Folic Use Research Articles

PROSPECTS OF MELDONIUM AND FOLIC ACID USING TO IMPROVE THE CONDITION OF PATIENTS WITH ISCHEMIC HEART DISEASE AND CONCOMITANT HYPERTENSION

Coronary heart disease (CHD) is a leading cause of high mortality, disability and reduced quality of life for patients. At the heart of coronary heart disease - ischemia and activation of oxidative stress. With concomitant hypertension, the condition of patients and the prognosis for the course of their disease deteriorates significantly. The prognosis of coronary heart disease, the occurrence of new hospitalizations or deaths from cardiovascular disease can be further assessed by monitoring ST2 and malonic dialdehyde (MDA). Traditional treatment of coronary heart disease does not always guarantee the achievement of the desired clinical results. That is why it is advisable to use in the complex treatment of patients with coronary heart disease and concomitant hypertension cytoprotectors and drugs that have antioxidant properties, such as meldonium and folic acid.
 The aim of the research. Detect anti-ischemic activity in meldonium and folic acid and evaluate the effect of these drugs on the level of ST2, MDA in the blood in patients with coronary heart disease and concomitant hypertension.
 Materials and methods. The research included 80 patients (women - 4, men - 76, aged 57,7 ± 9,8 years) with diagnoses of coronary heart disease: stable angina, functional class II-III (FC), chronic heart failure (CHF) I-IIa, FC II-III ", with concomitant arterial hypertension II-III stages, 2-3 degrees, risk 4 (very high), CHF I-IIa, FC II-III". Patients were divided into 4 groups of 20 patients, respectively: 1) patients who, in addition to basic therapy, were prescribed folic acid at a dose of 0.8 mg / d for six months; 2) patients who, in addition to basic treatment, were prescribed meldonium at a dose of 750.0 mg / d for six months; 3) patients who, in addition to basic treatment, were prescribed folic acid at a dose of 0.8 mg / d and meldonium at a dose of 750.0 mg / d for six months; 4) patients who were prescribed only basic antianginal, disaggregating, hypolipidemic treatment.The number of anginal attacks and doses of nitroglycerin during the day were determined, the results of the test with a 6-minute walk and the plasma concentration of ST2 and MDA before and after 6 months of treatment with meldonium and folic acid were evaluated.
 Results. Found anti-ischemic activity in meldonium and its combination with folic acid. The combination of these drugs as an adjunct to basic therapy significantly reduced the concentration of ST2. Both drugs alone or in combination reduced the concentration of MDA in the blood of patients.
 Conclusions. Our research showed the presence of anti-ischemic activity in meldonium, both when added to the basic therapy of patients with coronary heart disease and concomitant hypertension, and when used together with folic acid. In the groups of patients where these drugs and their combinations were used, the frequency of anginal attacks and the number of doses of nitroglycerin used during the day were significantly reduced.
 The combined use of folic acid and meldonium when added to the basic therapy after 6 months significantly reduced the concentration of ST2 in the blood. Folic acid and meldonium showed pronounced antioxidant properties. At separate adding of these medications to basic therapy or their combined adding significantly decreased the concentration of MDA - a marker of oxidative stress.
 Therefore, we consider it appropriate to use folic acid and meldonium in the complex treatment of patients with coronary heart disease with stable angina and concomitant hypertension.

Multiple ovulations between ovarian stimulation treatment and primary ovarian insufficiency

The release of several oocytes during the same menstrual cycle can occur both physiologically and iatrogenic, following ovarian stimulation treatments. Ovarian induction can be achieved either by mild stimulation, in the case of anovulatory or dysovulatory patients, or by controlled ovarian hyperstimulation, to obtain a large number of follicles in the In Vitro Fertilization procedure. At this time, the ideal ovarian stimulation treatment is to suppress the pituitary release of gonadotrophin-releasing hormone (GnRH), a co-opted regimen with high doses of exogenous follicle-stimulating hormone (FSH). The physiological process of multiple ovulations can lead to superfertilization (SF). SF is a biological process by which two eggs are fertilized successively, at intervals of a few days apart, both eggs coming from the same ovulation. Among the factors that can lead to superfertilization are mentioned: family history of dizygotic pregnancies (DZ), increased parity, advanced age, high stature of women, a high weight index, the use of oral contraceptives and folic acid. The premenopausal period is characterized by elevated levels of FSH and a low ovarian reserve, both conditions contributing to the development of multiple follicular and DZ pregnancies.

