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PubMed2001

Knowledge and use of folic acid among women of reproductive age--Michigan, 1998.

Neural tube defects (NTDs), which include spina bifida and anencephaly, are serious malformations that occur in the developing fetus during the first 17-30 days after conception. Consumption of supplements containing folic acid can reduce NTDs 50%-70%. In the United States, approximately 4000 pregnancies are affected by NTDs each year, including approximately 140 infants in Michigan. In 1992, the U.S. Public Health Service recommended that all women of childbearing age consume at least 400 microg of folic acid daily. In 1998, the Institute of Medicine reaffirmed that recommendation and added that women capable of becoming pregnant take 400 microg of synthetic folic acid daily from fortified foods and/or supplements and consume a balanced, healthy diet of folate-rich foods. This report summarizes findings from the 1998 Behavioral Risk Factor Surveillance System (BRFSS) about multivitamin use and folic acid knowledge among women of reproductive age in Michigan. The findings suggest that public health campaigns that promote the consumption of folic acid should target women who are young, unmarried, obese, smoke, eat few fruits and vegetables, and have a low level of education.

Adult↗
PubMed2001

Discontinuing antidepressants and benzodiazepines upon becoming pregnant. Beware of the risks of abrupt discontinuation.

QUESTION: Two of my patients are planning to become pregnant. One is taking paroxetine and the other lorazepam. We have discussed what to do when they become pregnant and have decided they should stop taking these drugs as soon as pregnancy is confirmed. Is this the right decision? ANSWER: The decision to discontinue these drugs during pregnancy should be based on scientific evidence rather than "hearsay" that women should not take psychotropic medications during pregnancy. Recent epidemiologic studies have documented the relative safety of these drugs, so women should not feel compelled to stop taking them when they become pregnant. If, after receiving appropriate evidence-based information, a woman decides to stop taking the drugs, they should be gradually tapered off to avoid abrupt discontinuation syndrome.

Anti-Anxiety Agents↗
PubMed2001

Diabetes in pregnancy.

Diabetes mellitus is one of the most common medical complications of pregnancy. Two percent to 5% of pregnancies are complicated by diabetes, of which 90% are classified as gestational diabetes mellitus. Prevention of the fetal and maternal complications of diabetes presents unique challenges to all providers of healthcare to reproductive-aged diabetic women. The management of diabetes before, during, and after pregnancy can serve as a model of preventive healthcare. Preconception counseling and metabolic control before pregnancy reduce the rate of congenital malformations and the burden of suffering in offspring.

Diabetes, Gestational↗
PubMed2001

[Recommendations on the use of antiretroviral agents in pregnant women infected with HIV-1].

In February 1994, a clinical trial by the Pediatrics AIDS Clinical Trials Group (PACTG 076) demonstrated, for the first time, that it was possible to reduce the risk of vertical transmission of human immunodeficiency virus type 1 (HIV-1) by nearly 70% by means of a triple therapeutic regimen: 1) oral zidovudine (ZDV) beginning anytime between the 14th and 34th week of gestation until the end of pregnancy; 2) intravenous ZDV during pregnancy, and 3) administration of oral ZDV to neonates during the first 6 weeks of life. Later, epidemiologic studies performed in the United States of America and France showed that this regimen drastically reduced perinatal transmission in clinical practice. Since then, important strides have been made, not only in terms of treatment (new drugs and highly effective therapeutic regimens) and diagnosis (tests that can measure the viral load), but also in terms of an increased understanding of the pathogenesis of perinatal transmission of HIV-1. This report contains: a) a review of special considerations to be kept in mind when administering antiretroviral agents to pregnant women; b) a current overview of the results of clinical and epidemiologic trials dealing with the prevention of perinatal transmission of HIV-1; c) a look at the use of tests for measuring HIV-1 RNA (viral load) during pregnancy; d) the most recent recommendations on the use of antiretroviral chemoprophylaxis and elective cesarean section for reducing perinatal viral transmission. These recommendations apply to the United States, and other countries may prefer to use different approaches.

Anti-HIV Agents↗
PubMed2001

Impact evaluation of a folate education campaign with and without the use of a health claim.

OBJECTIVE: To measure the impact of a Kellogg/Northcott Society multimedia folate education campaign, run nationally from July 1998 to June 1999, with and without the use of health claims. METHOD: Three national telephone surveys of more than 500 Australian women aged 18-44 in July and November 1998 and May 1999. RESULTS: Awareness of the role of folate in the prevention of birth defects rose from 21% at baseline to 29% in November 1998 and 44% in May 1999. Awareness of the recommendation to take folate before pregnancy rose by 8% in the first six months of the campaign (without health claims) and by 22% in the second half (when health claims were incorporated). At the end of the campaign, the foods most commonly cited as sources of folate were leafy green vegetables (72%), breakfast cereals (70%), fruit (41%) and bread (40%). CONCLUSION: Inclusion of a specific health claim explaining the role of folate in preventing birth defects appeared to increase the impact of the folate education campaign. IMPLICATIONS: Changing food regulations to permit health claims may increase the impact of health promotion campaigns involving industry partnerships. Future folate programs should target young women (aged 18-24), those in rural areas and those on lower incomes.

Adolescent↗
PubMed2000

[Preventing neural tube defects with periconceptional folic acid supplementation: a population-based intervention program in the China].

