Knowledge and Practice of Childbearing Women in Saudi Arabia towards Folic Acid Supplement—Evidence from a Cross-Sectional Study

Background and objectives: Neural tube defects are congenital anomalies which canlead to infant death and serious disability. They are initiated during embryogenesis, between the 23rd and 27th day of fetal life, and can be prevented by the administration of folic acid. Therefore, this study aims to evaluate the knowledge and practice of Saudi women at childbearing age regarding NTDs and FA supplementation. Methodology: This is a cross-sectional study on Saudi women of reproductive age who were asked to complete an online survey to examine their knowledge and practice regarding folic acid supplementation and neural tube defects. Descriptive and simple linear regression analyses were conducted using SPSS v.26 (SPSS Inc., Chicago, IL, USA). Results: A total of 613 women have completed the questionnaire, from which the majority (46.7%) were aged between 36 and 40 years. About 94% of women heard about folic acid and 80% indicated that its deficiency has some relation to neural tube defects. Approximately 37%, 25.3%, and 23.2% of women reported the proper time for folic acid intake to be during first trimester of pregnancy, before pregnancy, or throughout pregnancy, respectively. Linear regression analysis revealed that increase age and education were significantly correlated with a decrease in folic acid administration (p = 0.008) and (p = 0.001), respectively. However, there was no association between time of folic acid administration and income or number of parities. Conclusion: Despite the acceptable level of awareness about the relation of folic acid and neural tube defects, our results revealed that more education is required towards the proper time of supplementation among Saudi childbearing women.

Role of Folate and Folic Acid During Pregnancy

Pregnancy represents a period of fast tissue growth of maternal and foetal tissues that's related to enhanced energy and nutrient needs. Maternal nutrition throughout gestation period, has being essential for best offspring development, reducing long unwellness burden and for general health throughout life. Maternal Folate throughout pregnancy might have numerous roles in offspring health, as well as neurodevelopment and psychological feature performance in childhood. Folate is crucial for C1 metabolism, a network of pathways concerned in many biological processes as well as nucleotide synthesis, deoxyribonucleic acid repair and methylation reactions. The periconceptional use of pteroylglutamic acid (Folic Acid ) containing supplements reduces the primary incidence, as well as recurrence of neural tube defects. Folic Acid (FA) are artificial form of a necessary vitamin generically considered Folates or B9. It is concerned in one-carbon metabolism, and it's been connected to lowering neural tube Defect (NTD). National programs to mandate fortification of food with Folic Acid have reduced the prevalence of NTDs worldwide . The indisputable protecting role of Folic Acid in the hindrance of NTD, in addition to the low compliance of women to Folic Acid recommendations, has aroused the choice of mandatory Folic Acid fortification, a policy currently in place in over eighty countries worldwide. Mandatory food fortification needs food makers to feature Folic Acid to certain foods (e.g. starch or grain products), whereas voluntary fortification permits Folic Acid to be added to foods at the discretion of manufacturers. Food fortification with Folic Acid because the intervention is likely to achieve increasing Folic Acid intake among populations throughout the world. The objective of this article is to discuss the Role of Folic Acid and Folate during pregnancy and to review the role of Folate and Folic Acid , metabolism , absorption and Folic Acid effects on maternal on the basis of recent findings that are important for implementation of fortified food to design future studies. Keywords: Neurodevelopment, Methylation Reactions, Pteroylglutamic Acid, Bioavailability, Monoglutamates.

Fatores Maternos associados à ocorrência de Mielomeningocele: Uma Revisão Bibliográfica / Maternal Factors Associated with the Occurrence of Myelomeningocele: A Literature Review

