History Of Neural Tube Defects Research Articles

Retrospective Examination of Infants With Congenital Neural Tube Defect.

In the present study, neonates presenting with neural tube defects (NTDs) and undergoing observation within the confines of the neonatal intensive care unit (NICU) were subjected to a comprehensive assessment encompassing concurrent morbidities, clinical manifestations, laboratory parameters, and instituted interventions. A retrospective examination was conducted on the medical records of 135 neonates diagnosed with congenital NTD within the temporal span from 2008 to 2018. The study cohort was drawn from the NICU of the Health Sciences University Erzurum Regional and Research Hospital Health Practice and Research Center. The current investigation encompasses a retrospective analysis of 135 patients diagnosed with NTDwho received treatment at the NICUbetween the years 2008 and 2018. Among these, 74 individuals (54.2%) were male, while 61 (45.8%) were female. Maternal ages ranged from 17 to 46 years, with variations in the number of pregnancies, ranging from 1 to 10. Notably, 71 cases (52.6%) were delivered through normal spontaneous delivery, whereas 64 cases (47.4%) underwent cesarean section. The familial context revealed that five patients (3.6%) had siblings with a history of NTD, while no instances were noted where mothers had received antenatal folic acid support. Birth weights of the neonates ranged from 1425 to 4500 grams. Consanguinity was identified in the parental relationships of 17 cases (12.6%). The average diameter of the neural tube sac was determined to be 4.83± 1.94 cm (1-12 cm). Predominantly, the lumbosacral region emerged as the most common site of NTD, with meningomyelocele being the prevailing NTD type. Hydrocephalus coexisted in 67 cases, and notably, 44 instances exhibited the development of hydrocephalus post-sac operation. Eight patients were deemed inoperable, and the initial surgery transpired at an average age of 4.3 ± 2.6 (0-17) days. Flap closure constituted 32 of the surgical interventions, while primary closure was implemented in 95 cases. Neurogenic bladder antedated the operation in 14 patients, and 12 individuals developed neurogenic bladder postoperatively. Ventriculoperitoneal shunt placement was warranted in 47 patients. The average duration of hospitalization was 22.5 ± 14.4 days. Regrettably, three patients died due to complications and infections during their hospital stay. NTDrepresents a significant cohort of pathologies necessitating a comprehensive and interdisciplinary management strategy. These anomalies are characterized by elevated morbidity and mortality rates, not only exerting substantial financial strains on societal, familial, and state healthcare resourcesbut also inflicting profound emotional distress upon affected families. Crucially, periconceptional strategies emphasizing balanced nutritioncoupled with targeted multivitamin and mineral supplementation, particularly the inclusion of folic acid, assume paramount importance in the prophylaxis of this debilitating condition.

Preconception of folic acid supplementation knowledge among Ethiopian women reproductive age group in areas with high burden of neural tube defects: a community based cross-sectional study.

Periconceptional folic acid supplementation is effective in the prevention of neural tube defects (NTDs). The aim of the present study was to determine the level of knowledge about the benefits of preconceptional folic acid supplementation in a sample of women of childbearing age and its associated factors. A cross-sectional community-based study design was carried out on a total of 441 women of childbearing age. Questionnaires included knowledge of preconception of folic acid supplements and socio-demographic characteristics. The χ 2 was used to compare categorical data. Multivariate logistic regression was used to isolate the predictive variables and examined individually by calculating the adjusted odds ratio. Statistical significance is declared as P < 0·05. We found that 35·1 % (n 155) knew preconceptional folic acid supplementation could prevent NTDs, and 3·8 % (n 17) knew the right time to take preconceptional folic acid supplementation and only 1·7 % (n 7) who had a history of NTDs. Attended secondary education (OR 2·7; 95 % CI 1·1, 6·0, P = 0·017), governmental employee (OR 3·5; 95 % CI 2·3, 17·8, P < 0·001), current pregnancy status (OR 3·0; 95 % CI 2·1, 4·2, P = 0·043), history of visiting the antenatal care service during pregnancy (OR 2·9; 95 % CI 1·07, 7·8, P = 0·03), history of taking folic acid supplement (OR 4·5; 95 % CI 2·9, 7·1, P < 0·001) were associated. More than half of the participant women did not know about preconception of folic acid supplements that reduce the risk of NTDs. Identification of the level of knowledge on preconception of folic acid may allow for targeted educational or other interventions to further encourage folic acid use.

