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PubMed1997

A survey of knowledge and use of folic acid among women of child-bearing age in Dublin.

BACKGROUND: The Medical Research Council vitamin trial highlighted the importance of folic acid in the prevention of neural tube defects. Since 1993, the Irish Department of Health has recommended periconceptional folic acid supplements. The objective of this study was to document the knowledge and behaviour of women in child-bearing years to periconceptional folic acid. METHODS: A cross-sectional community-based survey was conducted in Dublin using an interviewer administered questionnaire. RESULTS: A total of 335 women took part in the study, a response rate of 84 per cent. Approximately two-thirds (213/ 335, 63.6 per cent) had heard of folic acid. Knowledge was significantly associated with higher social class and higher education (p < 0.05). Few (18/335, 5.4 per cent), had been advised to take folic acid before pregnancy. Only 9/335 (2.7 per cent) of the women in the study were currently taking folic acid supplements. Three-quarters (75.9 per cent) of the group would be willing to take periconceptional folic acid supplements if they believed it would reduce the risk of malformations. The majority (77.4 per cent) would prefer to take folic acid in tablet form rather than have it added to food. CONCLUSIONS: This study shows that few women in child-bearing years in Dublin have been advised on folic acid, and very few are taking supplements. However, if advised appropriately the majority would be willing to take periconceptional folic acid in tablet form.

Adolescent↗
PubMed1995

Periconceptional multivitamin use in relation to the risk of congenital urinary tract anomalies.

To study the relation of maternal periconceptional vitamin use to the risk of a congenital urinary tract anomaly (CUTA), we conducted a case-control study using the Washington State Birth Defect Registry. We identified CUTA cases with no known chromosomal abnormality in seven counties in western Washington State occurring between January 1, 1990, and December 31, 1991. We randomly selected a sample, as controls, of all infants delivered in five large hospitals in King County who did not have a birth defect and who were born in the same year as the cases. About 55% of all infants in King County and a smaller proportion of infants in the other six counties are delivered in these five hospitals. We interviewed mothers of 118 cases and 369 controls to obtain information about their vitamin use during the pregnancy and during the year before the conception. After adjustment for maternal race, family income, county of maternal residence, and birth year, we found that women who used multivitamins during the first trimester had only 15% the risk of bearing a child with a CUTA compared with women who did not take vitamins [odds ratio (OR) = 0.15; 95% confidence interval (CI) = 0.05-0.43]. The reduction was smaller for use restricted to the second or third trimesters (OR = 0.31; 95% CI = 0.09-1.02). Among women who used vitamins during the first trimester, vitamin use before conception was not associated with any further reduction in the risk, nor did there appear to be an association with the amount or brand of vitamin used.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Periconceptional vitamin use, dietary folate, and the occurrence of neural tube defects.

With a case-control study, we investigated whether periconceptional intake of supplemental or dietary folate reduced the risk of having a neural tube defect (NTD)-affected pregnancy. Mothers of 549 (88% of eligible) cases and 540 (88%) controls were interviewed in person about vitamin supplements used in either the 3 months before or the 3 months after conception and also about usual diet in the 3 months before conception. Women with any use of a folic acid-containing vitamin in the 3 months before conception had a lower risk of having an NTD-affected pregnancy [odds ratio (OR) = 0.65; 95% confidence interval (CI) = 0.45-0.94]. ORs were similar for 3 levels (< 0.4, 0.4-0.9, and > 0.9 mg per day) of average daily intake of folic acid. Any level of use in the first 3 months after conception resulted in a lowered risk as well (OR = 0.60; 95% CI = 0.46-0.79). Reduced risks were less marked for Hispanics and were not observed among women who graduated from college. Modest reduced risks were noted among non-vitamin users whose estimated daily dietary intake of folate was more than 0.227 mg. We observed decreasing risk with increasing folate intake from combined dietary sources and vitamin supplements. A reduction in NTD risk associated with folate intake is consistent with other studies; however, the reduced risk may be particular to subsets of the population, primarily non-Hispanic women and women whose education does not exceed high school.

