Dietary Approaches to the Prevention of Neural Tube Defects

1983 ◽  
Vol 2 (3-4) ◽  
pp. 181-189 ◽  
Author(s):  
K. M. Laurence
Keyword(s):  
Neural Tube ◽  
First Trimester ◽  
Subsequent Pregnancy ◽  
Vitamin Supplementation ◽  
Control Group ◽  
Dietary Counselling ◽  
Increased Risk ◽  
Diet Study ◽  
Group 5 ◽  
Dietary Education

Two dietary studies are reported on women resident in Glamorgan and Gwent who had had a child with a neural tube defect (NTD). In the first study the contemporaneous inter-pregnancy and pregnancy diets of 415 women were recorded. Blood samples were taken and analysed for folates and vitamin B12. The quality of the diets correlated with the serum and red cell folate concentrations. The diets during the subsequent pregnancy were worse than the inter-pregnancy diet. Half of the women, selected on a geographical basis were advised to improve their diet before and during the next pregnancy. Of these women 174 reported 186 pregnancies in time for a further diet study. Of the women counselled to improve their diet 75% had done so, compared to 10% of those not counselled. There were 8 recurrences of NTD in 186 pregnancies, all the 8 mothers receiving a poor diet during the first 3 months of pregnancy. In the second study the interpregnancy diets of 244 women who had had a child with a NTD were compared to the diets of their own sisters and a group of professional women. The diet of the index cases was worse than that of either control group. 5 mothers who had poor diets during the first 3 months of the pregnancy had a child with a NTD. It is concluded that women on a better diet during the first trimester have a lower risk of NTD recurrence. Dietary counselling can be effective in improving the diet in women at increased risk for NTD. Improvement in the diet of prospective mothers by dietary education at school should not be neglected. The relationship between improvements in diet, folic acid and vitamin supplementation, in the prevention of recurrence of NTD is discussed.

scholarly journals Anticoagulation for the Pregnant Patient with a Mechanical Heart Valve, No Perfect Therapy: Review of Guidelines for Anticoagulation in the Pregnant Patient

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Aaron Richardson ◽  
Stuart Shah ◽  
Ciel Harris ◽  
Garry McCulloch ◽  
Patrick Antoun
Keyword(s):  
Heart Valve ◽  
Thrombotic Event ◽  
Alternative Therapy ◽  
Mechanical Heart Valve ◽  
Mechanical Valve ◽  
Pregnant Patient ◽  
First Trimester ◽  
Subsequent Pregnancy ◽  
Mechanical Valves ◽  
Increased Risk

Heart valve replacement with a mechanical valve requires lifelong anticoagulation. Guidelines currently recommend using a vitamin K antagonist (VKA) such as warfarin. Given the teratogenic effects of VKAs, it is often favorable to switch to heparin-derived therapies in pregnant patients since they do not cross the placenta. However, these therapies are known to be less effective anticoagulants subjecting the pregnant patient to a higher chance of a thrombotic event. Guidelines currently recommend pregnant women requiring more than 5 mg a day of warfarin be switched to alternative therapy during the first trimester. This case report highlights a patient who was switched to alternative therapy during her first pregnancy and suffered a devastating cerebrovascular accident (CVA). Further complicating her situation was during a subsequent pregnancy; this patient continued warfarin use during the first trimester and experienced multiple transient ischemic attacks (TIAs). This case highlights the increased risk of thrombotic events in pregnant patients with mechanical valves. It also highlights the difficulty of providing appropriate anticoagulation for the pregnant patient who has experienced thrombotic events on multiple anticoagulants.

scholarly journals Could molecular assessment of calcium metabolism be a useful tool to early screen patients at risk for pre-eclampsia complicated pregnancy? Proposal and rationale

2015 ◽  
Vol 53 (7) ◽  
Author(s):  
Salvatore Gizzo ◽  
Marco Noventa ◽  
Stefania Di Gangi ◽  
Carlo Saccardi ◽  
Erich Cosmi ◽  
...  
Keyword(s):  
Calcium Intake ◽  
Calcium Metabolism ◽  
Large Scale ◽  
Calcium Supplementation ◽  
English Literature ◽  
First Trimester ◽  
Control Group ◽  
Hypertensive Disorders ◽  
Increased Risk ◽  
First Trimester Of Pregnancy

