Owing to its association with known risk factors for neural tube defects (NTDs) and its impact on physiologic processes relevant to fetal development, physical activity was identified as a potential risk factor for NTD-affected pregnancy.
Using data from a population-based case-control study of deliveries occurring in California from 1989 to 1991, we estimated the potential risk of having an NTD-affected pregnancy associated with variation in maternal physical activity. In-person interviews were conducted with 538 (88% of eligible) mothers of NTD cases and with mothers of 539 (88%) nonmalformed controls on average 5 months from the term delivery date. An index reflecting reported frequency and exertion level for six activity groups (e.g., jogging and running) was used to summarize each woman's physical activity level in the periconceptional period.
Unadjusted analyses indicated that compared to women considered inactive by this index, physically active women had 30-50% lower risk for NTD-affected pregnancies. After adjustment for several potential confounders and an evaluation of potential effect modification, results suggested that the association was restricted to women who did not take multivitamin/mineral supplements during the periconceptional period. Excluding mothers with reported medical problems did not substantially alter findings.
This study suggests that the benefits of physical activity may extend to reduction of NTD risk among certain subgroups of women.
"In addition, recent studies have suggested potential associations between NTDs and maternal myo-inositol, zinc, and glucose levels [Groenen et al., 2003a,b], maternal intake of sucrose and foods with high glycemic index values [Shaw et al., 2003], maternal dieting behavior [Carmichael et al., 2003b] and physical activity [Carmichael et al., 2002], and maternal diarrhea [Felkner et al., 2003]. "
[Show abstract][Hide abstract] ABSTRACT: The epidemiological investigation of the common open neural tube defects (NTDs), anencephaly, and spina bifida, has a long history. The most significant finding from these past studies of NTDs was the identification of the protective effect of maternal, periconceptional supplementation with folic acid. Fortuitously, the association between folic acid and NTDs became widely accepted in the early 1990s, at a time when genetic association studies of complex traits were becoming increasingly feasible. The confluence of these events has had a major impact on the direction of epidemiological, NTD research. Association studies to evaluate genes that may influence the risk of NTDs through their role in folate-related processes, or through other metabolic or developmental pathways are now commonplace. Moreover, the study of genetic as well as non-genetic, factors that may influence NTD risk through effects on the nutrient status of the mother or embryo has emerged as a major research focus. Research efforts over the past decade indicate that gene-gene, gene-environment, and higher-order interactions, as well as maternal genetic effects influence NTD risk, highlighting the complexity of the factors that underlie these conditions. The challenge for the future is to design studies that address these complexities, and are adequately powered to detect the factors or combination of factors that influence the development of NTDs.
American Journal of Medical Genetics Part C Seminars in Medical Genetics 05/2005; 135C(1):88-94. DOI:10.1002/ajmg.c.30057 · 3.91 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Obesity is presently the most prevalent health threat in the western world, and its influence on general health is rapidly increasing. Obesity has also developed as a major and frequent risk factor for pregnancy complications. Complications often encountered in obese pregnant women are hypertensive disorders, gestational diabetes mellitus, caesarean section, and postpartum and postoperative infections. The incidence of pulmonary embolism and primary postpartum haemorrhage is most likely also increased. Anaesthetic complications are more frequent. Neonatal consequences of obesity include an increased rate of congenital anomalies, stillbirth, and macrosomia. This article focuses on practical implications of obesity in pregnancy and childbirth for the caregiver.
European Clinics in Obstetrics and Gynaecology 07/2005; 1(2):74-88. DOI:10.1007/s11296-005-0019-0
[Show abstract][Hide abstract] ABSTRACT: Bipolar disorders are prevalent in women. Women with bipolar disorder often present with different clinical features than men. Reproductive events and hormonal treatments may impact the course of bipolar disorder. Our main objectives are to i) assess the impact of reproductive events on the course of the disorder, and ii) to discuss the relationships between reproductive events and psychiatric treatments.
A literature search was conducted of MEDLINE journals from 1965 to present. Manual literature searches were also conducted. We review the presentation, clinical course, and treatment considerations of bipolar disorder in women, with emphasis on treatment considerations in the context of reproductive events. Treatment-related issues such as teratogenicity, breastfeeding, polycystic ovarian syndrome, weight gain and obesity, and medication interactions with oral contraceptives are reviewed.
Women with bipolar disorder may be more vulnerable to mood episodes in the context of reproductive events, particularly postpartum. In women of reproductive age, mood stabilizers must be selected with teratogenic risks in mind, with the highest reported risks in pregnancy with valproate, and the greatest concern during breastfeeding with lithium use. In the areas of the perimenopause and polycycstic ovarian syndrome, more data are needed to advise treatment decisions.
We urgently need further study in these areas to deliver care that is appropriate to women with bipolar disorder.
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