Excess Folic Acid Supplementation before and during Pregnancy and Lactation Alters Behaviors and Brain Gene Expression in Female Mouse Offspring.

Use of folic acid (FA) during early pregnancy protects against birth defects. However, excess FA has shown gender-specific neurodevelopmental toxicity. Previously, we fed the mice with 2.5 times the recommended amount of FA one week prior to mating and during the pregnancy and lactation periods, and detected the activated expression of Fos and related genes in the brains of weaning male offspring, as well as behavioral abnormalities in the adults. Here, we studied whether female offspring were affected by the same dosage of FA. An open field test, three-chamber social approach and social novelty test, an elevated plus-maze, rotarod test and the Morris water maze task were used to evaluate their behaviors. RNA sequencing was performed to identify differentially expressed genes in the brains. Quantitative real time-PCR (qRT-PCR) and Western blots were applied to verify the changes in gene expression. We found increased anxiety and impaired exploratory behavior, motor coordination and spatial memory in FA-exposed females. The brain transcriptome revealed 36 up-regulated and 79 down-regulated genes in their brains at weaning. The increase of Tlr1; Sult1a1; Tph2; Acacb; Etnppl; Angptl4 and Apold1, as well as a decrease of Ppara mRNA were confirmed by qRT-PCR. Among these genes; the mRNA levels of Etnppl; Angptl4 and Apold1 were increased in the both FA-exposed female and male brains. The elevation of Sult1a1 protein was confirmed by Western blots. Our data suggest that excess FA alteres brain gene expression and behaviors in female offspring, of which certain genes show apparent gender specificity.

Assessing Preconception Wellness in the Clinical Setting Using Electronic Health Data.

Background: One key strategy to reduce maternal morbidity and mortality involves optimizing prepregnancy health. Although nine core indicators of preconception wellness (PCW) have been proposed by clinical experts, few studies have attempted to assess the preconception health status of a population using these indicators. Methods: We conducted a retrospective chart review study of patients who received prenatal or primary care, identified by pregnancy-related ICD-10 codes, at either of two health systems in geographically and socioeconomically different areas of North Carolina between October 1, 2015, and September 30, 2018. Our primary study aim was to determine the feasibility of measuring the proposed PCW indicators through retrospective review of prenatal electronic health records at these two institutions. Results: Data were collected from 15,384 patients at Site 1 and 6,983 patients at Site 2. The indicators most likely to be documented and to meet the preconception health goal at each site were avoidance of teratogenic medications (98.8% and 98.3% at Sites 1 and 2, respectively) and entry to care in the first trimester (64.5% and 73.5% at Sites 1 and 2, respectively), whereas our measures of folic acid use, depression screening, and discussion of family planning were documented less than 20% of the time at both sites. Conclusions: Differences in measuring and documenting PCW indicators across the two health systems in our study presented barriers to monitoring and optimizing PCW. Efforts to address health and wellness before pregnancy will likely require health systems and payors to standardize, incorporate, and promote preconception health indicators that can be consistently measured and analyzed across health systems.

A Comprehensive Investigation on Potential Risk Factors for NSCL/P in a Rural District of Hebei Province, China.

