period. A comprehensive public health campaign is needed to increase folic acid use. Fortification may be required to reach those women who do not plan their pregnancies.     

Effects of folic acid supplementation during different pregnancy periods and relationship with the other primary prevention measures to neural tube defects

Objective: To find out the prevention effects of folic acid supplements during different pregnancy periods on neural tube defects (NTDs) and the relationship of folic acid supplements with the other NTDs’ primary preventive measures.

Methods: A 1:1 case-control study was conducted. Four hundred and fifty-nine women who delivered or gestate infants/fetuses with NTDs in the last two years were randomly selected as cases and were matched with women who delivered babies without obvious birth defects as controls.

Results: For anencephaly, folic acid supplementation during the periconceptional period and preconceptional period has a 57–83% reduction in risk of NTDs(ORs ranged from 0.17 to 0.43). For spina bifida, folic acid supplementation during the periconceptional period has a 79% reduction in risk of NTDs (OR?=?0.21). For encephalocele, folic acid supplementation during the periconceptional period has a 67% reduction in risk of NTDs (OR?=?0.33). The prevention effects on NTDs were significant when these preventive measures combined with folic acid supplements during the periconceptional period, with OR 0.04, 0.07, 0.10 and 0.11.

Conclusion: The specific effects of folic acid supplementation during different periods show the reduction in the risk of NTDs, anencephaly, spina bifida, encephalocele. During periconceptional period, folic acid supplements have preventive effects on all NTDs’ subtypes.     

Awareness of the benefits of folic acid and prevalence of the use of folic acid supplements to prevent neural tube defects among Thai women

Objective To determine the level of knowledge about the usefulness of periconceptional folic acid supplementation among pregnant women. Materials and methods An anonymous questionnaire was completed by selected subjects to assess folic acid awareness. The questionnaire was administered to pregnant women who were seeking antenatal care at King Chulalongkorn Memorial Hospital May to December 2005. The questions covered their knowledge and use of folic acid supplements, pregnancy intention, and demographic and socioeconomic characteristics. Results Out of 401 women surveyed, 76.1% of them reported that they had heard of folate. Of these, only 24.4% of the total subjects knew that folate was something important. Overall, 9.7% of the total women took folic acid during periconceptional period. The most common information sources on folate were the media. Logistic regression analysis showed that education of mother was the strongest predictor of having taken folic acid during the correct period. Conclusion Although some pregnant women are aware of the need to take folic acid, the actual impact of the present recommendations is almost negligible. Information to specifically inform patients about the need to take folic acid to prevent neural tube defects by medias and healthcare personnel seem to improve the final intake of folic acid during the protective period.     

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 prevents neural tube defects: international comparison of awareness among obstetricians/gynecologists and urologists

AIM: It has been suggested that periconceptional intake of folic acid prevents risks of having fetuses afflicted with neural tube defects. We aim to internationally investigate knowledge of the role of folic acid and attitudes toward the life-style of young women of child-bearing age among obstetricians/gynecologists and urologists. METHODS: A questionnaire was sent to obstetricians/gynecologists and urologists residing in Japan, South Korea, Taiwan, North America, Europe, Australia and New Zealand by post or e-mail. The investigation was conducted between December 2002 and November 2004. RESULTS: A mean of 91% of obstetricians/gynecologists and 56% of urologists are aware of the role of folic acid, where Asian urologists knew less compared to those of North America, Europe, Australia and New Zealand. A majority of doctors always, or occasionally, recommend folic acid supplements or multivitamins, well-balanced meals, and the cessation of smoking and drinking. An average of 85% of doctors believes information on folic acid should be disseminated to young women. CONCLUSIONS: A majority of obstetricians/gynecologists and urologists know the importance of periconceptional folic acid in reducing the risk of neural tube defects and have been advising young women to improve their lifestyle.     