AbstractOne of the most frequent causes of maternal and perinatal morbidity is represented by hypertensive disorders during pregnancy. Women at high risk must be subjected to a more intensive antenatal surveillance and prophylactic treatments. Many genetic risk factors, clinical features and biomarkers have been proposed but none of these seems able to prevent pre-eclampsia onset. English literature review of manuscripts focused on calcium intake and hypertensive disorders during pregnancy was performed. We performed a critical analysis of evidences about maternal calcium metabolism pattern in pregnancy analyzing all possible bias affecting studies. Calcium supplementation seems to give beneficial effects on women with low calcium intake. Some evidence reported that calcium supplementation may drastically reduce the percentage of pre-eclampsia onset consequently improving the neonatal outcome. Starting from this evidence, it is intuitive that investigations on maternal calcium metabolism pattern in first trimester of pregnancy could represent a low cost, large scale tool to screen pregnant women and to identify those at increased risk of pre-eclampsia onset. We propose a biochemical screening of maternal calcium metabolism pattern in first trimester of pregnancy to discriminate patients who potentially may benefit from calcium supplementation. In a second step we propose to randomly allocate the sub-cohort of patients with calcium metabolism disorders in a treatment group (calcium supplementation) or in a control group (placebo) to define if calcium supplementation may represent a dietary mean to reduce pre-eclampsia onset and to improve pregnancy outcome.

scholarly journals Prevalence of bicuspid aortic valve in patients with aneurysmal sub-arachnoid hemorrhage: neurologic features and outcomes

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Vallabhajosyula ◽  
L T Yang ◽  
M Enriquez-Sarano ◽  
A Rabinstein ◽  
H Michelena
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Final Analysis ◽  
Control Group ◽  
World Federation ◽  
Neurologic Outcomes ◽  
Routine Surveillance ◽  
Increased Risk ◽  
Group 5 ◽  
Arachnoid Hemorrhage

Abstract Background Intracranial aneurysm (IA) has been associated with bicuspid aortic valve (BAV) with prevalence of 6–10% which has led some to recommend routine surveillance for IA in BAV patients. Higher incidence of IA in BAV could signal towards systemic arteriopathy beyond the thoracic aorta. With CoA as an independent risk factor for IA formation, it is currently uncertain if the association between IA and BAV reflects the association of BAV and CoA, or the result of BAV-related systemic arterial changes. Purpose Despite this association, 2 small studies suggest no increased risk of the most important patient outcome: aneurysmal sub-arachnoid hemorrhage (aSAH). Our primary aim was identifying the prevalence of BAV in aSAH patients and compare it with that of a control group without aSAH. Secondary aims included neurologic outcomes of aSAH and anatomical characteristics of IA in BAV, and final disposition and outcome. Methods Patients (>18 years age) with an accurate diagnosis of aSAH and at least one echocardiogram in the system between January 2000-December 2019 were identified from a prospectively maintained registry of aSAH admissions. Controls, without a diagnosis of SAH ever, were age- and gender-matched (1:2 cases:controls). BAV prevalence was echocardiographically-confirmed in all patients. Severity of aSAH was categorized using the modified Fisher (mFisher) and the World Federation of Neurological Scale (WFNS). Results A total of 488 aSAH cases and 990 controls were included in the final analysis with confirmed aortic valve status. The prevalence of BAV in aSAH patients was 1.2% (6/488) vs 3.5% (35/990) in controls, p=0.01. None of the aSAH cases were noted to have CoA, whereas 3 (0.3%; p=0.12) control patients had presence of both BAV and CoA. Within aSAH patients, BAV+aSAH were noted to be younger than tricuspid aortic valve (TAV)+aSAH (56±11 vs 68±14; p=0.03). Aneurysm size was smaller in the BAV+aSAH group (5±2 vs 7±4 in TAV+aSAH; p=0.31). The severity of the bleed was lesser in BAV+aSAH than TAV+aSAH (mFisher grade >2 50% vs 74%; p=0.19, WFNS grade >3 17% vs 36%; p=0.43) which is clinically significant. The BAV+aSAH group had higher disposition rate to home (67% vs 39%; p=0.21) with no difference in in-hospital mortality rates (17% vs 18%; p=0.93). BAV had lower odds on univariate and multivariate analyses adjusted for age/sex/body mass index (OR 0.33 [CI 0.14–0.81]; p=0.01, OR 0.23 [CI 0.08–0.65]; p=0.01) of presenting with aSAH. Conclusion Within a large prospective registry with accurate aSAH diagnoses, we found 3-times lower prevalence of echocardiographically-confirmed BAV as compared to non-aSAH controls. We observed 3-times higher prevalence of BAV in controls than among aSAH cases. In addition, size of intracranial aneurysms was clinically smaller in BAV patients, and the severity of SAH was significantly lesser in BAV from a clinical standpoint. Our findings argue against routine surveillance for IA in BAV patients without CoA. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Exposure to Propylthiouracil in the First Trimester of Pregnancy and Birth Defects: A Study at a Single Institution