Determinants of neural tube defect among children at zewditu memorial hospital, addis ababa, ethiopia a case control study

BackgroundNeural tube defects are one of the most common malformations with a worldwide prevalence of 1–3 per1000 live births. They are the result of failure of the neural tube to close during the 21–28 embryonic days and it had multi-factorial etiology. ObjectiveThe aim of this study was to assess the determinants of neural tube defects at Zewditu Memorial hospital in Addis Ababa, Ethiopia. MethodA hospital based unmatched case control study was conducted with a ratio of 1:2 cases to control cases and a total of 60 cases and 120 controls were selected. Data was collected using a structured questionnaire. Data analysis was conducted using SPSS version 23 software. Results were summarized using descriptive statistics. Bivariate and multivariate logistic regression analyses were conducted for statistical testing. Statistical association was declared with p-value<0.05. ResultsThe results show that oral contraceptive use, young maternal age, parental low educational status, hot tub use, passive smoking, caffeine consumption of ≥ 3 cup/day, maternal occupation, family history of neural tube defects, maternal fever and being multiparous had an association with neural tube defects. In the multivariate analysis, maternal fever (OR 65.5 CI 4.4–957.9), family history of neural tube defects (OR 43.5 CI 1.2–1506.9), coffee consumption (OR 18.5 CI 3.7–91.1), antipyretic use (OR 0.01 CI 0.00 -0.53) and maternal age of < 19 (OR 33.3 CI 2.5–448.4) and 25–29 (OR 9.7 CI 1.3–67.6) had a significant association with neural tube defects. ConclusionThis study shows that maternal fever, family history of neural tube defects, coffee consumption, and young maternal age were associated with the increasing the risk of neural tube defect whereas antipyretic drug use had a protective effect.

Complex Fetal Care Cases: Fetoscopic Myelomeningocele Repair

* Abbreviations: CSF: : cerebrospinal fluid MMC: : myelomeningocele MRI: : magnetic resonance imaging VP: : ventriculoperitoneal A 34-year-old gravida 6, para 2-0-3-2 pregnant woman was referred to the fetal center with a diagnosis of fetal lumbosacral myelomeningocele (MMC). Her medical history was significant for polycystic ovarian syndrome, migraine headaches, seasonal allergies, and anxiety. She had a surgical history of wisdom teeth extraction and 2 prior cesarean sections. She was taking prenatal vitamins and using vaginal progesterone for an obstetrical history of 3 early first-trimester spontaneous abortions. She had no family history of neural tube defects, but 1 child with Asperger syndrome and sensory processing disorder and 1 child with speech delay. Prenatal laboratory testing was unremarkable. Imaging at the referring obstetrician’s office was significant for an L3 lesion with a lemon-shaped calvarium, findings of Chiari II malformation in the posterior fossa, and lateral ventricular enlargement with a dangling choroid. Amniocentesis performed by the referring provider showed a normal female karyotype and microarray. She was referred to our center at 23 5/7 weeks’ gestation, with imaging and multidisciplinary team meeting at 24 6/7 weeks’ gestation. The following results were obtained: Figure 1. A. Prerepair fetal magnetic resonance imaging …

Risk factors, presentations, associated anomalies, and outcomes of patients with encephalocele

