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PubMed2000

Folic acid supplements are more effective than increased dietary folate intake in elevating serum folate levels.

In 1992, recommendations were disseminated aimed at reducing the incidence of neural tube defects. Women were advised to increase consumption of folic acid supplements and dietary folates during the periconceptional period and a major integrated national campaign was launched to help achieve this. In this study we found that only one-quarter of the women with an uncomplicated obstetric history and 51% with a complicated obstetric history took supplements for the recommended time period. Dietary modification was extremely unusual. Serum analysis demonstrated that intake of folic acid supplements provides a greater elevation in serum folate levels than dietary food intake, suggesting dietary manipulation is an ineffective strategy and that efforts would be better focused on increasing supplement intake at a clinically important time. More effective education strategies are required, and since approximately one-third of pregnancies are unplanned, fortification of foods with folic acid is warranted.

Adult↗
PubMed2001

Modelling the potential impact of population-wide periconceptional folate/multivitamin supplementation on multiple births.

OBJECTIVE: To develop a model of the impact of population-wide periconceptional folate supplementation on neural tube defects and twin births. DESIGN: A hypothetical cohort of 100,000 pregnancies > or =20 weeks, plus terminations of pregnancy after prenatal diagnosis before 20 weeks. METHODS: Application of pooled data on the relative risks for neural tube defects and twins following periconceptional folate from meta-analysis of the randomised trials. MAIN OUTCOME MEASURES: 1. Pregnancies with a neural tube defect (i.e. terminations of pregnancy, perinatal deaths, and surviving infants); 2. twin births (i.e. preterm births, perinatal deaths, postneonatal deaths, birth defects, cerebral palsy); 3. numbers needed to treat. RESULTS: The change in neural tube defects would be 75 fewer terminations (95% CI -47, -90), 30 fewer perinatal deaths (95% CI 18, -35), and 13 fewer surviving infants with a neural tube defect (95% CI -8, -16). The change in twinning would be an additional 572 twin confinements (95% CI -100, +1587), among whom there would be 63 very preterm twin confinements (95% CI -11, +174), 54 perinatal and postneonatal deaths (95% CI -9, +149), 48 surviving twins with a birth defect (95% CI -8, +133), and nine with cerebral palsy (95% CI -2, +26). The numbers needed to treat for the prevention of one pregnancy with a neural tube defect is 847, for the birth of one additional set of twins is 175, for the birth of one additional set of very preterm twins is 1587, and for the birth of an additional twin with any of the following outcomes (perinatal death, postneonatal death, survival with a birth defect, or survival with cerebral palsy) is 901. CONCLUSIONS: Monitoring rates of neural tube defects and twinning is essential as supplementation or fortification with folate is implemented.

Cohort Studies↗
PubMed2004

Evidence for suboptimal use of periconceptional folic acid supplements globally.

OBJECTIVE: To systematically summarise the available evidence concerning the rate of folic acid supplement use pre- and periconceptionally, to identify those characteristics associated with low rates of use and to assess whether folic acid public awareness campaigns are associated with higher folic acid use. DESIGN: Systematic overview. SETTING: Survey studies. POPULATION: Women of reproductive age, most of whom were currently or recently pregnant. METHODS: Two investigators searched MEDLINE, Embase and Nutriotiongate databases between 1990 and 2003. Bibliographies of retrieved references were scanned for other relevant publications, and authors were contacted if necessary. Studies were included that evaluated the rate of folic acid supplement use either before conception or in early pregnancy. MAIN OUTCOME MEASURES: Rate of preconceptional and/or periconceptional folic acid use, rate of planned pregnancy in each study, as well as significant characteristics differentiating non-users from users of folic acid, including the effect of folic acid awareness campaigns. RESULTS: A total of 52 studies were included. In 34 studies, reported preconceptional folic acid use varied from 0.9% to 50%. In 49 studies, the reported rate of periconceptional supplement use ranged from 0.5% to 52%. Significant predictors of reduced periconceptional folic acid use were a low level of formal education, immigrant status, young maternal age, lack of a partner and an unplanned pregnancy. Four studies examined the effect of mass media campaigns on periconceptional folic acid use; the reported rates increased significantly, by a factor of 1.7 to 7.2, but in no study was the post-campaign rate above 50%. CONCLUSIONS: In many countries, fewer than 50% of women take periconceptional folic acid supplements. Consideration should be given to the practical advantages of folic acid fortification of centrally processed foods, such as wheat, corn and rice flour, while further promoting vitamin tablet supplement use and planned pregnancy.