Non syndromic cleft lip with or without palate (NSCL/P), one of the most common birth defects, is closely related to various risk factors. However, information regarding risk factors for NSCL/P in rural districts in China is very limited thus far. The objective of this study was designed to identify the potential risk factors for NSCL/P in rural districts. A comprehensive retrospective investigation including 435 NSCL/P patients and 402 healthy children was carried out in Hebei Province, China. Multiple logistic regression analysis and transmission disequilibrium test (TDT) were respectively used to identify non-genetic and genetic risk factors for NSCL/P, and then PLINK was used to explore the relationship between non-genetic and genetic risk factors. The results showed that maternal periconceptional exposure to pesticides and herbicides, as well as low parental education level were involved in the increased risk of NSCL/P, whereas maternal folic acid and multivitamin supplementation use during preconception period were associated with the reduced risk of NSCL/P. TDT analysis identified 2 single nucleotide polymorphisms (SNPs) (rs7078160 and rs4752028) in VAX1 and one SNP (rs17563) in BMP4 as the genetic risk factors for NSCL/P. Further analysis showed that the genetic risk factors were closely related with the negative non-genetic risk factors. Our study identified the potential risk factors for NSCL/P in rural districts, thus providing a theoretical basis for the prevention of NSCL/P occurrence.

Supplemental folic acid and/or multivitamins in pregnancy is associated with a decreased risk of childhood and adolescent nasopharyngeal carcinoma.

The aim of this study was to evaluate the association between prenatal and neonatal period exposures and the risk of childhood and adolescent nasopharyngeal carcinoma (NPC). From January 2009 to January 2016, a total of 46 patients with childhood and adolescent NPC (i.e., less than 18 years of age) who were treated at Sun Yat-sen University Cancer Center were screened as cases, and a total of 45 cancer-free patients who were treated at Sun Yat-sen University Zhongshan Ophthalmic Center were selected as controls. The association between maternal exposures during pregnancy and obstetric variables and the risk of childhood and adolescent NPC was evaluated using logistic regression analysis. Univariate analysis revealed that compared to children and adolescents without a family history of cancer, those with a family history of cancer had a significantly higher risk of childhood and adolescent NPC [odds ratios (OR) = 3.15, 95% confidence interval (CI) = 1.02-9.75, P = 0.046], and the maternal use of folic acid and/or multivitamins during pregnancy was associated with a reduced risk of childhood and adolescent NPC in the offspring (OR = 0.07, 95% CI = 0.02-0.25, P < 0.001). After multivariate analysis, only the maternal use of folic acid and/or multivitamins during pregnancy remained statistically significant. These findings suggest that maternal consumption of folic acid and/or multivitamins during pregnancy is associated with a decreased risk of childhood and adolescent NPC in the offspring.

Clinical profile and role of C-reactive protein and lactate dehydrogenase as prognostic marker and comparative efficacy of different pharmacotherapeutic agents in patients with cerebrovascular accident

The current study was conducted to determine the role of C-reactive protein (CRP) and lactate dehydrogenase (LDH) as prognostic-marker and outcomes of different pharmacotherapeutic agents among patients with cerebrovascular accident (CVA). A hospital-based observational study was conducted and patients with CVA admitted were included. Serum-CRP on admission correlated positively with modified Rankin score (mRS) (r = 0.9, P < 0.001) in ischemic stroke, whereas no correlation between serum LDH with mRS (r = 0.1, P = 0.5) was observed. Neither CRP nor LDH was helpful in predicting the outcome in hemorrhagic stroke. The use of Vitamin B12 was associated with favorable outcome in ischemic CVA cases and use of folic acid was associated with favorable outcome among hemorrhagic-CVA patients.

Efficacy of folic acid therapy for the association between high serum vitamin B12 level with all cause mortality among hypertensive population: the CSPPT randomized clinical trial post-hoc analysis