Background and objectives: Encephalocele is a rare neural tube birth defect. Aim of this study was to find the risk factors and associated anomalies of patients with encephalocele, and its outcomes. Methods: We used a case-series study for 30 patients with encephalocele who were admitted to Shahid Dr. Aso Hospital from January 2017 to July 2018. The patients’ clinical features and computed tomography findings were recorded and their outcomes classified into death, cerebral palsy, delayed milestones, and good. Results: The genders of the patients were 11 (36.7%) male and 19 (63.3%) female with a female: male ratio of 1.7:1. There were significant associations between the site of the skull defect with microcephalus, seizure, and outcome and statistically significant association between the content of the sac and family history. The content of the sac was mostly mixed brain and cerebrospinal fluid (56.7%). The size of the sac was significantly associated with family history and hydrocephalus and all of encephaloceles were located in the midline mostly at occipital and occipito-cervical region. The outcomes were death (10%), poor (10%), delayed milestones (23.3%), and 56.7% good. There was also statistically significant association between outcome and other brain abnormality and microcephalus. Conclusions: Encephalocele was located in midline mostly at occipito-cervical region, the size of its sac is associated with hydrocephalus, the content was mixed brain and CSF, and its site was associated with seizure. Moreover, content and size of the sac was significantly associated with family history of neural tube defect.

Study of Neural Tube Defects at Al-Diwaniyah Province / Iraq

Background: The Neural tube defects NTDs refers to defect ocurr at birth resulting from defect in closure of the neural tube during early intra uterine life after conception; these anomalies are usually divided into cephalic and spinal forms. They include three main type , anencephaly, spina bifida and encephalocele , These NTDs are considered important causes of morbidity and mortality in infancy, childhood, and even young adulthood .&#x0D; Objective: The aim of study is to study the type and incidence of the neural tube defect and it is it is risk factors and other associated variable.&#x0D; Methods : This descriptive prospective study was carried on 120000 lived newborns from December 201 3 to December 2015 in al diwaniya teaching hospital , neurosurgical department and pediatrics hospital in al diwaniya province in south west Iraq ,the questionnaire include all the information's case were defined as women residing in the al diwaniya government , delivered live or still born with neural Tube defect . important feature related to the neonates and their parents like gender ,date of birth , type of neural tube defect ,father and mother age ,consanguineous marriage, drug take during pregnancy ,maternal diseases ,previous history of neural tube defect .&#x0D; &#x0D; RESULTS : During a period of three years 2013-2015, there were (120,768 total ) birth ; the number of total births registered during the 3 years was 41761 in 2013, 39353 in 2014, and 39652 in 2015 . Among this sample population,112 women had fetus or newborn with NTD ( 1.078 per 1000birth ), An encephaly {3 (2.7%)} , spina bifida {103(92%)}, Encephalocele{6(5.3%)} Meningocele {20(17.9%)},Meningomyelocele {76 (67.9%)}, myeloschiasis {7 (6.2%)}, The age of 112 women that her babies affected NTDs , 30(26.8%) had 16-25 years , 55 (49.1%) had 26-35 years while 27 (24.1%) had above 35 years .&#x0D; Conclusion: This study showed that folate deficiency are very important in reducing the NTDs occurrences consanguineous marriage is not important risk factor for NTDs.

Association between biomarkers of vitamin B12 status and the risk of neural tube defects.

The aim of this study was to evaluate the association between vitamin B12 and its biomarkers and the risk of neural tube defects. A total of 120 pregnant Egyptian women were included in the study. They were classified into two groups. Group A consisted of 50 women with neural tube defects in current pregnancy or with a history in previous pregnancies, and Group B consisted of 70 women with no history of neural tube defects in previous pregnancies or in the current pregnancy. All women were subjected to ultrasound anomaly scan and serum analysis of vitamin B12, homocysteine (Hcy), methyl malonic acid (MMA) and active vitamin B12 concentrations. Receiver operating characteristic curve analysis was used to determine the best cut-off values of vitamin B12. Serum levels of vitamin B12 were decreased in Neural tube defects (NTDs) cases compared to controls (2.736 vs 3.091 ng/mL; P = 0.0015), while Hcy and MMA concentrations were elevated (18.39 vs 13.95 μmol/L; P = 0.0008 and 263 vs 229.7 μmol/L; P = 0.003, respectively). Active vitamin B12 reduction was not statistically significant (96.8 vs 99.36 pmol/L; P = 0.8013). The optimal cut-off value of vitamin B12, 2.9 ng/mL, is the best threshold to expect neural tube defects, with a sensitivity of 60% and specificity of 74.29%. Low vitamin B12 is a risk factor for having a fetus with neural tube defects. The monitoring of MMA and Hcy levels might be important in understanding and following cases with neural tube defects. Adding vitamin B12 to folic acid may help to decrease the incidence of neural tube defects in the Egyptian population.

