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PubMed1999

Periconceptional use of folic acid amongst women of advanced maternal age.

Between February 1994 and February 1997 a group of 881 women completed a questionnaire on the use of folic acid. During the study period the percentage of women who had been informed about the benefits of folic acid rose from 41 per cent to 90 per cent and the percentage taking supplementation rose from 18 per cent to 60 per cent. Nevertheless, few women used folic acid at the right time and dose and although 90 per cent would have been willing to follow recommendations, correct use did not exceed 25 per cent. It is concluded that effective folic acid supplementation requires food fortification rather than information provided by healthcare workers.

Adult↗
PubMed1999

Knowledge and use of folic acid by women of childbearing age--United States, 1995 and 1998.

In the United States, approximately 4000 pregnancies are affected by neural tube defects each year; 50%-70% of these developmental defects could be prevented with daily intake of 400 microg of the B vitamin folic acid throughout the periconceptional period. In 1992, the Public Health Service recommended that all women capable of becoming pregnant consume 400 microg of folic acid daily throughout their childbearing years to reduce their risk for having a pregnancy affected by neural tube defects. In 1998, the Institute of Medicine recommended that all women of childbearing potential consume 400 microg of synthetic folic acid per day from fortified foods and/or a supplement in addition to food folate from a varied diet. This report summarizes the findings of a survey conducted during July-August 1998 to assess folic acid knowledge and practices among women of childbearing age in the United States and compares these results with those from a similar survey conducted in 1995. The findings indicate that 7% of women know folic acid should be taken before pregnancy to reduce the risk for neural tube defects.

Adolescent↗
PubMed1999

[Diabetes before pregnancy, apropos of 143 cases].

OBJECTIVE: The authors want to appraise the management of diabetes prior to pregnancy in a local population treated in the Lille University Hospital. METHOD: This is a retrospective study of 143 pregnancies occurring in 111 patients with diabetes prior to pregnancy, between 1987 and 1997, in the Obstetrics Department at the Lille University Hospital. RESULTS: Only one-third of the patients benefited from preconception management; the stability of diabetes during the first trimester was satisfactory in 50% of the cases. The maternal complications are represented by preeclampsia (20%), metabolic complications specific to diabetes (hypoglycemia, ketoacidosis), the aggravation or the emergence of a retinopathy (10%) and polyhydramnios (19%). Concerning the termination of the pregnancies, of the 147 fetuses (four twin pregnancies), 140 newborns in good health, two neonatal deaths, three in-utero deaths and two therapeutic terminations of pregnancy were observed. The fetal malformation rate was 9.5% (14 cases/147). The cesarean section rate was 63%, whereas the fetal macrosomatia rate was 35%, with dystocia in 26% of the deliveries (outside of planned cesareans). Three shoulder dystocia were observed (two requiring the Jacquemier's maneuver and one with transitory plexus brachial palsy for a newborn weighing 5,650 g). CONCLUSION: The authors conclude that preconception management (one-third of the patients in this series) and management of during the first trimester of pregnancy (50% in this series) was insufficient. This fact is perhaps due to the confusion, for many practitioners, with gestational diabetes, which is a very mediatized affection, though much less severe for the fetus and mother.

Adolescent↗
PubMed2000

Neural-tube defects.

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Abortion, Spontaneous↗
PubMed2000

[Prevalence of neural tube defects in births before and after promotion of periconceptional folic acid supplementation].

OBJECTIVE: To describe the incidence and the expected clinical picture of neural tube defects (NTD) in years when periconceptional folic acid use increased. DESIGN: Descriptive. METHOD: Data on the prevalence of NTD in the Netherlands in 1994-1998 and on the prognosis at the time of the report obtained from the Nederlands Signalerings Centrum Kindergeneeskunde (Netherlands Paediatric Spotting Centre), where all practising physicians in the Netherlands monthly report children in whom a rare disease has been diagnosed. Prevalence figures from before and after 1996 were compared, because periconceptional use of folic acid increased since late 1996. RESULTS: In 1994-1998, 414 children with NTD were reported, 164 boys, 191 girls and 59 unreported. The prevalence of NTD was 4.6 per 10,000 live births (95% confidence interval (CI): 3.7-5.6) compared with 3.8 per 10,000 live births (95% CI: 2.9-4.6) in the period 1997-1998. Of the 414 children, 257 had a meningomyelocele; the early mortality in this group amounted to 37%. Hydrocephalus was found in 84.8% of the infants, 40.9% of the infants were believed never be able to sit, stand, and walk. CONCLUSION: The prevalence of NTD was lower in the period 1997-1998 than in the period 1994-1996 although the difference was not statistically significant.

Female↗
PubMed2000

[Evaluation of the benefits brought by pregnancy planning in type 1 diabetes mellitus].

Fetal mortality and morbidity remain dramatically increased in diabetic women. To evaluate the benefit of a preconceptional education combined with a good metabolic control, we compared the outcome of pregnancy in 2 groups of type I diabetic women: group A (n = 21) planned before conception versus group B (n = 40) not planned. Both groups were similar related to the type and duration of diabetes, its complications, age, body mass index and different factors of risk. In group A, HbA1C levels were < or = 3 SD of the normal mean of non diabetic values before conception and during the pregnancy course and > or = 3 SD in group B. We observed a significant reduction (p < 0.05) of the main adverse events regarding fetus outcome (fetal, perinatal and neonatal mortality, malformations) and obstetrical complications in the planned group. These data lead to the need of an extensive policy of early planification of pregnancy in diabetic women.

Congenital Abnormalities↗