Abstract Background While higher vitamin B12 level was found to be co-related with mortality in various population, the effectiveness of folic acid therapy for this association remained unknown. Purpose 1: Explore the association between high B12 level and all cause mortality in hypertensive population. 2: To test the primary hypothesis that therapy with enalapril and folic acid is more effective in reducing all cause mortality than enalapril alone among targeted population. Methods Current study used post hoc analysis to examin data from the china stroke primary prevention trial (CSPPT), a randomized, double-blind, multi-center clinical trial. After excluded those lack of vitamin B12 data and with extreme B12 value, 20,204 participants (mean age 60 [SD. 8.54]; 59.16% male gender; total mean serum vitamin B12 level 410.51 [SD. 124.85] pg/ml) were included in present study.10,093 participants were treated with enalpril alone and 10,111 patients took the combine use of enalapril and folic acid. The primary outcome was all cause mortality, which collected based on hospital issued death certificate and investigation during follow up period. Results Over the medium follow-up time of 4.5 years, 308 death occurred in enalapril group and 295 death happened in enalapril-folic acid group. Differences were observed regarding sex, center, smoking &amp; drinking status at baseline. In enalapril group, high vitamin B12 level presented positive linear association with all cause mortality and was found to be significantly differences (P=0.018). Whereas no association between high vitamin B12 level and all cause mortality were observed in enalapril and folic acid group. (P=0.448). KM curves and tertile analysis of vitamin B12 level also showed same finding. Sensitivity analysis were processed to ensure the accuracy of the study result. Conclusion The present study not only explored that higher vitamin B12 level will increase all cause mortality in hypertensive population, but also found that high vitamin B12 level loses its co-relationship with all cause mortality after folic acid therapy, which potentially reflected the benefits of long-term, low-dose folic acid supplementation. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Key R&amp;D Projects, Jiangxi National Key Research and Development Program Smoothing curveKM curve

Preconception Risk Factors and Preconception Care Practices in Turkish Women Sample

Introduction: The aim of the study was to evaluate the preconception risk factors that may adversely affect pregnancy outcomes, and preconception care practices.&#x0D; Methods: A descriptive study was completed with 359 women. The data were collected with a questionnaire that was drawn up by the researchers.&#x0D; Results: Findings demonstrated that preconception risk factors were advanced age (20.6%), smoking (23.1%), existence of a chronic illness (23.6%) and being overweight (26.7%). Applied to a health institution to receive preconception care was 12.3 %. The most common preconception care practices were the use of folic acid (45.4%) and applying to the doctor for reorganization of the treatment for chronic illness (41.2%). &#x0D; Discussion: The data showed that women had preconceptional risk factors and did not receive adequate preconceptional care. Women need to be provided with awareness on preconception risk factors. Policies should be developed to increase the frequency of women receiving preconception care.

Investigating the association between prenatal exposure to folic acid and risk of neonatal diabetes/hyperglycemia and type 1 diabetes: A Norwegian register-based study.

Experimental animal studies suggest a novel role for the folate receptor 1 in β-cell differentiation in the pancreas, with potential implications for glycemic control. We tested the hypothesis of a protective association between prenatal folic acid use and neonatal diabetes or hyperglycemia and type 1 diabetes in an observational cohort study using data from the national population health registers in Norway. All singleton pregnancies resulting in live births from 2005 to 2018 were identified. Prenatal exposure to folic acid was determined based on maternal report at antenatal care in early pregnancy. Diagnoses of neonatal diabetes, hyperglycemia, and type 1 diabetes for the children were identified. Associations were estimated with logistic regression or Cox proportional hazard model and included crude and adjusted estimates. Among 781,567 children, 69% had prenatal exposure to folic acid, 264 were diagnosed with neonatal diabetes or hyperglycemia, and 1390 with type 1 diabetes. Compared to children with no prenatal exposure to folic acid, children with prenatal exposure to folic acid had similar odds of having a neonatal diabetes or hyperglycemia diagnosis (adjusted odds ratio 0.95, 95% confidence interval [CI] 0.72, 1.25) and similar risk of being diagnosed with type 1 diabetes (adjusted hazard ratio 1.05, 95% CI 0.93, 1.18). No association between prenatal folic acid exposure and neonatal diabetes/hyperglycemia or type 1 diabetes was found. These findings do not rule out a translational effect of the experimental results and future studies with longer follow-up and more precise information on the window of prenatal exposure are needed.