Letter to the Editor. Family history of neural tube defects.

Letter to the Editor. Family history of neural tube defects.

The relationship between mother and infant plasma trace element and heavy metal levels and the risk of neural tube defect in infants

Objective: To determine levels of trace elements [copper (Cu), zinc (Zn), selenium (Se), and cobalt (Co)] and heavy metals [arsenic (As), mercury (Hg), lead (Pb), and cadmium (Cd)] in the plasma of mothers and infants and investigate the relationship between those levels and neural tube defects (NTD).Methods: A total of 100 neonates diagnosed with NTD and placed in the Neonatal Intensive Care Unit of Yuzuncu Yil University, Turkey between May 2013 and December 2016 comprised the study group. The control group consisted of 70 healthy neonates not diagnosed with NTD or any other congenital anomalies. For both the groups, mother and infant plasma levels of Cu, Zn, Co, Cd, Se, Hg, As, and Pb were measured and compared. Plasma levels of Cu, Zn, Co, Cd, Se, Hg, As, and Pb were measured and compared between two groups of mothers and infants.Findings: Mother and infant plasma levels of trace elements Zn and Se were determined to be significantly lower in the study group compared with the control group, while Cu levels were significant elevated in the study group (all p values < .05). Plasma levels of heavy metals As, Pb, and Cd were found to be significantly higher in the NTD control group (p < .05 for all). There was no association between maternal infection, maternal smoking status, history of miscarriage, or history of NTD with the development of NTD (p > .05). Differences in maternal age, birth weight, length of gestation, and infant gender for the two groups were also determined not to be statistically significant.Results: High plasma levels of heavy metals As, Pb, and Cd and trace element Cu were identified as risk factors for the development of NTD. At the same time, low plasma levels of trace elements Zn and Se were also found to be risk factors for NTD. However, no association between Hg and Co plasma levels and increased risk for the development of NTD was observed. This study, while being the most comprehensive case study to date investigating the relationship between heavy metals and trace element levels and increased risk of NTD, nonetheless highlights the need for further research in order to make definite statements regarding this relationship.

Iniencephaly: a rare congenital anomaly reaching the term

Abstract Introduction Iniencephaly is characterized by a defect in the occipital bone in the inion, occipital encephalocele, spinal dysraphism and fixed hyperextension of the fetal head. The associated anomalies are observed in many systems including the central nervous system and the gastrointestinal system. Prenatal diagnosis is rare because early and careful ultrasonographic evaluation is necessary. Fetuses with iniencephaly are almost always stillborn. We aimed to present a fetus with iniencephaly reaching term in utero. Case A 25-year-old healthy primigravida Syrian woman consulted with labor pain at 39 weeks of gestation. She had no laboratory tests or ultrasonographic examination during the pregnancy. Ultrasound evaluation demonstrated a single live intrauterine fetus with a retroflexed fetal head and excess amniotic fluid. A girl was delivered by cesarean section weighing 3350 g with a length of 48 cm. The fetal head was retroflexed with an occipital bone defect. Associated anomalies such as club foot were also observed (Figures 1 and 2). Discussion Iniencephaly is an extremely rare neural tube defect first described by Saint-Hilare in 1836. Its incidence varies from 0.1 to 10 : 10,000. The incidence is higher in families with a history of neural tube defect. Maternal drug use, smoking, alcohol use, low parity and low socioeconomic status are risk factors. Prenatal diagnosis is possible by careful and early ultrasonographic examination. Termination of pregnancy is the generally accepted approach in these pregnancies because of poor prognosis and severe mortality. The most important precaution is to prevent obstructed labor and maternal trauma due to corporal distortion of the fetus.