Comparison of serum folate, 25-OH vitamin D,and calcium levels between pregnants with and without fetal anomaly of neural tube origin

Aim: The aim of this study was to compare serum folate, vitamin B12, 25-OH vitamin D, and calcium levels between pregnants with and without fetal anomaly of neural tube origin.

Methods: One hundred seventy-eight pregnants were recruited for this study. Pregnants with and without sonographically detected fetal anomaly of neural tube origin were compared in terms of serum folate, vitamin B12, 25-OH vitamin D, and calcium levels.

Results: There were significant differences between groups with regard to age, serum 25 OH vitamin D, 1,25 OH vitamin D, folate, calcium, and B 12 levels. Multivariate regression analyses revealed significant associations between the serum 25 OH vitamin D level, age, and the neural tube defect (NTD).

Conclusions: Vitamin D and the age of pregnants were significantly associated with the NTDs.     

Application of the social ecological model in folic acid public health initiatives

All women of childbearing age who are capable of becoming pregnant should consume 0.4 mg/400 microg of folic acid daily. Folic acid decreases the incidence of neural tube defects in newborns. Despite continued public health initiatives, many women still do not consume the recommended daily requirement. This article analyzes the use of the social ecological model in folic acid public health initiatives and emphasizes assessing the outcomes of such initiatives.     

The regional campaign for women on awareness of neural tube defects and folic acid in Narlidere,Izmir: a community-based intervention

Objectives To create an awareness among women and to update the knowledge of health personnel about neural tube defects (NTDs) and folate in order to reduce the incidence of NTD in Narlidere, ?zmir.

Methods In 2006, a regional campaign was organized in Narlidere, Izmir that aimed at informing women of child-bearing age on folic acid and prevention of NTD. Nearly 4400 women participated in the study. By means of questionnaires the level of knowledge before and after the intervention was evaluated.

Results Before the campaign was carried out, 18% of women had heard of folic acid. Their level of knowledge increased after the campaign (p < 0.0001). Post-intervention scores of high school and university graduates and women with high or middle income, as well as those having a friend or kin with spina bifida were found to have significantly improved.

Conclusions The pilot community-based training programme was very successful. Similar programmes, integrated within routine health care services, promoting the use of folic acid will be fostered in the whole country.     

Periconceptional factors affect the risk of neural tube defects in offspring: a hospital-based case-control study in China

Abstract

Objective: To explore the periconceptional factors affecting the risk of neural tube defects (NTDs), we carried out a hospital-based case-control study in China.

Methods: A 1:1 matched case-control study was conducted. With self-designed questionnaires, we solicited relevant information from 459 case mothers and 459 control mothers selected in two provinces of China through face-to-face interviews. Univariate and multivariate conditional logistic regression analyses were conducted to evaluate the effect values by odds ratios (ORs) and 95% confidence intervals (95%CIs) with SAS9.1.3.software.

Results: Daily passive tobacco smoke exposure was a risk factor for total NTDs (OR?=?8.688, 95%CI?=?2.329–32.404). Diet adjustment in the first trimester (OR?=?0.061, 95%CI?=?0.014–0.274), periconceptional folic acid intake (OR?=?0.059, 95%CI?=?0.011–0.321) and health education (OR?=?0.251, 95%CI?=?0.081–0.781) were protective factors for total NTDs. Differences in factors and their effects on NTDs were found for the three subtypes of NTDs: anencephaly, spina bifida and encephalocele.

Conclusions: Daily passive tobacco smoke exposure, diet adjustment in the first trimester, periconceptional folic acid intake and health education were associated with NTDs.     

