Article

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 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.
We conducted a systematic review and meta-analysis to evaluate the protective effect of folic acid-fortified multivitamin supplements on other congenital anomalies.
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 the source and identity of the articles extracted data based on predetermined inclusion and exclusion criteria. Using a random effects model, rates of congenital anomalies in babies born to women who were taking multivitamin supplements were compared with rates in the offspring of controls who were not.
From the initial search, 92 studies were identified; 41 of these met the inclusion criteria. Use of multivitamin supplements provided consistent protection against neural tube defects (random effects odds ratio[OR] 0.67, 95% confidence intervals [95% CI] 0.58-0.77 in case control studies; OR 0.52, 95% CI 0.39-0.69 in cohort and randomized controlled studies), cardiovascular defects (OR 0.78, 95% CI 0.67-0.92 in case control studies; OR 0.61, 95% CI 0.40-0.92 in cohort and randomized controlled studies), and 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). For cleft palate, case control studies showed OR 0.76 (95% CI 0.62-0.93), and cohort and randomized controlled studies showed OR 0.42 (95% CI 0.06-2.84); for oral cleft with or without cleft palate, case control studies showed OR 0.63 (95% CI 0.54-0.73), and cohort and randomized controlled studies showed OR 0.58 (95% CI 0.28-1.19); for urinary tract anomalies, case control studies showed OR 0.48 (95% CI 0.30-0.76), and cohort and randomized controlled studies showed OR 0.68 (95% CI 0.35-1.31); and for congenital hydrocephalus case control studies showed OR 0.37 (95% CI 0.24-0.56), and cohort and randomized controlled studies showed OR 1.54 (95% CI 0.53-4.50). No effects were shown in preventing Down syndrome, pyloric stenosis, undescended testis, or hypospadias. Conclusion: Maternal consumption of folic acid-containing prenatal multivitamins is associated with decreased risk for several congenital anomalies, not only neural tube defects. These data have major public health implications, because until now fortification of only folic acid has been encouraged. This approach should be reconsidered.

2 Bookmarks
 · 
178 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Back ground: Folic acid deficiency has been studied as one of the factors responsible for congenital birth defects. Aim of study : To determine the relation between poor folic acid supplement & incidence of birth defects. Patients & methods: the study was conducted in Babylon Teaching Hospital for Gynaecology & Paediatrics from January 2008 to June 2008. Sixty pregnant women were enrolled, exclusion criteria included those with risk factors for congenital anomalies such as those with diabetes mellitus or those taking anti-epileptic medications. After labour & delivery newborn babies were examined for any birth defects & registration of them if any exist. Results: twenty percent of women under study were compliant with folic acid intake where as (38.33%) had poor compliance & (41.67%) did not take folic acid at all. The relative risk of birth defects in women with no folic acid supplement was approximately 2. the most common birth defect was anencephaly (42.8%) followed by hydrocephaly & meningocele (28.6%). Conclusions& recommendations: folic acid deficiency is associated with increased risk of birth defects especially neural tube defects. We recommend that women of child bearing age should take folic acid supplement to decrease the risk of congenital birth defect, this will need more awareness of these women by using mass media & other educational resources to encourage folic acid intake. Introducution:
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to examine the presence and extent of publication bias and small-study effects in meta-analyses (MAs) investigating pediatric dentistry-related subjects. Following a literature search, 46 MAs including 882 studies were analyzed qualitatively. Of these, 39 provided enough data to be re-analyzed. Publication bias was assessed with the following methods: contour-enhanced funnel plots, Begg and Mazumdar's rank correlation and Egger's linear regression tests, Rosenthal's failsafe N, and Duval and Tweedie's "trim and fill" procedure. Only a few MAs adequately assessed the existence and effect of publication bias. Inspection of the funnel plots indicated asymmetry, which was confirmed by Begg-Mazumdar's test in 18% and by Egger's test in 33% of the MAs. According to Rosenthal's criterion, 80% of the MAs were robust, while adjusted effects with unpublished studies differed from little to great from the unadjusted ones. Pooling of the Egger's intercepts indicated that evidence of asymmetry was found in the pediatric dental literature, which was accentuated in dental journals and in diagnostic MAs. Since indications of small-study effects and publication bias in pediatric dentistry were found, the influence of small or missing trials on estimated treatment effects should be routinely assessed in future MAs. Copyright © 2015 Elsevier Inc. All rights reserved.
    Journal of Evidence Based Dental Practice 03/2015; 15(1):8-24. DOI:10.1016/j.jebdp.2014.09.001
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: In developed countries, the incidence of neonatal hydrocephalus ranges from 3 to 5 cases per 1000 live births, but little is known about the frequency of hydrocephalus in Africa. In Mozambique, there is no primary information related to this disorder, but using the above data, the expected incidence of neonatal hydrocephalus would range from 2900 to 4800 cases per year. Methods: This study is based on 122 children younger than 1 year with neonatal hydrocephalus, followed up between January 2010 and December 2012, their origin and treatment, and aims to evaluate difficulties with diagnosis, treatment, and follow‑up in northern Mozambique. Results: Identified cases were mainly less than 6 months old (77%), with severe macrocephaly and the classic stigmata of this condition. A high rate of follow‑up loss (44.3%) was detected, particularly among children from more distant locations. Our findings contrast with the expected 1000-1700 cases that would occur in the area during the study period, being considerably lower. Conclusions: Hydrocephalus is a serious problem in sub‑Saharan Africa, whose effects can be minimized by a better organization of the health system in hydrocephalus prevention, referral, and follow‑up. New management alternatives to provide treatment to more children with this disorder and reduction of the follow‑up difficulties caused due to geographical reasons for the children undergoing treatment are essential.
    Surgical Neurology International 12/2014; 5(1). DOI:10.4103/2152-7806.146489 · 1.18 Impact Factor