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Ai Yoshihara ◽  
Jaeduk Yoshimura Noh ◽  
Natsuko Watanabe ◽  
Miho Fukushita ◽  
Masako Matsumoto ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Birth Defects ◽  
Antithyroid Drug ◽  
First Trimester ◽  
Control Group ◽  
Graves Disease ◽  
Increased Risk ◽  
Group A ◽  
First Trimester Of Pregnancy ◽  
Maternal Thyroid

Abstract Context Medical treatment of Graves disease during the first trimester has been the subject of controversy ever since treatment with an antithyroid drug during the first trimester was reported to possibly be associated with an increased risk of birth defects in newborns. Objective We investigated whether the incidence of birth defects among newborns born to mothers with Graves disease (GD) treated with propylthiouracil (PTU) during the first trimester of pregnancy was higher than in a control group that was not exposed to any medication. Methods We reviewed the cases of 1913 women with GD who gave birth between January 1, 2015, and May 31, 2019. Detailed information concerning the outcome of pregnancy and the presence of birth defects was collected at the first visit after the delivery and again 1 year after delivery. We classified the mothers and infants into 3 groups according to the treatment the mother had received for GD in the first trimester of pregnancy: a group in which the mothers had been treated with PTU alone (PTU group), a group in which the mothers had not been treated with any medication (control group), and a group in which the mothers had received some other medical treatment, such as thiamazole, potassium iodide, or 2 or more drugs (other treatment group). Results The incidence of malformed infant births was 5.5% (30/541 infants) in the PTU group and 5.7% (27/ 475 infants) in the control group. There were no specific birth defects in the PTU group, and there were no significant differences between PTU dosages or maternal thyroid function according to whether mothers had delivered a child with a birth defect. Conclusion The results of our retrospective study showed that treatment with PTU during the first trimester of pregnancy did not increase the incidence of birth defects among newborns.

scholarly journals A COMPARATIVE STUDY OF MATERNAL OUTCOME IN FIRST-TRIMESTER VAGINAL BLEEDING IN THE DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY, SMS MEDICAL COLLEGE, JAIPUR

2021 ◽  
Vol 5 (7) ◽  
Author(s):  
Savita Meena ◽  
Suniti Verma ◽  
R N Sehra ◽  
Suman Choudhary
Keyword(s):  
Gestational Age ◽  
Vaginal Bleeding ◽  
Adverse Pregnancy Outcome ◽  
First Trimester ◽  
Control Group ◽  
Case Group ◽  
Medical College ◽  
Obstetrics And Gynaecology ◽  
Increased Risk ◽  
Adverse Pregnancy

Background: The outcome of ongoing pregnancies after first trimester vaginal bleeding is of relevance to women and obstetricians for planning antenatal care and clinical interventions in pregnancy. Hence, this study was conducted to identify the risks associated with first trimester bleed which may facilitate decision making regarding mode, place and timing of delivery during management, which may improve maternal and neonatal outcome. Methods: Hospital based comparative prospective study conducted at Department of Obstetrics and Gynaecology, SMS Medical College & associated Hospitals, Jaipur. Results: APH was found in 4 (8.00%) patients of case group and nil in control group. So, APH was found to be more in the case group than control group but was statistically not significant. Pre-eclampsia was found in 4 (8.00%) in case group and 3 (6.00%) in control group with statistically insignificant difference between the two groups.  26 (52.00%) delivered at the gestational age of ?37 weeks, whereas only 8 (16%) of control group delivered at ?37 weeks. So, the gestational age at delivery of control group subjects was found to be higher as compared to case group subjects and the difference was statistically significant (p=0.001). Conclusion: Threatened miscarriage in early pregnancy increases the risk of adverse pregnancy outcome. In our study, these patients were found to be at an increased risk of preterm delivery, PPROM. Keywords: PROM, Miscarriage, Gestational age