EARLY OUTCOME ANALYSIS OF NEURAL TUBE DEFECTS PRESENTING IN NEONATAL PERIOD: OUR EXPERIENCE

Background: Neural tube defects (NTDs) are congenital malformation resulting from failure of complete or partial closure of the neural tube in developing embryo. Aims and Objectives: The aim of this study is to present our experience, management and early outcomes (one month post-operatively) of neural tube defects presenting in neonatal period at our high volume tertiary care teaching Institutions. Materials and methods: This retrospective cohort study was conducted over a period of 10 years from January 2007 to December 2016. Medical records of neonates treated for neural tube defects were recorded in a pre-designed Performa. Results: A total of 286 patients with clinically diagnosed neural tube defects presenting in the neonatal period were studied. Male: female ratio was 1.11. The mean birth weight was 2350g. History of peri-conceptional use of folic acid was found in 15 (5.24%) mothers. One hundred seventeen (40.90%) of the patients had multiple system involvement. Most common was orthopedic deformities. Associated hydrocephalus was appreciated in 259 (90.56%) patients. Meningomyelocele was the most common anomaly seen in 239 (83.57%), 24 (8.39%) as meningocele and 23 (8.04%) were diagnosed as having Encephalocele. Surgery with decapping and repair was performed in 277 (96.85%) of the patients. Ventriculoperitoneal (VP) shunt operation before repair of meningomyelocele was performed in 9 (3.15%) patients, while in 19 (6.64%) patients, VP shunt operation was performed after the repair of NTD's in the early (one month) postoperative period. Clinical sepsis developed in the postoperative period in twenty one (7.58%) out of 277 patients, for which antibiotics were stepped up. Thirteen patients (4.69%) died postoperatively due to sepsis and associated anomalies. Conclusions: We present our retrospective report on neural tube defects from Indian subcontinent with accurate baseline data. Meningomyelocele was the most common type of NTD's. We recommend that folic acid supplementation should begin before marriage to raise its serum levels before the conception. Antenatal care especially antenatal ultrasonography must be contemplated as early as possible in early detection of NTDs.

Increased arsenic levels in both environmental measurements and biomonitoring results are associated with elevated risk of spina bifida

BACKGROUND AND AIM: Arsenic is associated with multiple adverse reproductive outcomes, and previous studies suggested higher risk of neural tube defects among mothers exposed to higher concentration of well water arsenic in Bangladesh. We further examine the association using water arsenic as proxy for external exposure and toenail as biomarkers for internal dose. METHODS: Parental toenail and water arsenic concentrations were examined in a case-control study in National Institute of Neurosciences & Hospital, Dhaka, Bangladesh. The associations between log-transformed and percentile arsenic concentrations and physician-diagnosed spina bifida were evaluated with logistic regression and cluster analysis, adjusted for maternal age, maternal BMI, parity, educational level, folic acid use and second-hand smoke exposure during pregnancy and weighted by self-reported dietary patterns. RESULTS:Median concentration for water, maternal and paternal arsenic are 2.0 ppb, 0.4 and 0.5 microgram per gram toenail among 280 included child-parent trios (156 with spina bifida) with complete exposure data. We observed associations between highest quartile maternal arsenic levels, higher than 10 ppb arsenic in water and spina bifida risk for their children after weighted for diet (Adjusted OR for water arsenic=1.49, 95% CI=1.00-2.06; adjusted OR for maternal arsenic=1.57, 95% CI=1.10-2.24), and higher composite exposure in both hierarchical clustering and k-means clustering were also associated with increased risk after weighting. Effect heterogeneity was observed between different folic acid supplement conditions, in which dose-response was attenuated for both water and paternal concentrations. CONCLUSIONS:Prenatal inorganic arsenic exposure was associated with elevated risk of spina bifida in Bangladesh, and joint parental exposure is associated with a higher risk. Investigations and interventions to mitigate arsenic exposure during for pregnant women are warranted. KEYWORDS: Heavy metals, birth outcomes, children's environmental health

Simulation and computational study of graphene oxide nano-carriers, absorption, and release of the anticancer drug of camptothecin.