Research: Prevalence of neural tube defects Khartoum, Sudan August 2014-July 2015.

Background Neural tube defects (NTDs) are birth defects that results from failure of the neural tube to develop properly during early pregnancy.Methods We studied the prevalence of neural tube defects in newborns admitted to the NICU in Soba University and Omdurman Maternity hospitals, during the period 1st August 2014 to 31st July 2015. A cross-sectional hospital based study, involved all newborns with any type of neural tube defect admitted to the NICU in the study area during the study period. Data was collected using a questionnaire reviewing the medical, social history and clinical examination.ResultsOut of the 36,785 delivered newborns during the study period, the prevalence of NTDs was 2.8:1000. Females were 56 (54.4%) predominated males 47 (45.6%). History of neural tube defects was found in 11 (10.7%) of the affected newborns siblings. Sixty-eight (66%) of the studied mothers received folic acid during pregnancy with the current child, of those who received folic acid 66 (97.1%) started folic acid after conception, 36 (54.5%) in the first trimester and 39 (57.4%) had no regular intake of the folic acid. The types of NTDs include myelomeningocele 49 (47.6%), anencephaly 18 (17.5%), encephalocele 14 (13.6%), myelomeningocele and hydrocephalus 11 (10.7%) and meningocele 8 (7.8%).ConclusionThe prevalence of neural tube defects is 2.8:1000. Myelomeningocele is the commonest encountered NTD. The use of preconception folic acid needs to be advocated.

Effects and safety of periconceptional oral folate supplementation for preventing birth defects.

It has been reported that neural tube defects (NTD) can be prevented with periconceptional folic acid supplementation. The effects of different doses, forms and schemes of folate supplementation for the prevention of other birth defects and maternal and infant outcomes are unclear. This review aims to examine whether periconceptional folate supplementation reduces the risk of neural tube and other congenital anomalies (including cleft palate) without causing adverse outcomes in mothers or babies. This is an update of a previously published Cochrane review on this topic. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2015). Additionally, we searched the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (31 August 2015) and contacted relevant organisations to identify ongoing and unpublished studies. We included all randomised or quasi-randomised trials evaluating the effect of periconceptional folate supplementation alone, or in combination with other vitamins and minerals, in women independent of age and parity. Two review authors independently assessed the eligibility of studies against the inclusion criteria, extracted data from included studies, checked data entry for accuracy and assessed the risk of bias of the included studies. We assessed the quality of the body of evidence using the GRADE approach. Five trials involving 7391 women (2033 with a history of a pregnancy affected by a NTD and 5358 with no history of NTDs) were included. Four comparisons were made: 1) supplementation with any folate versus no intervention, placebo or other micronutrients without folate (five trials); 2) supplementation with folic acid alone versus no treatment or placebo (one trial); 3) supplementation with folate plus other micronutrients versus other micronutrients without folate (four trials); and 4) supplementation with folate plus other micronutrients versus the same other micronutrients without folate (two trials). The risk of bias of the trials was variable. Only one trial was considered to be at low risk of bias. The remaining studies lacked clarity regarding the randomisation method or whether the allocation to the intervention was concealed. All the participants were blinded to the intervention, though blinding was unclear for outcome assessors in the five trials.The results of the first comparison involving 6708 births with information on NTDs and other infant outcomes, show a protective effect of daily folic acid supplementation (alone or in combination with other vitamins and minerals) in preventing NTDs compared with no interventions/placebo or vitamins and minerals without folic acid (risk ratio (RR) 0.31, 95% confidence interval (CI) 0.17 to 0.58); five studies; 6708 births; high quality evidence). Only one study assessed the incidence of NTDs and showed no evidence of an effect (RR 0.07, 95% CI 0.00 to 1.32; 4862 births) although no events were found in the group that received folic acid. Folic acid had a significant protective effect for reoccurrence (RR 0.34, 95% CI 0.18 to 0.64); four studies; 1846 births). Subgroup analyses suggest that the positive effect of folic acid on NTD incidence and recurrence is not affected by the explored daily folic acid dosage (400 µg (0.4 mg) or higher) or whether folic acid is given alone or with other vitamins and minerals. These results are consistent across all four review comparisons.There is no evidence of any preventive or negative effects on cleft palate (RR 0.73, 95% CI 0.05 to 10.89; three studies; 5612 births; low quality evidence), cleft lip ((RR 0.79, 95% CI 0.14 to 4.36; three studies; 5612 births; low quality evidence), congenital cardiovascular defects (RR 0.57, 95% CI 0.24 to 1.33; three studies; 5612 births; low quality evidence), miscarriages (RR 1.10, 95% CI 0.94 to 1.28; five studies; 7391 pregnancies; moderate quality evidence) or any other birth defects (RR 0.94, 95% CI 0.53 to 1.66; three studies; 5612 births; low quality evidence). There were no included trials assessing the effects of this intervention on neonatal death, maternal blood folate or anaemia at term. Folic acid, alone or in combination with vitamins and minerals, prevents NTDs, but does not have a clear effect on other birth defects.