scholarly journals Marcadores Bioquímicos do Primeiro Trimestre e Recém-Nascidos Leves para Idade Gestacional

2014 ◽  
Vol 27 (2) ◽  
pp. 191
Author(s):  
Cláudia Andrade ◽  
Joana Santos ◽  
Ana Rita Pinto ◽  
Pedro Manso ◽  
Susana Pereira
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Odds Ratio ◽  
Biochemical Markers ◽  
First Trimester ◽  
Control Group ◽  
Maternal Weight ◽  
Increased Risk ◽  
Β Hcg

<strong>Introduction:</strong> Several studies suggested an association between first trimester biochemical markers (PAPP-A and β- HCG) and infants below 10th percentile. Our goal was to describe this relationship of biochemical markers with small-for- gestational-age fetuses in our population.<br /><strong>Material and Methods:</strong> Retrospective analytic study of 2 035 pregnant women that underwent first-trimester screening in the period between March 2009 and September 2011. Small-for-gestational-age infants below 10th percentile were compared with control group (term newborn with birth weight above 10th percentile). Infants below 3rd percentile and control group were also compared. Multiple and logistic regression analysis were done with PAPP-A, β-HCG (multiples of the expected normal median) and demographic maternal characteristics (ethnicity, weight and smoker status).<br /><strong>Results:</strong> This study demonstrated an independent contribution of PAPP-A, maternal weight and smoker status in predicting small-for-gestational-age infants. For PAPP-A, the odds ratio for small-for-gestational age below 10th and 3rd percentile was 2.41 and 3.41, respectively (p &lt; 0.01). For β-HCG, odds ratio below 10th percentile was 1.70 (p = 0.03) and for birth weight below the 3rd percentile, the odds ratio was 3.22 (p &lt; 0.01).<br /><strong>Conclusions:</strong> Low levels of PAPP-A and β-HCG (values below 5th percentile of the study population) were associated with an increased risk of small-for-gestational-age infants in the pregnant population included in this study.

scholarly journals To study the feto-maternal outcome in cases with previous surgical intervention for first trimester abortion on subsequent pregnancy and to compare with cases without history of previous abortion

2020 ◽  
Vol 9 (10) ◽  
pp. 4227
Author(s):  
Kritika Tanwar ◽  
Bani Sarkar ◽  
Anjali Chauhan
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Surgical Intervention ◽  
First Trimester ◽  
Subsequent Pregnancy ◽  
P Value ◽  
Trimester Abortion ◽  
Increased Risk ◽  
History Of ◽  
Surgical Abortion

Background: To study the Feto-maternal outcome in cases with previous surgical intervention for first trimester abortion on subsequent pregnancy and to compare with cases without history of previous abortion.Methods: A cross sectional observational study was conducted over a period of two years. Study included 80 consenting females at 28 weeks POG. Females with history of prior surgical abortion just before the present pregnancy were included as cases (n=40) and rest as controls (n=40). Detailed obstetric history was taken, subjects were then followed till delivery and feto-maternal outcomes such as period of gestation, mode of delivery birth weight, Apgar score, increased NICU stay at the time of delivery were recorded and analyzed.Results: We observed that the women with history of induced surgical abortion were at increased risk of Pre term birth (52.5%, p value0.006), Cesarean section (40%, p value 0.012), Low birth weight (47.5%, p value <0.001), increased NICU stay (32.5%, p value 0.027) compared to primi-gravida controls.Conclusions: We concluded that women with previous history of induced surgical abortions were at increased risk of preterm birth, very preterm birth and low birth weight babies, NICU stay in the subsequent pregnancies. The risk of caesarean was found to be increased in women with previous induced abortions exposing the women to the morbidity associated with the C-section. Hence patient with prior history of surgical first trimester abortion needs more vigilant monitoring during antenatal period in subsequent pregnancy.