Dietary Supplements↗
PubMed2004

A prospective study of pregravid oral contraceptive use in relation to fetal growth.

OBJECTIVE: Because oral contraceptives are so widely used, any health consequences may have substantial public health implications. Whether pregravid oral contraceptives could affect subsequent pregnancies has not been adequately studied. The study objectives were to examine whether pregravid oral contraceptive use affects fetal growth and pregnancy hormone levels. DESIGN: A prospective study of pregnant women followed through pregnancy. SETTING: A major teaching hospital in Boston, USA. POPULATION: Two hundred and sixty Caucasian pregnant women, with a mean age of 31, and a parity of no more than two. Seventy-nine percent of the women were pregravid oral contraceptive users. METHODS: Exposure and covariate data were collected through structured questionnaires. Blood was drawn for hormonal analysis during the 16th and 27th gestational week. Information on pregravid oral contraceptive use included duration and recency of use, and oral contraceptive formulation. Multivariate regression models were used to examine the effect of pregravid oral contraceptive use on birth outcomes and the studied pregnancy hormones. MAIN OUTCOME MEASURES: Birthweight, placental weight, gestational age, pregnancy hormone levels of oestriol and progesterone at 16th and 27th gestational week. RESULTS: Adjusting for confounders, pregravid oral contraceptive use increased birthweight (mean difference =+207.3 g, 95% CI =+77.6 to +337.1) and placental weight (mean difference =+64.9 g, 95% CI =+13.0 to +116.9) compared with never use. Women with prior oral contraceptive use had higher levels of serum progesterone (P= 0.002) and oestriol (P= 0.12) at the 27th gestational week measurement. The effect on birthweight, placental weight and hormones was stronger among those using oral contraceptives in the previous year and those using a high progestin/high oestrogen potency preparation. CONCLUSIONS: Pregravid oral contraceptive use is positively associated with fetal growth, and this effect may be mediated through oestriol and progesterone.

Adolescent↗
PubMed2005

Recreational drugs and fetal gastroschisis: maternal hair analysis in the peri-conceptional period and during pregnancy.

OBJECTIVE: To objectively measure individual recreational drug groups in maternal hair samples timed for the period of conception and different stages of pregnancy in expectant mothers with a diagnosis of fetal gastroschisis. DESIGN: Prospective observational study. SETTING: Tertiary level Fetal Medicine Unit in a University teaching hospital. POPULATION: Pregnant women with a diagnosis of fetal gastroschisis (n= 22) and a control group of women (n= 25) with a normal fetus. METHODS: Hair samples were cut from the vertex of the head of expectant mothers with a diagnosis of fetal gastroschisis and a matched control group in whom the fetus was normal. The samples were analysed by enzyme-linked immunosorbent assay (ELISA) for individual drug groups. Confirmatory tests using gas chromatography with mass spectrometry (GCMS) were used. MAIN OUTCOME MEASURES: Presence of recreational drug compounds in hair samples. RESULTS: In the group with fetal gastroschisis there were four proven positive cases for recreational drug abuse (18%) and there were none in the control group. CONCLUSIONS: The incidence of recreational drug use in the peri-conceptional period and the first trimester by expectant mothers with a diagnosis of fetal gastroschisis is 18%. This association may be linked to the recent increase in the incidence of gastroschisis among younger mothers.

Adolescent↗
PubMed2006

Inadequate compliance with periconceptional folic acid supplementation in South Australia.