The natural history of neural tube defects in the setting of an Irish tertiary referral foetal medicine unit

Neural tube defects (NTDs) carry a heavy burden for affected individuals and their family. Physical and neurological outcome measures may help in counselling couples. The aim of this audit was to review all cases of NTDs seen at a tertiary referral foetal medicine unit. Cases were identified from obstetric, neonatal and neurosurgical records. Thirty-six cases of NTDs were identified. Of the 36, 25% (n = 9, one trisomy 18) opted for termination of pregnancy abroad. Of the remaining 27, 19% (n = 5) died in the antepartum period. 81% (n = 22) were liveborn with four neonatal deaths (one trisomy 18). Of 15 cases, 14 had neurosurgical repair within a median time of 3 days and 9 of these also had a ventriculoperitoneal shunt inserted. Antenatal ultrasound accurately diagnosed lesion level in the majority of cases. The survival rate for babies diagnosed with non-lethal neural tubes defects is high when multidisciplinary care is initiated early.

Pre-conception Folic Acid and Multivitamin Supplementation for the Primary and Secondary Prevention of Neural Tube Defects and Other Folic Acid-Sensitive Congenital Anomalies.

Abstract Objective To provide updated information on the pre- and post-conception use of oral folic acid with or without a multivitamin/micronutrient supplement for the prevention of neural tube defects and other congenital anomalies This will help physicians, midwives, nurses, and other health care workers to assist in the education of women about the proper use and dosage of folic acid/multivitamin supplementation before and during pregnancy. Evidence Published literature was retrieved through searches of PubMed, Medline, CINAHL, and the Cochrane Library in January 2011 using appropriate controlled vocabulary and key words (e.g., folic acid, prenatal multivitamins, folate sensitive birth defects, congenital anomaly risk reduction, pre-conception counselling). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies published in English from 1985 and June 2014. Searches were updated on a regular basis and incorporated in the guideline to June 2014 Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies Costs, risks, and benefits The financial costs are those of daily vitamin supplementation and eating a healthy folate-enriched diet. The risks are of a reported association of dietary folic acid supplementation with fetal epigenetic modifications and with an increased likelihood of a twin pregnancy These associations may require consideration before initiating folic acid supplementation The benefit of folic acid oral supplementation or dietary folate intake combined with a multivitamin/micronutrient supplement is an associated decrease in neural tube defects and perhaps in other specific birth defects and obstetrical complications. Values The quality of evidence in the document was rated using the criteria described in the Report of the Canadian Task Force on Preventative Health Care (Table 1).