Resumo- A mielomeningocele configura um defeito primário do tubo neural mais comum, tal defeito constitui uma das malformações congênitas mais graves do recém-nascido, uma vez que o sistema nervoso central tem início em um tubo que se desenvolve nas estruturas mais complexas do corpo humano. O defeito pode ocorrer na sua porção cranial, resultando em malformações como anencefalia e encefalocele ou na porção caudal resultando em malformações que em grupo são conhecidas como espinha bífida. A mielomeningocele é classificada como espinha bífida aberta e ocorre nas primeiras quatro semanas de gestação. O objetivo deste estudo foi identificar na literatura fatores maternos associados ao aparecimento da mielomeningocele. A coleta de dados foi realizada em outubro a novembro de 2021, nas bases de dados SciELO, Google acadêmico e BVS – Brasil utilizando as palavras chaves: “mielomeningocele”, “malformação tubo neural” e “fatores maternos”, sendo necessária também a pesquisa em livros específicos, constituindo uma amostra de 13 publicações. A deficiência de ácido fólico destacou-se como principal fator materno associado à ocorrência da mielomeningocele; além da ingestão materna de anticonvulsivantes, ingestão de fármacos antagonistas do ácido fólico, doenças como o diabetes e a obesidade, deficiência de zinco, baixas condições socioeconômicas e influências perturbadoras como a irradiação e a hipertermia materna. Conclui-se que medidas públicas no combate aos fatores maternos preveníveis são necessárias, uma vez que a mielomeningocele é uma patologia limitante, complexa, com impacto na qualidade de vida dos pacientes e de seus familiares além de requerer equipe especializada e multidisciplinar.Palavras-Chave: Mielomeningocele; Malformações; Espinha bífida. Abstract- Myelomeningocele is a primary defect of the most common neural tube, this defect is one of the most serious congenital malformations in newborns, since the central nervous system starts in a tube that develops in the most complex structures of the human body. The defect can occur in its cranial portion, resulting in malformations such as anencephaly and encephalocele, or in the caudal portion, resulting in malformations that, in group, are known as spina bifida. Myelomeningocele is classified as open spina bifida and occurs within the first four weeks of pregnancy. The aim of this study was to identify maternal factors associated with the onset of myelomeningocele in the literature. Data collection was carried out from October to November 2021, in the SciELO, Google Academic and BVS – Brazil databases using the keywords: “myelomeningocele”, “neural tube malformation” and “maternal factors”, also requiring the research in specific books, constituting a sample of 13 publications. Folic acid deficiency stood out as the main maternal factor associated with the occurrence of myelomeningocele; in addition to maternal intake of anticonvulsants, intake of drugs that are antagonists to folic acid, diseases such as diabetes and obesity, zinc deficiency, low socioeconomic conditions and disturbing influences such as radiation and maternal hyperthermia. It is concluded that public measures to combat preventable maternal factors are necessary, since myelomeningocele is a limiting and complex pathology, with an impact on the quality of life of patients and their families, in addition to requiring a specialized and multidisciplinary team.Keywords: Myelomeningocele. Malformations. Spina bifida.

Fetal Occipital Encephalocele: A Case Report

Encephaloceles are considered neural tube defects, but their exact cause is unknown. The outcome is dismal, and essential management and counseling are needed for patients. Two-dimensional and three-dimensional sonography can be used to detect encephaloceles as early as 11 weeks, assist in treatment planning, and improve patient care. This case report presents an occipital encephalocele diagnosed by sonography and followed until delivery.

Restricted proliferation during neurogenesis contributes to regionalization of the amphioxus nervous system.

The central nervous system of the cephalochordate amphioxus consists of a dorsal neural tube with an anterior brain. Two decades of gene expression analyses in developing amphioxus embryos have shown that despite the lack of overt segmentation the amphioxus neural tube is highly regionalized at the molecular level. However, little is known about the mechanisms that generate such precise regionalization. Proliferation is a key driver of pattern formation and cell type diversification, but in amphioxus it has never been studied in detail nor in the specific context of neurogenesis. Here, we describe the dynamics of cell division during the formation of the central nervous system in amphioxus embryos and its contributions to the regionalization of the neural axis. We show that after gastrulation, proliferation pauses to become spatially restricted to the anterior and posterior ends of the neural tube at neurula stages. Only at the onset of larval life, proliferation resumes in the central part of the nervous system. By marking specific populations and inhibiting cell division during neurulation, we demonstrate that proliferation in the anterior cerebral vesicle is required to establish the full cell type repertoire of the frontal eye complex and the putative hypothalamic region of the amphioxus brain, while posterior proliferating progenitors, which were found here to derive from the dorsal lip of the blastopore, contribute to elongate the caudal floor plate. Between these proliferative domains, we find trunk nervous system differentiation is independent from cell division, which decreases during neurulation and resumes at the early larval stage. Taken together, our results highlight multiple roles for proliferation in shaping the amphioxus nervous system.

Mengenal Spina Bifida dan Pencegahannya

Neural tube defects (NTD) are one of the birth defects or congenital abnormalities that occur in the brain and spine, and commonly find in newborns worldwide. Anencephaly and spina bifida are the two prevalent forms of NTD. The incidence of spina bifida happen on average 1 in 1000 cases of birth worldwide and there are 140,000 cases per year worldwide. Source searches were carried out on the online portal of journal publications as many as 20 sources from MedScape, Google Scholar and the Nation Center for Biotechnology Information / NCBI with the keywords “Neural tube defects (NTD), prevention, and spina bifida”. Spina bifida is a congenital abnormality that occurs in the womb due to a failure of closing process the neural tube during the first few weeks of embryonic development which causes the spine not completely close around the developing spinal cord nerves. NTD can ensue multifactorial conditions such as genetic, environmental, and folate deficiency. The use of folic acid supplementation starting at least 3 months before pregnancy, those are 400 mcg (0.4 mg) per day and 800 mcg per day during pregnancy can reduce the risk of developing neural tube defects such as spina bifida. Generally, spina bifida is undertaking by surgery and the regulation of patients comorbid. Public can find out prevention to avoid or reduce the risk of spina bifida so that the incidence of spina bifida can decrease along with the increasing awareness of the community regarding this disease.