母体叶酸水平与子代生长发育状况相关性的研究进展

叶酸是一种重要的人体必需营养素。研究表明,孕期补充叶酸可以预防多种出生缺陷的发生,已有多个国家全面推行了叶酸强化政策。但有证据指出,过量补充叶酸不仅无法预防疾病,还会适得其反。目前研究聚焦在母体叶酸补充剂量与子代健康的相关性上,特别是孕期过量补充叶酸是否会对子代造成副作用。本文拟从叶酸的代谢、人群叶酸营养水平、临床常见的叶酸检测方法、应用以及母体叶酸摄入异常对后代生长发育的影响4个方面进行综述。     

孕妇血清叶酸和维生素B12水平与子代神经管畸形发生的关系

目的 探讨我国神经管畸形(neural tube defects,NTD)高发地区孕妇血清叶酸、维生素B12(vitamin B12,VitB12)水平与子代NTD的关系.方法 采用病例对照研究设计,以NTD高发的山西省5个县作为研究现场.病例组为经B超诊断胎儿合并NTD并通过终止妊娠确诊的孕妇以及分娩NTD的孕妇,对照组为B超诊断胎儿发育正常的孕早、中和晚期孕妇.比较两组血清叶酸和VitB12水平(以几何均数及第5～95百分位数表示)的差异.分别以对照组血清叶酸和VitB12浓度的第10百分位作为界值,划分为2个水平组,分析低浓度水平组NTD的发病风险.结果 病例组和对照组血清VitB12浓度分别为83.8 pmol/L(30.5～209.1)pmol/L、102.6 pmol/L(51.9～269.7)pmol/L,差异具有统计学意义(P<0.05);两组孕妇血清叶酸浓度分别为10.5 pmol/L(4.4～24.5)nmol/L、12.9 pmol/L(6.3～32.7)nmol/L,差异具有统计学意义(P<0.05).子代合并脊柱裂的孕妇血清叶酸、VitB12浓度均低于对照组(P分别=0.017和0.001),子代合并无脑儿的孕妇仅血清叶酸浓度低于对照组(P=0.011),而子代合并脑膨出的孕妇血清叶酸、VitB12浓度与对照组相比差异均无统计学意义(P均>0.05).低VitB12水平孕妇发生NTD的校正危险度为正常水平者的2.58倍(95%CI:1.20～5.51),低叶酸水平孕妇发生NTD的校正危险度是正常叶酸水平孕妇的2.76倍(95%CI:1.30～5.87).结论 低水平血清叶酸和/或VitB12可能是本研究人群NTD发生的危险因素.     

血浆同型半胱氨酸、叶酸、5,10-亚甲基四氢叶酸还原酶基因多态性与先天性心脏病的相关性研究

目的　研究母亲血浆同型半胱氨酸 (HCY ) ,叶酸及 5 ,10 -亚甲基四氢叶酸还原酶(MTHFR)第 6 77位核苷酸多态性与子女先天性心脏病 (CHD)的相关性。　方法　选择 CHD患儿母亲 32例和正常儿童母亲 2 3例 ,应用高压液相色谱检测血浆 HCY水平 ,放射免疫法检测血浆叶酸水平 ,PCR- REL P方法检测 MTHFR基因型。　结果　以正常值 15μmol/ L为界 ,CHD母亲组发生高HCY血症的有 11例 ,占该组的 34% ,对照组均在正常范围无增高者 ,经χ2 检验两组差异有高度显著性 (P<0 .0 1)。血浆叶酸 CHD母亲组为 (4.9± 3.6 )μg/ L ,小于对照组 (6 .8± 2 .2 )μg/ L ,差异有显著性 (P<0 .0 5 )。两组母亲 MTHFR纯合突变率的差异无显著性。　结论　母亲血浆 HCY升高及叶酸降低是子女 CHD发生的危险因素 ,叶酸预防 CHD的途径可能与降低血浆 HCY有关 ,母亲 MTHFR基因第 6 77位的突变与子女 CHD的发生无相关性。     

Folate intake in young women and their knowledge of pre- conceptional folate supplementation to prevent neural tube defects