Factors Associated with Neural Tube Defects of Neonates in Al-Najaf Government

Objective: To identify the association of neural tube defects with some possible risk factors in Iraqi neonates. Methodology: This is a hospital based case control study carried out in two major hospitals in AL Najaf province during the period (first of February through the end of May 2014). All the available fifty responded cases of neonates with gross Neural Tube Defects (NTDs) who were diagnosed and confirmed as neural tubes defects by specialist pediatrician were studied as cases and compared with (100) randomly selected sex and age matched control group neonates ( Free of neural tube defects). Data collection were done through a structured questionnaire by interviewing mothers of both groups single handy by the researcher ,Odds Ratios (OR)were calculated to identify the probable risk factors of neural tube defects. Results: The proportions of types of neural tubes defects in this study were; spina bifida (52%), encephalocele (36%) and anencephaly (12%). the factors that significantly associated with increased risk for NTDs were a lack of folic acid supplementation (OR=12.55, (95% confidence interval CI 5.59-28.17); poor ante natal care OR=3.67(95% CI 1.80-7.48), abortions OR=5.52(95% 2.64-11-54) ,previous still birth OR=2.02( CI 95% 0.79-5.14), number of parity OR=1.10( CI 95% 0.48-2.30), maternal smoking OR=2.25( CI 95% 0.87-5.83) maternal age 0R=1.95 (0.88-4.31), maternal family history OR=1.36(0.37-5.1), maternal educational level [low educational level] was OR=4.86[2.2-10.9], while paternal factors were father family history of neural tube defect OR=21.7[2.67-53.42] ,father smoking OR=3.8 [1.77-8.34] father age OR=4.04 [1.55-10.55]. Residence OR=3.78[1.85-7.72], consanguinity OR=3.84[1.77-8.34] ,while the association between neonates factors and anomalies were age of neonates OR=2.125[1.10-4.30], birth weight OR=1.52[0.72-3.30]. Conclusion: The main factors that associated positively with neural tube defects among others factors were ( father family history of neural tube defects, lack of folic acid supplementations ,mothers with low education and consanguinity marriages) which highly significant and strongly effects in neural tubes defects among others factors ,while mothers with higher education was protected them siblings of this anomaly and found the number of parity had no relation on neural tube defects formation. Recommendation: Confirmation to avoid internal marriages and especially for families that have birth defects and an emphasis on taking the tab of folic acid before and during pregnancy in dose (400-500 micrograms) for women with children deformed previously or frequent abortion or who take drugs interferon Folic acid, parents should avoid smoking and urge the supplement level of science education due to increasing awareness of the health help them avoid all the factors causing neural tube defects

A Case of Dichorionic Twin Pregnancy Concordant for Bilateral Cleft Lip and Palate and Discordant for Spina Bifida; Schisis Association

Backround: The schisis theory suggests that neural tube defect (NTD), cleft lip and palate (CL/P), omphalocele and diaphragmatic hernia are associated to each other more frequently than at the expected random combination rates in a given fetus. However, it is unusual to see schisis-associated defects concordantly in dichorionic twin pregnancy with other schisis-associated and non-associated defects. In addition, the association of lower limb oligodactly with oral cleft and spina bifida has not been reported before. Case: A 24-year-old woman with twin gestation at 21 weeks was referred to our unit. At ultrasound examination, bilateral CL/P and single umbilical artery in male fetus, and bilateral CL/P and open lumbar spina bifida in female fetus were revealed. At autopsy, oligodactyly of both lower limbs was demonstrated in the female fetus. The parents had no family history of NTD and CL/P. There was no consanguinity, nor was the mother exposed to teratogens.

