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.
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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- "However, adequate nutrient intake may partially mitigate the harmful effects of alcohol on fetal development. Vitamin B 3 , folic acid, zinc, iron, and choline have all been shown to prevent and/or mitigate some of the effects of prenatal alcohol exposure    . "
ABSTRACT: Objective: Compare nutritional status of 57 South African mothers of children with fetal alcohol spectrum disorders (FASD) with 148 mothers of controls. Methods: Dietary data were analyzed for macronutrients, micronutrients, and fats via Estimated Average Requirements (EAR) and Adequate Intakes (AI) for pregnant women. Results: Virtually all mothers were likely deficient on most micronutrients by either EAR (<50%) or AI values. Mothers of FASD children consumed more of 13 of 25 micronutrients. For percentage below EAR, only vitamin D was significantly higher for FASD mothers. Despite no difference in total food intake, control mothers had a higher mean body mass index (BMI) than FASD mothers. Maternal BMI is more significant for positive child outcomes than any individual nutrient. Conclusions: Most mothers have inadequate dietary intake. Minor advantages in nutrient intake are overpowered by teratogenic effects of alcohol. Further study is needed of the interaction of alcohol, maternal nutrition, and metabolism.
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- "However, the Hungarian RCT  and some observational studies [34-37] suggest that FA may reduce the risk of CMs overall, or the risk of a specific and selected group of them , namely oral clefts [39-42], cardiac defects [43-46], urinary tract anomalies except hypospadias , limb reduction defects , omphalocele , anal atresia . "
ABSTRACT: BackgroundIn 2010 a Cochrane review confirmed that folic acid (FA) supplementation prevents the first- and second-time occurrence of neural tube defects (NTDs). At present some evidence from observational studies supports the hypothesis that FA supplementation can reduce the risk of all congenital malformations (CMs) or the risk of a specific and selected group of them, namely cardiac defects and oral clefts. Furthermore, the effects on the prevention of prematurity, foetal growth retardation and pre-eclampsia are unclear.Although the most common recommendation is to take 0.4 mg/day, the problem of the most appropriate dose of FA is still open.The aim of this project is to assess the effect a higher dose of peri-conceptional FA supplementation on reducing the occurrence of all CMs. Other aims include the promotion of pre-conceptional counselling, comparing rates of selected CMs, miscarriage, pre-eclampsia, preterm birth, small for gestational age, abruptio placentae.Methods/DesignThis project is a joint effort by research groups in Italy and the Netherlands. Women of childbearing age, who intend to become pregnant within 12 months are eligible for the studies. Women are randomly assigned to receive 4 mg of FA (treatment in study) or 0.4 mg of FA (referent treatment) daily. Information on pregnancy outcomes are derived from women-and-physician information.We foresee to analyze the data considering all the adverse outcomes of pregnancy taken together in a global end point (e.g.: CMs, miscarriage, pre-eclampsia, preterm birth, small for gestational age). A total of about 1,000 pregnancies need to be evaluated to detect an absolute reduction of the frequency of 8%. Since the sample size needed for studying outcomes separately is large, this project also promotes an international prospective meta-analysis.DiscussionThe rationale of these randomized clinical trials (RCTs) is the hypothesis that a higher intake of FA is related to a higher risk reduction of NTDs, other CMs and other adverse pregnancy outcomes. Our hope is that these trials will act as catalysers, and lead to other large RCTs studying the effects of this supplementation on CMs and other infant and maternal outcomes.Trial registrationItalian trial: ClinicalTrials.gov Identifier: NCT01244347.Dutch trial: Dutch Trial Register ID: NTR3161.
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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) "
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.
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