The structure of nano-graphene oxide has attracted special attention in drug release due to its special properties such as hydrophilicity, special surface, biocompatibility, and the possibility of high loading of hydrophilic and hydrophobic drugs. In this study, after simulating and optimizing the structure of nano-graphene and then nano-graphene oxide (NGO), it was used to load the anti-cancer drug of camptothecin (CA) in an aqueous medium, and the optimal conditions for achieving maximum loading efficiency of the drug were investigated. Due to the structure of the drug, there are two forms, one form of lactone ring and the other carboxylate. If the lactone ring form is predominant, the effectiveness of the drug is increased. This depends on pH of the environment. The calculated thermodynamic and structural results show that the solubility of the drug about nano-graphene and its lactone ring state is maintained by using nano-graphene oxide. To increase the effectiveness of the drug, the lactone ring form must be maintained in the drug structure. The use of folic acid as an intermediate in the aqueous medium preserves the lactone form in the drug structure and increases its effectiveness. The results show that the presence of the ring in the drug structure and its binding to the mediator of folic acid to nano-graphene oxide is a stabilizing factor of keto tautomer. The calculation of vibrational frequencies shows that the presence of folic acid intermediate reduces the vibrational frequency of the hydroxyl group (OH) so that its absorption energy (Ead) is equal to the lowest value 65.24 a.u.

Protective Role of Folic Acid Versus Atorvastatin on Experimentally Induced Doxorubicin Toxicity on Testes of Adult Albino Rats: Anatomical, Histological and Immunoassay Study

Background: Infertility is a worldwide common health problem that might be induced by many factors and anti-cancerous are among the most common causes. Doxorubicin, and similar drugs are widely used anti cancerous agents mainly in the treatment of solid tumors, lymphoma and leukemia. they are attributable to male infertility due to testicular intoxication, and issue necessitates the concomitant usage of protective agents especially with increase life expectancy of cancer patients associated with better health care.Aim of the work: The current study is designed to compare the possible protective effect of both folic acid and Atorvastatin in doxorubicin induced testicular intoxication in adult male albino rats. Materials and methods: The experiment was conducted on sixty adult animals divided randomly and equally as control group (including three subgroups, 10 rats EACH, received no treatment, 10 rats received Atorvastatin and 10 rats received Folic acid), Doxorubicin treated group and two more groups that received folic acid and Atorvastatin in the second concomitantly as protective agents.Results: The results assessed anatomically (body weight, testicular weight and body: testicular weight ratio), biochemical assay (LH, antioxidant and testosterone serum level), and histologically both by light and Transmission Electron Microscopy (TEM). All results suggest that folic acid has a significant protective role on doxorubicin induced testicular intoxication. Administration of Atorvastatin at the used dose has a limited role in protection. Conclusion: The results recommend the use of folic acid as a routine protective agent for those under doxorubicin treatment especially in males during childhood and young age.

Counseling Practice towards Folic Acid use among Health Care Provider's in Selected Public Hospitals in Addis Ababa, Ethiopia

Background: Periconceptional folic acid supplementation is an effective way to prevent neural tube defects (NTDs) and other congenital anomalies. It is shown that 9.7% of healthcare providers practiced periconceptional folic acid supplements in Ethiopia. Fewer than 50% of women receive information on folic acid before or only during pregnancy. This study was conducted to assess folic acid supplementation counseling practices among health care providers.Methods: This institution-based cross-sectional study was conducted on 421 healthcare providers in selected public hospitals, Addis Ababa, Ethiopia. The hospitals were selected using a lottery sampling method, and a systematic random method was used to enroll participants. A structured self-administered instrument was used to gather information from participants. Data were checked for completeness and entered into Epi-Data software (version 3.1) and exported to SPSS software (version 25) for analysis. Descriptive statistics were used to describe participants' characteristics, and logistic regression, such as bivariate and multivariable analysis, were tested for associations. The level of significance was determined at a p-value of Results: In this study,periconceptional folic acid supplementation counseling practice wasfound in 51% of participants. Profession,salary, work load, patient flow, and assisted birth of a neonate with NTD were the factors associated with counseling practice (adjusted odds ratio [AOR]=3.215, 95% CI:1.085-9.523, AOR=0.213, 95% CI:0.95-0.487, AOR= 0.427 95% CI:0.213-0.859, AOR=0.223, 95% CI: 0.1-0.498, and AOR=15.107 95% CI:8.157-27.979, respectively).Conclusion: Health care providers demonstrated a good level of knowledge and counseling practice about the folic acid supplement in this study. Medical doctor, salary, workload, patient flow, assisted birth of a neonate with NTD were found predictors for counseling practice.