Calculation skills for nurses: Preconceptual care

Question b It is recommended that women planning pregnancy should take folic acid before conception to reduce the risk of neural tube defects. Women with no family history of neural tube defect and who do not have coeliac disease, diabetes mellitus, or sickle-cell anaemia, or take antiepileptic medicines, are considered to be low risk and should take a daily dose of 400 μg of folic acid (Joint Formulary Committee, 2012). It is recommended that this dose should be continued until week 12 of pregnancy. ■ If Lesley takes folic acid as recommended for the 9 weeks before she conceives and the 12 weeks after, how many tablets would she have taken? ■ How much folic acid, expressed as milligrams, would this equate to?

Use of Family History Information for Neural Tube Defect Prevention

Background: A family history of neural tube defects (NTDs) can increase the risk of a pregnancy affected by an NTD. Periconceptional folic acid use decreases this risk. Purpose: Our objective was to determine whether seconddegree relatives of NTD-affected children showed differences in folic acid use compared with the general population and to provide them with folic acid education. Methods: Michigan and Colorado health workers contacted families with a previous pregnancy or child affected by an NTD, identified through NTD recurrence prevention programs. Families were interviewed to identify the number of second-degree relatives of child-bearing age. Families mailed surveys to these relatives, who returned them to the state health departments. The survey assessed folic acid use, views on having an affected child, and reproductive planning. Folic acid education materials were sent to relatives who provided contact information. Results: Folic acid supplement use among relatives was similar to that of the general population, despite elevated risk perceptions. Discussion: Both state health departments plan to increase efforts to contact affected families and their relatives through partnerships with family support groups. Translation to Health Education Practice: Including outreach to second-degree relatives in NTD recurrence prevention programs could increase the impact of these programs.

Effects and safety of periconceptional folate supplementation for preventing birth defects.

It has been reported that neural tube defects can be prevented with periconceptional folic acid supplementation. The effects of different doses, forms and schemes of folate supplementation for the prevention of other birth defects and maternal and infant outcomes are unclear. This review updates and expands a previous Cochrane Review assessing the effects of periconceptional supplementation with folic acid to reduce neural tube defects (NTDs). We examined whether folate supplementation before and during early pregnancy can reduce neural tube and other birth defects (including cleft palate) without causing adverse outcomes for mothers or babies. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (July 2010). Additionally, we searched the international clinical trials registry platform and contacted relevant organisations to identify ongoing and unpublished studies. We included all randomised or quasi-randomised trials evaluating the effect of periconceptional folate supplementation alone, or in combination with other vitamins and minerals, in women independent of age and parity. We assessed trials for methodological quality using the standard Cochrane criteria. Two authors independently assessed the trials for inclusion, one author extracted data and a second checked for accuracy. Five trials involving 6105 women (1949 with a history of a pregnancy affected by a NTD and 4156 with no history of NTDs) were included. Overall, the results are consistent in showing a protective effect of daily folic acid supplementation (alone or in combination with other vitamins and minerals) in preventing NTDs compared with no interventions/placebo or vitamins and minerals without folic acid (risk ratio (RR) 0.28, 95% confidence interval (CI) 0.15 to 0.52). Only one study assessed the incidence of NTDs and the effect was not statistically significant (RR 0.08, 95% CI 0.00 to 1.33) although no events were found in the group that received folic acid. Folic acid had a significant protective effect for reoccurrence (RR 0.32, 95% CI 0.17 to 0.60). There is no statistically significant evidence of any effects on prevention of cleft palate, cleft lip, congenital cardiovascular defects, miscarriages or any other birth defects. There were no included trials assessing the effects of this intervention on maternal blood folate or anaemia at term.We found no evidence of short-term side effects. Folic acid, alone or in combination with vitamins and minerals, prevents NTDs but does not have a clear effect on other birth defects.

RETIRED: Pre-conceptional Vitamin/Folic Acid Supplementation 2007: The Use of Folic Acid in Combination With a Multivitamin Supplement for the Prevention of Neural Tube Defects and Other Congenital Anomalies

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