scholarly journals Loci C677T and A1298C of the methylenetetrahydrofolate reductase gene and the risk of neural tube defects in the Kyrgyz population

2019 ◽  
pp. 3-8
Author(s):  
Н.М. Алдашева ◽  
Э.М. Мамбетсадыкова ◽  
Э.Т. Талайбекова ◽  
С.Дж. Боконбаева ◽  
Х.М. Сушанло ◽  
...  
Keyword(s):  
Neural Tube ◽  
Neural Tube Defects ◽  
Methylenetetrahydrofolate Reductase ◽  
Strong Association ◽  
Mthfr Gene ◽  
Control Group ◽  
Increased Risk ◽  
Pcr Rflp ◽  
1298C Allele ◽  
Kyrgyz Population

Цель. Изучить ассоциацию полиморфных локусов С677Т и А1298С гена MTHFR с развитием дефектов нервной трубки (ДНТ) у детей киргизской национальности. Методы. В исследование включены 76 детей и их матери. В основную группу вошли 30 детей с пороками невральной трубки, чаще всего в виде изолированной спиномозговой грыжи или в сочетании с другими врожденными пороками развития, а также их матери. 46 детей без ДНТ и их матери составили контрольную группу. Идентификация генотипов полиморфных локусов С677Т и А1298С гена MTHFR проводилась методом анализа полиморфизма длин рестрикционных фрагментов (ПДРФ). Результаты. При анализе распределения генотипов и аллелей полиморфизма А1298С гена MTHFR выявлено, что среди детей с ДНТ статистически значимо чаще встречались гетерозиготный генотип А1298С (χ²=9,67; р=0,0079) и аллель 1298С (χ²=4,17; р=0,04). При наличии генотипа А1298С риск развития ДНТ повышается в 4,71 раза (OR=4,71; p=0,0079), а при наличии аллеля 1298С - в 2,2 раза (OR=2,20; p=0,04). Полиморфный локус С677Т гена MTHFR самостоятельно не был ассоциирован с ДНТ, однако гетерозиготность по двум полиморфным аллелям ассоциирована с ДНТ (χ²=5,60; p=0,018) и существенно повышает относительный риск развития ДНТ (OR=9,75; p=0,018). Заключение. У детей киргизской национальности полиморфный локус А1298С гена MTHFR ассоциирован с развитием дефекта нервной трубки. Комбинированная гетерозиготность (С677Т/А1298С) по обоим полиморфизмам является дополнительным отягощающим фактором. Aim. The aim of the study was to investigated whether polymorphisms С677Т and А1298С of the MTHFR gene are associated with neural tube defects (NTDs) in the Kyrgyz population. Methods. The study included 76 children and their mothers. The study group included 30 children and their mothers, where the child had a neural tube defect, most commonly in the form of an isolated spina bifida or in combination with congenital anomalies. Control group - 46 children without congenital malformations. С677Т and А1298С polymorphisms analysis in the MTHFR gene were performed by PCR-RFLP method. Results. The frequency of the heterozygous A1298C genotype (χ²=9,67; p=0,0079) and 1298C allele (χ²=4,10; p=0,041) of the MTHFR gene was higher in cases than in controls. Child with heterozygous A1298C genotype had a 4,71- fold (OR=4,71; p=0,0079) higher risk of NTDs when compared with those who had the AA genotype. Child carriers of the 1298C allele had a 2,2-fold higher risk of NTDs (OR=2,20; p=0,041). С677Т/А1298С genotypes are more frequent among cases than controls (χ²=5,00; p=0,025). We showed that the combinations of С677Т/А1298С is strong association with NTDs (χ²=5,60; p=0,018). Subjects carriers of the combinations of С677Т/А1298С genotypes had a significant 9,7-fold higher risk of NTDs (OR=9,75; p=0,018). Conclusion. There is significant association between С677Т and А1298С polymorphism in MTHFR gene and neural tube defects in the Kyrgyz population. An increased risk of neural tube defects associated with heterozygous A1298C genotype, 1298C allele and combinations of С677Т/А1298С in MTHFR gene.

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