Perception of preconception care among women attending antenatal care clinic in a tertiary health care hospital in south east, Nigeria

Preconception care is the provision of biomedical, behavioral and social health interventions to women and couples before conception occurs. This study aimed to assess women’s knowledge, practice, perceived views and ideas and associated factors in preconception care amongst women attending antenatal care at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra state, Nigeria. A facility based cross-sectional study conducted among 150 randomly selected reproductive age group women who attended antenatal clinic from September 9 to September 26, 2020.The data were collected using self-administered and interviewer-administered questionnaires. The data were analyzed using Statistical Package for Social Sciences version 20.0. The study revealed 31.3% overall knowledge of preconception care. The knowledge level on preconception care was significantly associated with occupation, level of education, residence, number of pregnancies and past obstetrics complications. Age has no association with the level of knowledge. Only about one-fifth of the participants have good knowledge of the importance of folic acid use prior to and during pregnancy (17.3%), 32% had wrong knowledge and the rest had no knowledge (50.7%). Majority of the participants (87.7%) had prospective views concerning preconception care encouraging every woman to partake in it. In this finding, the level of women’s knowledge on preconception care was very low. Having a high level of education, living in urban area and having an obstetrics history were associated with good knowledge. The finding also showed positive views on the uptake and practice preconception care. This finding suggests that there is a need to give more emphasis on educating women on preconception care with the sole aim of achieving a sound maternal and child health.

Congenital heart defects among Down’s syndrome cases: an updated review from basic research to an emerging diagnostics technology and genetic counselling

Congenital heart defects (CHD) affect 50% of Down's syndrome (DS) cases. This review focusses on the pathogenic molecular mechanism leading to the formation of DS-associated CHD along with the advancement of the emerging diagnostic techniques available for such patients in past few decades. We have shed light on the causative genes of DS-associated CHD that are located either on chromosome 21 or outside chromosome 21. Along with locus-specific mutation, numerous SNP and CNV, miRNA, use of maternal folic acid during pregnancy and signalling pathways are also reported to contribute to the formation of CHD in patients with DS. With the help of both these our understanding of pathogenic mechanism causing CHD in DS cases along with the availability of emerging technologies has facilitated a novel discovery that has ultimately provided a better treatment and management for such cases. Accurate diagnosis and treatment are now available with the introduction of CNV detection and NGS based approaches such as WES, WGS, target sequencing and sequencing of foetal cell-free DNA by the medical geneticist and cardiologist have now allowed further identification of familial recurrence risk and relatives who are at risk through genetic counselling, thereby providing reproductive options and improving proper care of DS-associated CHD. Further, gene-editing studies explore novel pathogenic mechanisms and signalling pathways in DS-associated CHD.

Prevalence and Pattern of Birth Defects in a Tertiary Referral Center

Background: Congenital disorders (birth defects) are structural or functional abnormalities, which are present from birth, whether recognized at birth or later and constitute a major health problem worldwide. Congenital anomalies occur in 3 to 5 % of all pregnancies and 2 to 3 % of all births. The exact magnitude of birth defect related events is still unrevealed. Prevalence is high in Nepal but true magnitude is still unknown.&#x0D; Materials and Methods: This is a prospective cross sectional study of all antenatal women who had an ultrasound revealing congenital anomalies as well who delivered with a fetal congenital malformation at department of Obstetrics and Gynecology, Nobel Medical College Teaching Hospital. Maternal variables like age, parity, period of gestation at detection, medical history, mode of delivery and complications were recorded. Fetal outcomes and details of anomalies were analyzed. Consanguinity and history of use of folic acid was also inquired.&#x0D; Results: Our institutional prevalence of congenital anomalies was 1.25%. The mean age of the mother is 25.88 years. Anencephaly was seen in 5 live birth among the mothers of consanguineous marriage. The predominant system involved was central nervous system 37(37%) followed by Musculoskeletal system 13 (13%). Most of them 38/56 (68%) were pre diagnosed by antenatal ultrasound only in the third trimester. Majority of them didn’t give history of the use of folic acid. Vaginal delivery was the preferred choice of the termination of pregnancy.&#x0D; Conclusion: Congenital anomaly rate was 1.25% and Central Nervous System was the predominant system involved with Anencephaly being common in consanguineous marriage.