Adult↗
PubMed2002

Maternal vitamin use and reduced risk of neuroblastoma.

BACKGROUND: Previous studies have suggested that maternal vitamin use during pregnancy may reduce the incidence of childhood brain tumors. Using data from a large North American study, we conducted an analysis to investigate maternal vitamin use and neuroblastoma in offspring. METHODS: Cases were children diagnosed with neuroblastoma over the period 1 May 1992 to 30 April 1994 at Children's Cancer Group and Pediatric Oncology Group institutions throughout the United States and Canada. One matched control was selected for each case using random-digit dialing. We obtained vitamin use information during specific periods before and during pregnancy from 538 case and 504 control mothers through telephone interviews. RESULTS: Daily vitamin and mineral use in the month before pregnancy and in each trimester was associated with a 30-40% reduction in risk of neuroblastoma. For example, daily use in the second trimester had an odds ratio of 0.6 (95% confidence interval = 0.4-0.9). We were unable to isolate the effects of specific vitamins or minerals. Neither age at diagnosis nor oncogene amplification status materially altered the results. CONCLUSIONS: The results of this study suggest that vitamin use during pregnancy might reduce incidence of neuroblastoma, consistent with findings for other childhood cancers.

Adolescent↗
PubMed2002

Maternal periconceptional vitamins: interactions with selected factors and congenital anomalies?

BACKGROUND: The mechanisms by which folic acid may contribute to reductions in risk of several congenital anomalies are unknown. The data gap includes a lack of information on possible effect modification between maternal folic acid use and other maternal exposures. We hypothesized that effects of congenital anomalies associated with maternal fever, cigarette smoking or alcohol use would be modified by intake of vitamins. METHODS: We explored case-control data that showed risk reductions among infants and fetuses whose mothers consumed vitamins. Data were from California deliveries of infants and fetuses in the period 1987-1989. Maternal telephone interviews were completed for 207 (87%) conotruncal cases, 489 (85%) orofacial cleft cases, 265 (84%) neural tube defect cases, 165 (82%) limb anomaly cases, and 734 controls (nonmalformed infants). RESULTS: Considering women who reported vitamin use and no periconceptional fever as referents, for each anomaly group we observed elevated effects for the combinations of maternal vitamin use/fever, no use/no fever and no use/fever. Effects were most elevated for the combination of no vitamin use and fever. Adjusted for maternal body mass index, education and race/ethnicity, odds ratios were 2.4 (95% confidence inter-val = 1.0-5.9) for conotruncal defects, 2.9 (1.4-5.8) for cleft lip with or without cleft palate, 1.3 (0.4-3.9) for cleft palate, 3.1 (1.4-6.8) for neural tube defects, and 2.6 (1.0-6.4) for limb-deficiency defects. These interactions were further investigated relative to maternal use of fever-reducing medications. Effects tended to be highest among those women who did not use vitamins, had fevers, and did not use fever-reducing medications. Compared with women who used vitamins and did not smoke periconceptionally, anomaly risks tended to be highest among women who did not use vitamins and smoked. No specific pattern emerged involving alcohol intake. CONCLUSIONS: These data further suggest that the underlying mechanisms of folic acid associated with congenital anomalies may be complex.

Abnormalities, Multiple↗
PubMedDate not supplied

Folic acid and neural tube defects in pregnancy: a review.

Neural tube defects (NTDs) are common fetal malformations. They are multifactorial in origin, with folic acid as the primary known environmental factor. It is recommended that all women consume 0.4 mg of synthetic folic acid daily if there is any possibility of becoming pregnant. Women who have had a previous pregnancy affected by NTD should increase their folic acid intake to 4.0 mg daily periconceptually. The purpose of this article is to review the relationship between folic acid and NTDs. It also discusses how the knowledge and use of folic acid has affected the incidence of NTDs, and ways in which the knowledge and use of folic acid before pregnancy can be increased.