OBJECTIVES: To evaluate the effectiveness of periconceptional use of 400 microgram folic acid only on the prevention of neural tube defects (NTDs). METHOD: As part of a public health campaign in areas of high (North) and low (South) NTDs prevalence in the China during 1993 and 1995, 130 142 pill takers and 117 689 non-pill takers were recruited. Women were asked to begin taking a pill containing only 400 microgram of folic acid daily from the time of their premarital examination until the end of the first trimester of pregnancy. The outcomes of these pregnancies were ascertained through 1996. RESULTS: We identified 102 NTDs among offspring of pill takers and 173 NTDs among offspring of non-pill takers. The NTDs rate in offspring of non-pill takers was 4.8 per thousand (16/3 318) and 1.0 per thousand (28/28 625) in the south; while the rate in pill takers was 1.0 per thousand (13/13 012) in the north and 0.6 per thousand in the south. The greatest reduction in risk occurred among the fetuses or infants of a subgroup of women in the northern region with periconceptional use who took pills more than 80 percent of the time (reduction in risk, 85 percent as compared with the fetuses or infants of women who registered before their last menstrual period and who took no folic acid; 95 percent confidence interval, 62 to 94 percent). In the southern region the reduction in risk among the fetuses or infants of women with periconceptional use of folic acid was also significant (reduction in risk, 41 percent; 95% confidence interval, 3 to 64 percent). CONCLUSION: Periconceptional intake of supplements containing only 400 microgram folic acid can reduce the risk for NTDs in areas of high and low NTDs prevalence.

Adult↗
PubMedDate not supplied

Trends in periconceptional folic acid use by relatives in Irish families with neural tube defects.

Close relatives in families who have a child with a neural tube defect (NTD) are at greatly increased risk of having an affected child. Periconceptional folic acid reduces the risk of both occurrence and recurrence of NTDs substantially. Public health authorities currently recommend that the diets of all women between the ages of 15 and 44 who are capable of becoming pregnant be supplemented with folic acid tablets daily. We wondered if relatives in NTD families were more likely to use folic acid. From data obtained by interview with uncles and aunts in Irish NTD families we evaluated folic acid use in 144 of their pregnancies occurring between 1990 and 2000. There was a significant trend towards increasing use of folic acid both before and during pregnancy over the 10 years covered by the study. During the most recent years, 1998-2000, 57.9% of pregnancies reported by aunts were supplemented beforehand and 89.5% during the pregnancy. Pregnancies to smokers were significantly less likely to be supplemented with folic acid. In this study close relatives of an NTD child were more likely to report periconceptional folic acid use than the general public. While these results are encouraging, more remains to be done to ensure in this high risk group to ensure that the full prevention potential of folic acid is realised.

Dietary Supplements↗
PubMedDate not supplied

Folic acid intake of young women.

OBJECTIVE: To investigate the folic acid intake of young women ages 18-24. DESIGN: Nonexperimental, descriptive survey. SETTING: Small private college in western North Carolina. PARTICIPANTS: A convenience sample of 42 female college students ages 18-24. MAIN OUTCOME MEASURES: Survey of demographics, folic acid intake, knowledge of folic acid, and pregnancy contemplation. RESULTS: All participants were found to have an inadequate diet and an inadequate intake of folic acid. Only 33.3% reported taking daily multivitamins. These findings may be attributed to the participants' lack of knowledge about folic acid and the birth defects it helps to prevent. CONCLUSION: Inadequate folic acid intake is common in young women ages 18-24. These young women frequently have poor nutritional habits and are usually noncontemplators of pregnancy.

Adolescent↗
PubMed2002

[Screening for carriers of the fragile X syndrome; ethical exploration].

Large-scale population screening for carriers of fragile X syndrome is premature. Notably the limited possibilities to detect carriers (of an instable premutation) in the general population with certainty, poses some ethical dilemmas. The possible psychological consequences of this are unknown. A pilot study can only be started if the added value of population screening as opposed to cascade screening is plausible, and the requirement of proportionality is satisfied. If this is the case, preconceptional screening is preferable to prenatal screening. Information should be provided in a process-like manner as this fits in best with the decision-making process that possibly follows participation in a population screening for carriers of fragile X syndrome. Further research into the ethics of cascade screening is desirable. This screening can be carried out on a complementary basis to population screening.

Ethics, Professional↗
PubMed2002

A nationwide program for the use of preconceptional folic acid to prevent the development of open neural tube defects. Who is really using folic acid?

A nationwide program directed at stimulating the preconceptional use of folic acid (FA) for the prevention of open neural tube defects has been in effect in Puerto Rico for the last 4 years. To evaluate its effectiveness, 479 questionnaires were distributed among pregnant patients. The average age was 27 (range 14-21), and 64.9% of the pregnancies were unplanned. Preconceptional use of FA was 31.5%, despite 87.7% of patients reporting knowledge about the importance of FA use. Only 35.4% of patients who had knowledge about FA used it prior to conception. Among patients who planned their pregnancies and knew about the importance of FA, 92/168 (54.6%) used it prior to pregnancy. With these dismal results, we believe these campaigns should re-evaluate their educational strategies and consider reduction of unplanned pregnancies as part of their goals.

Adolescent↗