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OBSTETRICS OBSTETRICS Prenatal Multivitamin Supplementation and Rates of Congenital Anomalies: A Meta-Analysis

Department of Pharmaceutical Sciences, University of Toronto, and The Motherisk Program, Division of Clinical Pharmacology/Toxicology, The Hospital for Sick Children, Toronto, ON, Canada.
Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 09/2006; 28(8):680-9.
Source: PubMed

ABSTRACT Background: The use of folic acid-fortified multivitamin supplements has long been associated with decreasing the risk of neural tube defects. Several studies have also proposed the effectiveness of these supplements in preventing other birth defects; however, such effects have never been systematically examined. Objective: We conducted a systematic review and meta-analysis to evaluate the protective effect of folic acid-fortified multivitamin supplements on other congenital anomalies. Methods: We searched Medline, PubMed, EMBASE, Toxline, Healthstar, and Cochrane databases for studies describing the outcome of pregnancies in women using multivitamin supplements that were published in all languages from January 1966 to July 2005. The references from all collected articles were reviewed for additional articles. Two independent reviewers who were blinded to

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    • "In the present study 19.8% of mothers with affected offspring did not take folic acid during the first pregnancy, with OR (0.017) showing significant association between absence of folic acid intake during the first trimester and LRDs. Goh et al. (2006) revealed that the use of multivitamin supplements provided consistent protection against limb defects (OR 0.48, 95% CI 0.30–0.76, in case–control studies; OR 0.57, 95% CI 0.38–0.85, in cohort and randomized controlled studies). The Atlanta population-based case–control study also found a significant risk reduction for all birth defects (OR 0.80, 95% CI 0.69–0.93) "
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    ABSTRACT: Background Limb reduction defects (LRDs) refer to absence of either parts of a limb or entire limbs. They represent one of the most common visible phenotypic effects of several etiologies. The major causes of LRDs are abnormal genetic problems and intrauterine disruption. Many environmental risk factors have been implicated, such as teratogens. Objective The aim of the study was to identify environmental risk factors that may predispose to isolated LRDs. Patients and methods Forty-one Egyptian patients with isolated LRDs were studied. In addition to medical examination a detailed history was taken for each case, including parental exposure to different teratogens as a result of residence, occupation, special habits, or pregnancy history of the mother, including nutrition and maternal stress during pregnancy. Results Most studied cases were sporadic, without a positive family history for LRD. The results showed significant risk impact on LRD with maternal exposure to environmental hazards (pesticides, insecticides, radiation) (P=0.00) and maternal history of drug intake in the form of hormones and NSAIDs (P=0.001); the risk increased among mothers who did not take folic acid supplement during the first trimester (P=0.017). Finally, early maternal trauma played a role as a risk factor for LRD, with a P value of 0.005. Conclusion Delineation of the environmental risk factors could be the first approach to preventing isolated LRDs.
    01/2014; 3(2):53-64. DOI:10.1097/01.MXE.0000449828.39449.fa
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    • "Risk factors previously identified in the literature include young maternal age [Siega-Riz et al., 2009], low pre-pregnancy body mass index [Waller et al., 2007; Siega-Riz et al., 2009], low socioeconomic status [Torfs et al., 1994], change in paternity [Chambers et al., 2007], genitourinary infection [Feldkamp et al., 2008a], maternal smoking [Lam and Torfs, 2006; Feldkamp et al., 2008b], exposure to certain medications and/or recreational drugs [Werler et al., 2003], and genetic polymorphisms [Torfs et al., 2006]. Nutrition is an important modifiable environmental factor and has been implicated in the etiology of several birth defects [Goh et al., 2006; Shapira, 2008], most notably, the link between folic acid insufficiency and neural tube defects where improvements in maternal and/or fetal folic acid status due to supplementation "
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    ABSTRACT: Gastroschisis is a congenital abdominal wall defect, thought by many to represent a disruption in intrauterine blood flow, where there is herniation of abdominal organs. Dietary intake is an important environmental factor that has been implicated in the development of many diseases. Omega-6 polyunsaturated fatty acids (PUFAs) are nutrients that are substrates for eicosanoid and cytokine synthesis and prone to oxidation, and play a role in modulating inflammation, immune function, and vascular system development. This pilot case-control study explored the association of dietary intake of the omega-6 PUFA linoleic acid with risk of gastroschisis. Between 2008 and 2011, we recruited 13 pregnant women in mid-gestation who were referred to the UCSD Prenatal Center for evaluation of an abnormal alpha-fetoprotein (AFP) test and subsequently identified as carrying a baby with gastroschisis. Nine controls were selected from a false positive AFP or from the UCSD prenatal clinic. Maternal dietary intake was collected via repeated food record during the last 20 weeks of gestation. Logistic regression was used to test the association between dietary intake of linoleic acid and odds of gastroschisis. Dietary intake of linoleic acid was associated with increased odds of gastroschisis (OR = 1.72; 95% CI: 1.08, 2.74; P = 0.02). A higher maternal intake of omega-6 PUFAs may increase the risk of having a baby with gastroschisis. The mechanism by which this occurs may be via inflammatory processes and oxidative stress leading to a vascular disruption. More research is needed including studies investigating integrated markers of PUFA status or inflammatory markers.
    American Journal of Medical Genetics Part A 04/2012; 158A(4):803-7. DOI:10.1002/ajmg.a.35204 · 2.05 Impact Factor
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    • "A recent meta-analysis observed that use of multivitamin supplements provided consistent protection against neural tube defects with an odds ratio (OR) of 0.67 (95% CI 0.58 to 0.77) in case-control studies and an OR 0.52 (95% CI 0.39 to 0.69) in cohort and randomized controlled studies. An OR of 0.67 means 0.33 (or 33%) protective effect; an OR of 0.52 means 0.48 (or 48%) protective effect (Goh et al., 2006). A study investigating the relationship between serum and red blood folate concentrations and the risk of NTDs found an inverse relationship between maternal red blood cell folate and the risk of NTD (Daly LE et al., 1995). "
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    ABSTRACT: 1 report that 35·9% of the pregnancies were unplanned. This is an important statistic, the implications of which they do not explore. The figure concurs with findings from a 1997 Health Education Authority (HEA) survey of 299 pregnant women, 30% of whom had not planned their pregnancy. 2 One of the greatest challenges the HEA faces in the final year of its education campaign is to make all women of childbearing age aware of the importance of folic-acid supplementation by positioning it as a general women's health issue. In a recent HEA study, 95% of general practitioners knew that folic acid should be taken before conception, but only 42% gave this advice to women of childbearing age. 3 For more women to take supplements at the correct time, information about folic acid needs to reach them before they are planning to be pregnant. This is why the HEA is now calling on general practitioners, nurses, family-planning specialists, and other health professionals to broaden their approach to women by giving advice on folic acid as part of other related consultations, such as discussions about contraception or dietary advice. Women should be advised of the benefits of eating more foods rich in folic acid, particularly fortified foods such as breads and breakfast cereals. If this can be achieved, concentrations of this important B vitamin will be boosted before pregnancy. This would not only be of benefit to women whose pregnancies are unplanned, but also to those who have not taken supplements before conception. The HEA recently introduced a new folic-acid flash labelling scheme so that women can identify foods fortified with folic acid. The ideal is for all pregnancies to be planned, and for all women to take a daily 400 µg folic-acid supplement as
    Neural Tube Defects - Role of Folate, Prevention Strategies and Genetics, 03/2012; , ISBN: 978-953-51-0317-2
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