Objectives: To ascertain knowledge of periconceptional folate for prevention of neural tube defect (NTD) and to estimate folate intake in young women. Study design: Three hundred young women were questioned about their knowledge of folate for prevention of NTD. Their folate intake was assessed by food frequency questionnaire. Results: Fourteen per cent of 16–19 year olds and 41% of undergraduates were aware of the need to increase folate intake before conception. Median folate intake was estimated to be 235 μg/d in 16–19 year olds and 248.5 μg/d in undergraduates. More than a quarter of women in both groups had folate intakes less than the reference nutrient intake (RNI) (200 μg/d) below which prevalence of NTD rises dramatically and these women would therefore be at increased risk of having a child with NTD should they have an unplanned pregnancy. Conclusions: Strategies are required to increase folate intake among young women and inform them of the benefit of peri-conceptional folate supplementation.     

妊娠高血压综合征血浆叶酸同型半胱氨酸和内皮素浓度变化

目的　了解妊娠高血压综合征 (妊高征 )患者血浆叶酸 (FA)、同型半胱氨酸 (Hcy)和内皮素 (ET 1)浓度的变化。方法　采用放免法检测 4 3例妊高征患者 (妊高征组 )分娩前后及 67例正常晚孕妇女 (正常晚孕组 )和15例正常非孕妇女 (正常非孕组 )血浆FA、维生素B12 (VB12 )及ET - 1含量。用荧光标记免疫检测法测定血浆Hcy的含量。 结果　①正常晚孕组血浆叶酸浓度 [( 11 3 6± 5 3 8)nmol/L]明显低于正常非孕组 [( 2 7 77± 7 75 )nmol/L ,P <0 0 5 ];妊高征组分娩前血浆叶酸浓度 [( 6 4 3± 2 4 0 )nmol/L]明显低于正常非孕组及正常晚孕组(P <0 0 1,P <0 0 5 ) ;妊高征组分娩后血浆叶酸 [( 2 0 85± 8 80 )nmol/L]明显高于分娩前 (P <0 0 5 ) ;②正常晚孕组血浆同型半胱氨酸浓度 [( 7 89± 3 2 7) μmol/L]明显高于正常非孕组 [( 6 63± 1 0 7) μmol/L ,P <0 0 5 ];妊高征组分娩前血浆同型半胱氨酸浓度 [( 12 0 0± 4 5 9) μmol/L]明显高于正常非孕组及正常晚孕组 ( P <0 0 1,P <0 0 1) ;妊高征组分娩后血浆同型半胱氨酸浓度 [( 7 63± 3 2 9) μmol/L]明显低于分娩前 ( P <0 0 0 1) ;③妊高征组分娩前血浆内皮素 - 1质量浓度 [( 13 8 4 7± 3 0 0 3 )ng/L]明显高于正常晚孕组 [( 10 3 7     

Maternal periconceptional alcohol consumption and the risk of neural tube defects in offspring: a meta-analysis

Objective: Several studies have been conducted to examine the association between alcohol consumption during pregnancy and risk of neural tube defects (NTDs), while the results are inconsistent. In the present study, we aimed to clarify the relationship between maternal periconceptional alcohol consumption and NTDs risk in offspring.

Methods: PubMed, Springer Link, and Elsevier databases were searched up to November, 2014. All case–control and cohort studies of maternal alcohol consumption during pregnancy with risk of NTDs were included. The pooled odds ratios (ORs) and their 95% confidence intervals (CIs) for highest versus lowest category of alcohol consumption were calculated using a fixed- or random-effects model.

Results: The pooled ORs of maternal periconceptional alcohol consumption were 1.01 (95% CI: 0.71–1.45) for total NTDs and 1.03 (95% CI: 0.65–1.64) for NTDs subtype of spina bifida. Specifically, the pooled ORs of maternal alcohol consumption in the first trimester and binge drinking were 1.01 (95% CI: 0.71–1.43), and 1.07 (95% CI: 0.81–1.41), respectively.

Conclusions: Our findings suggested no association between maternal periconceptional alcohol consumption and NTDs risk in offspring.