BACKGROUND: Despite recommendations for women to take folic acid supplements, there has been little reduction in the number of neural tube defect cases occurring each year. AIMS: To assess the level of compliance of pregnant women to recommendations for folic acid supplementation in South Australia, and audit the labelled content in reported supplements used. METHODS: A survey was conducted from May to September 2005 with 304 pregnant women recruited from antenatal clinics at the Lyell McEwin Health Service, the Women's and Children's Hospital and the Modbury Hospital in Adelaide. RESULTS: Full compliance with supplementation recommendations for both timing and dose was achieved by 30% of women. Partial compliance was achieved by 43%, while 27% took no folic acid supplements. CONCLUSIONS: There is currently poor compliance with folic acid supplementation around conception. Additional food fortification may better achieve an adequate daily level of folic acid.

Adult↗
PubMed2006

Periconceptional folic acid use among women giving birth at Queen Mary Maternity Hospital in Dunedin.

BACKGROUND: The New Zealand Ministry of Health advises that all women planning a pregnancy take a folic acid supplement to reduce the risk of having a neural tube defect (NTD)-affected pregnancy. There is little information available to determine if women are following this advice. OBJECTIVE: The purpose of this study was to determine periconceptional folic acid use among women in the postnatal ward of Queen Mary Maternity Hospital in Dunedin. METHODS: A questionnaire was administered to women in the postnatal ward between 14 November and 22 December 2004. RESULTS: One hundred and six women were interviewed during the study period. Forty women (39%) used folic acid supplements before conception. Sixty-seven women (64%) planned their pregnancy. The proportion of women (P<0.001) who planned their pregnancy (53%) and used folic acid before conception was higher than those who did not (11%). The proportion of women 30 years of age (55%) who took folic acid supplements before conception was higher than women aged 17 to <25 years (10%). CONCLUSION: Despite a lack of a public health campaign in New Zealand, a high proportion of participants, especially those who planned their pregnancy, took folic acid during the periconceptional period. A comprehensive public health campaign is needed to increase folic acid use. Fortification may be required to reach those women who do not plan their pregnancies.

Adolescent↗
PubMedDate not supplied

Adherence to ACOG guidelines on exercise during pregnancy: effect on pregnancy outcome.

OBJECTIVE: To determine the extent to which exercising women adhered to the ACOG guidelines on exercise during pregnancy and the effect of nonadherence on pregnancy outcome. DESIGN: Nonexperimental, retrospective survey. SETTING: Two national physical fitness conferences. PARTICIPANTS: One hundred seventy-three women who exercised during their pregnancies. OUTCOME MEASURES: Maternal weight gain, neonatal birth weight, occurrence of cesarean delivery, and gestational age of newborn. RESULTS: Eighty-three percent of the women knew of the ACOG guidelines. A total of 87 (53%) adhered to the guidelines. Women who exercised with heart rate intensities above 150 beats per minute, for durations longer than 40 minutes through the 3rd trimester, or both had no significant difference in maternal weight gain, fetal birth weight, or gestational age of the newborn (p > .05) than those who exercised more moderately. The long-duration and moderate-intensity groups had significantly fewer cesarean deliveries (p < .05). CONCLUSION: Women who exercised regularly before conceiving and who had uncomplicated pregnancies did not adversely affect their own or their offsprings' health by exercising in excess of the ACOG guidelines.

Adult↗
PubMed1993

Paternal preconceptional radiation exposure in the nuclear industry and leukaemia and non-Hodgkin's lymphoma in young people in Scotland.