Female↗
PubMed2001

Safety and antibody persistence following Haemophilus influenzae type b conjugate or pneumococcal polysaccharide vaccines given before pregnancy in women of childbearing age and their infants.

BACKGROUND: Immunization of healthy women before pregnancy is a potential approach to providing increased levels of maternal antibody to newborns to protect them from infections occurring during the perinatal period and first months of life. METHODS: Healthy nonpregnant Pima Indian women of childbearing age were randomized to receive one of two Haemophilus influenzae type b (Hib) conjugate vaccines [HbOC or Hib-meningococcal outer membrane protein complex (OMP)] or a 23-valent pneumococcal polysaccharide vaccine (PnPs). Infants received Hib-OMP vaccine at 2, 4 and 12 months of age. Vaccine safety and immunogenicity was evaluated in the women and their infants. RESULTS: Anti-polyribose ribitol phosphate antibody titers were significantly higher in women in both Hib conjugate vaccine groups than in the pneumococcal vaccine group throughout the 37-month observation period. Antibody responses to HbOC vaccine were significantly higher than those to Hib-OMP. A subsequent booster dose of each Hib conjugate vaccine induced reactions and antibody responses similar to those of the first dose. Infants born to mothers immunized with Hib vaccines compared with PnPs had significantly higher polyribose ribitol phosphate-specific IgG antibody titers at birth and 2 months of age but lower antibody responses to Hib-OMP at 6 months and similar titers before and after boosting with Hib-OMP at 1 year of age. By contrast women immunized with PnPs did not have significantly elevated concentrations of pneumococcal-specific antibody at delivery, and their infants had pneumococcal antibody titers similar to those of infants born to mothers who did not receive pneumococcal vaccine before pregnancy. CONCLUSION: Hib conjugate vaccine given to women before pregnancy significantly increased the proportion of infants who had protective Hib antibody levels at birth and 2 months of age.

Adolescent↗
PubMed1996

Folic acid in the prevention of birth defects.

Maternal use of folic acid prior to conception reduces the risk for neural tube defects. In addition, other birth defects may be prevented by the periconceptional use of folic acid. Homocysteine-methionine metabolism appears to be altered in women with pregnancies affected by neural tube defects; however, the specific mechanisms of causation are not yet known. Fortification of flour with folic acid has been approved by the Food and Drug Administration, although at a level that still requires folic acid supplementation as recommended by the Public Health Service for all women of childbearing age to prevent neural tube defects.

Congenital Abnormalities↗
PubMedDate not supplied

Inconsistencies in genetic counseling and screening for consanguineous couples and their offspring: the need for practice guidelines.

PURPOSE: To determine current practices of genetic counseling and screening for consanguineous couples, their pregnancies and children, and to compare these practices to recommendations in the literature. METHODS: A questionnaire was mailed to 1,582 board certified genetic counselors and medical geneticists in the United States. RESULTS: The return rate was 20% (n = 309). There was wide variation in the risk figures quoted to consanguineous couples to have offspring with birth defects and mental retardation (1% to 75% for incest between first-degree relatives, and 0.25% to 20% for first cousin unions). Suggested screening practices differed for consanguineous unions before conception, during pregnancy, following birth, and for children placed for adoption. Most respondents recommended screening based on ethnicity, yet disagreed as to which genetic disorders to include. CONCLUSIONS: To standardize genetic services, guidelines for screening the offspring of consanguineous unions are needed. A consensus should be reached as to the empirical risks for genetic disorders, birth defects, and mental retardation that may impair the offspring of consanguineous unions, with definition as to what these disorders are, and if the data applies to global populations. Guidelines should consider costs, the sensitivity and specificity of DNA and biochemical testing, and current practices of prenatal and newborn screening. Consideration should be given to screening based on ethnicity, particularly in populations where consanguineous unions are common, while remaining sensitive to cultural belief systems. Recommendations for screening healthy children from consanguineous unions to be placed for adoption pose ethical challenges.