Promoting Interpersonal Communication for Anemia Reduction: Findings From the Reduction in Anemia Through Normative Innovations (RANI) Project

ObjectivesMore than half of women of reproductive age in India are anemic, a condition treatable through regular iron folic acid uptake. Previous studies have shown the importance of participatory interactions and interpersonal communication in improving women’s health. The Reduction in Anemia through Normative Innovations (RANI) study investigated the effect of general health and anemia- specific interpersonal communication on improving iron folic acid use among women of reproductive age. MethodsThe RANI Project is a cluster randomized trial that collected longitudinal data from control (N = 1896) and treatment (N = 1898) communities in Odisha, India at baseline and at midline, 6 months later. Structural equation models assessed the intervention effect on iron folic acid use through both, general health interpersonal communication focused on “the health of women in the community” and anemia-specific interpersonal communication. ResultsCompared to the control arm, iron folic acid use significantly increased in the treatment arm; health communication and anemia-specific communication also increased. The impact of the intervention on iron folic acid use was mediated through anemia-specific interpersonal communication (p < 0.001). The effect of general health interpersonal communication on iron folic acid uptake was only manifest in the indirect pathway, with anemia-specific interpersonal communication serving as the mediator. ConclusionsMany rural Indian women do not have access to health information through mass and social media thus interventions need to rely on novel ways of disseminating health information. These results indicate that interpersonal communication can serve this function as increased interpersonal communication among participants, resulted in improved iron folic acid use. These findings also emphasize the importance of distinguishing between general interpersonal communication and health topic-specific interpersonal communication. Strategic use of targeted interpersonal communication in promoting behavior change is a viable strategy in increasing iron folic acid use, leading to anemia reduction. Funding SourcesThis study was supported by a grant from The Bill and Melinda Gates Foundation.

Preconception Dietary Folate Intake and Risk of Spontaneous Abortion

ObjectivesPrevious studies suggest a beneficial effect of supplemental folic acid use and dietary folate intake on fertility, while results for fetal loss are conflicting. Most previous research on fetal loss focused on folic acid supplement use. We therefore, investigated the association between dietary folate intake and spontaneous abortion (SAB) in a Danish preconception cohort of couples trying to conceive. MethodsWe recruited couples who were trying to conceive and did not receive fertility treatment. Pregnancies were ascertained through bimonthly follow-up questionnaires completed up to 12 months after study entry. SABs were identified by self-report on the follow-up questionnaires and through the Danish National Patient Registry. Dietary folate intake at study entry was estimated using a validated food frequency questionnaire (FFQ). Folate intake was adjusted for total energy intake using the residual method and categorized as < 250,250–399 and > = 400μg/day. We used Cox proportional hazards regression models with gestational weeks as time scale to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for SAB, adjusting for age, partner’s age, educational attainment, smoking status, anthropometry, physical activity, alcohol intake, folic acid supplement use, time-to-pregnancy, gravidity and parity. In sensitivity analyses, we stratified by folic acid supplement use, body mass index (BMI) and alcohol intake. ResultsOf the 2,957 women who became pregnant within 12 months of study entry and completed the FFQ, we identified 432 SABs. HRs for an SAB among women who consumed 250–399 and >= 400 μg/day of dietary folate compared with <250 μg/day were 0.83 (95% CI: 0.53; 1.29) and 0.87 (95% CI: 0.54; 1.39), respectively. Comparing intake > = 400 with <250 μg/day, the association was stronger when the analysis was restricted to folic acid supplement users, 0.74 (95% CI: 0.39; 1.40), to women with a BMI >= 25, 0.67 (95% CI: 0.31; 1.43), and to a reported alcohol intake >4 drinks/week, 0.66 (95% CI: 0.16; 2.66). ConclusionsOur study may suggest that high dietary folate intake among folic acid supplement users is associated with a lower risk of SAB, although our estimates are imprecise. Funding SourcesNational Institute of Child Health and Human Development.