OBJECTIVE: To determine if a relation exists between paternal exposure to relatively high levels of radiation in the Scottish nuclear industry and the risk of leukaemia and non-Hodgkin's lymphoma is subsequently conceived children. DESIGN: Matched case-control study with three controls for each case. SETTING: The whole of Scotland. SUBJECTS: The fathers of 1024 children with leukaemia and 237 children with non-Hodgkin's lymphoma diagnosed in Scotland below the age of 25 among those born in Scotland since nuclear operations began (in 1958) and the fathers of 3783 randomly chosen controls. The fathers of 80 children with leukaemia and 16 with non-Hodgkin's lymphoma in north Cumbria were also covered since some workers at one Scottish nuclear site live over the border in that area. Details of all fathers were then matched against records of the nuclear industry. MAIN OUTCOME MEASURES: Paternal preconceptional radiation exposures, particularly relatively high levels, both lifetime and in the six and three months before conception. RESULTS: No significant excess was observed in any subgroup and there was no significant trend: fathers of three controls but no cases were exposed to lifetime preconceptional levels of 100 mSv or greater (Fisher's exact p value 0.84). In the six months before conception, fathers of two cases and three controls received 10 mSv or more, odds ratio 2.3 (95% confidence interval 0.31 to 17.24). In the three months before conception the fathers of one case and two controls received 5 mSv or more, odds ratio 1.7 (0.10 to 30.76). The results for leukaemia and non-Hodgkin's lymphoma combined were similar. CONCLUSIONS: No significant excess of leukaemia or of leukaemia and non-Hodgkin's lymphoma was found at any radiation level in any preconceptional period.

Adolescent↗
PubMed1993

Prevention of congenital abnormalities by periconceptional multivitamin supplementation.

OBJECTIVE: To study the effect of periconceptional multivitamin supplementation on neural tube defects and other congenital abnormality entities. DESIGN: Randomised controlled trial of supplementation with multivitamins and trace elements. SETTING: Hungarian family planning programme. SUBJECTS: 4156 pregnancies with known outcome and 3713 infants evaluated in the eighth month of life. INTERVENTIONS: A single tablet of a multivitamin including 0.8 mg of folic acid or trace elements supplement daily for at least one month before conception and at least two months after conception. MAIN OUTCOME MEASURES: Number of major and mild congenital abnormalities. RESULTS: The rate of all major congenital abnormalities was significantly lower in the group given vitamins than in the group given trace elements and this difference cannot be explained totally by the significant reduction of neural tube defects. The rate of major congenital abnormalities other than neural tube defects and genetic syndromes was 9.0/1000 in pregnancies with known outcome in the vitamin group and 16.6/1000 in the trace element group; relative risk 1.85 (95% confidence interval 1.02 to 3.38); difference, 7.6/1000. The rate of all major congenital abnormalities other than neural tube defects and genetic syndromes diagnosed up to the eighth month of life was 14.7/1000 informative pregnancies in the vitamin group and 28.3/1000 in the trace element group; relative risk 1.95 (1.23 to 3.09); difference, 13.6/1000. The rate of some congenital abnormalities was lower in the vitamin group than in the trace element group but the differences for each group of abnormalities were not significant. CONCLUSIONS: Periconceptional multivitamin supplementation can reduce not only the rate of neural tube defects but also the rate of other major non-genetic syndromatic congenital abnormalities. Further studies are needed to differentiate the chance effect and vitamin dependent effect.

Congenital Abnormalities↗
PubMed1993

Paternal radiation exposure and leukaemia in offspring: the Ontario case-control study.

OBJECTIVES: To test the hypothesis that there is an association between childhood leukaemia and the occupational exposure of fathers to ionising radiation before a child's conception. DESIGN: Case-control study with eight matched controls per case. SETTING: Regions of Ontario, Canada, with an operating nuclear facility. SUBJECTS: Cases were children (age 0-14) who died from or were diagnosed as having leukaemia from 1950 to 1988 and were born to mothers living in the vicinity of an operating nuclear facility. Controls were identified from birth certificates, matched by date of birth and residence at birth. There were 112 cases and 890 controls. MAIN OUTCOME MEASURES: Paternal radiation exposure was determined by a record linkage to the Canadian National Dose Registry. RESULTS: Six fathers of cases and 53 fathers of controls had had a total whole body dose > 0.0 mSv before the child's conception, resulting in an odds ratio of 0.87 (95% confidence interval 0.32 to 2.34). There was no evidence of an increased leukaemia risk in relation to any exposure period (lifetime or six months or three months before conception) or exposure type (total whole body dose, external whole body dose, or tritium dose), except for radon exposure to uranium miners, which had a large odds ratio that was not significantly different from the null value. CONCLUSIONS: The findings of this study in Ontario did not support the hypothesis that childhood leukaemia is associated with the occupational exposure of fathers to ionising radiation before the child's conception.

Adolescent↗