Child↗
PubMedDate not supplied

College women's awareness and consumption of folic acid for the prevention of neural tube defects.

PURPOSE: Awareness and consumption of folic acid in the context of neural tube defect prevention among college women were assessed. METHODS: Subjects documented folic acid awareness and multivitamin consumption. Beliefs about folic acid before and after an educational intervention were characterized using the Health Belief Model (HBM) and the Fetal Health Locus of Control Scale (FHLCS). RESULTS: Awareness of folic acid was not associated with multivitamin consumption. Belief variables were not associated with awareness or consumption of folic acid. CONCLUSION: This study does not support educational interventions based on the HBM or FHLCS to increase multivitamin consumption among college women.

Adolescent↗
PubMed2006

Associations of physical activity and inactivity before and during pregnancy with glucose tolerance.

OBJECTIVE: To investigate associations of physical activity and television viewing before and during pregnancy with risk of gestational diabetes mellitus (GDM) and abnormal glucose tolerance, the combination of GDM with less severe impaired glucose tolerance. METHODS: We assessed duration and intensity of physical activity and time spent viewing television both before and during pregnancy among 1,805 women enrolled in Project Viva, a cohort study in eastern Massachusetts. We identified 1,493 (83%) women with normal glucose tolerance and 312 (17%) with abnormal glucose tolerance, including 91 (5%) with GDM based on clinical glucose tolerance test results. RESULTS: After adjustment for age, race or ethnicity, history of GDM, family history of diabetes, and prepregnancy body mass index, our data suggest that women who engaged in any vigorous physical activity in the year before pregnancy experienced a reduced risk of GDM (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.33-0.95) and abnormal glucose tolerance (OR 0.76, 95% CI 0.57-1.00). Women who reported vigorous activity before pregnancy and light-to-moderate or vigorous activity during pregnancy appeared to have a lower risk of both GDM (OR 0.49, 95% CI 0.24-1.01) and abnormal glucose tolerance (OR 0.70, 95% CI 0.49-1.01) compared with women reporting these activities in neither time period. Walking and total physical activity provided modest benefits. We observed no association of television viewing before or during pregnancy with risk of GDM or abnormal glucose tolerance. CONCLUSION: Physical activity, especially vigorous activity before pregnancy and at least light-to-moderate activity during pregnancy, may reduce risk for abnormal glucose tolerance and GDM. LEVEL OF EVIDENCE: II-2.

Activities of Daily Living↗
PubMedDate not supplied

Practice patterns of obstetrician-gynecologists regarding preconception and prenatal screening for cystic fibrosis.

OBJECTIVE: To assess practices of obstetrician-gynecologists regarding carrier screening for cystic fibrosis (CF). METHODS: A questionnaire investigating practice patterns and opinions pertaining to CF screening was mailed to 1165 members of the American College of Obstetricians and Gynecologists (ACOG), of whom 565 participate in the Collaborative Ambulatory Research Network (CARN) and 600 were randomly selected. RESULTS: Of the questionnaires, 64% were returned. Statistical analyses were limited to the 632 respondents whose primary medical specialty was gynecology (Gyn Only) or obstetrics and gynecology (ObGyn). CARN membership was not a significant factor on any nondemographic measure. Almost one-half of physicians do not ask nonpregnant patients their family history of CF or provide them with information about CF screening. The majority of ObGyns (88.7%) ask obstetric patients their family history of CF, and offer CF carrier screening. Almost two-thirds (65.8%) offer screening to all prenatal patients. Among those ObGyns who selectively offer CF screening to pregnant patients, only 27.4% utilized all of the selection criteria in the guidelines. Liability for not offering screening, familiarity with CF, and the ability to interpret a positive screening test were important physician concerns. CONCLUSION: The results indicate a need for minimizing the complexity of clinical guidelines for population-based genetic screening, prospective assessment of implementation and focused continuing education for providers.

Cystic Fibrosis↗