Preconceptional Folic Acid Supplementation Research Articles

Pre-conception folic acid and multivitamin supplementation for the prevention of Neural Tube Defect: An umbrella Review.

Previous reviews explored the association between maternal use of folic acid and multivitamin supplements and risk of Neural Tube Defect (NTD) in children, with no definitive conclusion. Using PRISMA guideline, PubMed, Embase, Scopus, Web of Sciences, Cochrane Database of Systematic Reviews, Scopus and Google Scholar which reported the effects of folic acid and/or multivitamin supplementation for the prevention of NTD in offspring were searched. The quality of the included studies was assessed using Assessment of Multiple Systematic Reviews (AMSTAR). A weighted inverse variance random-effects model was applied to find the pooled estimates. The subgroup analysis, heterogeneity, publication bias and sensitivity analysis were also assessed. Ten SRM with 296,816 study participants were included. The random-effects model analysis revealed that, the pooled effect of either folic acid or multivitamin supplementation for the prevention of NTD globally is found to be 0.43( 0.29, 0.58). In subgroup analysis the pooled effect found to be 0.23in folic acid group, while this estimate is 0.63 and 0.61in groups who took multivitamin. The pooled effect of prevention of NTD was found to be 0.50 in SRMs aimed at occurrence prevention group, while this estimate is 0.20) among SRMs which aimed at reoccurrence prevention, and 0.61 among those SRMs aimed to assess the effect folic acid or multivitamin for prevention of both occurrence and re-occurrence. The pooled effect of either folic acid or multivitamin supplementation for the prevention of NTD was found to be 0.45 in SRMs of observational studies, while this estimate is 0.43among SRMs of randomized controlled trials. Prenatal folic acid and /or multivitamin supplementation was associated with a 57% reduction in NTD. Participants who took folic acid supplementation were associated with a slightly higher (77%) percentage of reduction in NTD. An 80% and 50% reduction were observed for re-occurrence and occurrence prevention of NTD. A 57% and 55% reduction of NTD have been found in SRM of RCTs and observational studies. Considering the incorporation of those supplements in NTD prevention strategies during pre-conception period is recommended. More large-scale prospective cohort and RCTs are needed.

Preconception folic acid supplementation for the prevention of birth defects: a prospective, population-based cohort study in mainland China

BackgroundFolic acid supplementation is recommended for reducing the risk of birth defects. We aimed to assess the protective association of periconception folic acid supplements with birth defects in real-world setting.MethodsThis prospective, population-based cohort study utilized national preconception registered data of married Chinese couples planning a pregnancy within 6 months between 2010 and 2012 in Mainland China. Participated women are freely provided folic acid starting 3 months before conception till 3 months after conception. Birth defects were self-reported at 42 days postpartumn followup. R software (v4.0.2) was applied for statistical analyses.ResultsComplete data of 567,547 couples with pregnancy outcomes and folic acid supplementation were extracted for final analysis. A total of 74.7% women were with folic acid supplementation, and 599 birth defects were self-reported. The odd of birth defects was lower among women taking folic acid compared to their counterparts not taking (0.102% vs 0.116%, P < 0.001). In the multiple logistic regression analyses, the odd of birth defects was lower among couples with maternal folic acid supplementation (OR = 0.78, 95%CI: 0.66–0.95, P = 0.011), especially decreased odd of neural tube defects (NTDs) (OR = 0.56, 95%CI: 0.39–0.82, P = 0.003). This association was confirmed by 1:4 and 1:10 case control analysis. Odds of birth defects were significantly lower among women with folic acid supplementation more than 3 months before pregnancy (P < 0.001), and moreover, the odds of cleft (P = 0.007) and NTDs (P = 0.007) were of notable decrease.ConclusionThis retrospective case cohort study provides programmatic evidence for public health strategy-making to for reducing the risk of NTDs and clefts.

Determinants of neural tube defects among women who gave birth in hospitals in Eastern Ethiopia: evidence from a matched case control study

IntroductionNeural tube defects (NTDs) are severe birth defects caused by nutritional, genetic or environmental factors. Because NTDs continue to have a significant health and economic impact on children and community at large, it is crucial to investigate potential risk factors in order to develop novel approaches to NTDs prevention. Determinants for the development of NTDs differ by country, region as well as within the country. The objective of this study was to identify the determinants of NTDs among newborns delivered in three hospitals found in eastern Ethiopia.MethodsA hospital-based matched case-control study was conducted among 138 cases and 138 control women who delivered in three teaching hospitals in Eastern Ethiopia in 2021. Data were collected using a structured and pre-tested interviewer-administered questionnaire. Cases were mothers who delivered a neonate with any type of NTDs regardless of gestational age or fetal viability, whereas controls were mothers who delivered an apparently healthy newborn. Chi-square was used to assess the significant difference between the two groups. Conditional logistic regression model was used to generate adjusted odds ratio with its corresponding 95% confidence intervals and compare the two groups.ResultsAnencephaly (51.4%) and spinal bifida (34.1%) were the most frequently observed NTDs. None of study participants took preconception folic acid supplementation. Being a non-formal mothers (AOR = 0.34, 95% CI: 0.12–0.92, P = 0.034), rural residence, (AOR = 3.4, 95% CI: 1.18–9.78, P = 0.023), history of spontaneous abortion (AOR = 2.95, 95% CI: 1.15–7.55, P = 0.023), having severe anemia (AOR = 3.4, 95% CI: 1.17–9.87, P = 0.024), history of fever or cold (AOR = 2.75; 95% CI: 1.05–7.15, P = 0.038), and an exposure to various agro-chemicals (AOR = 3.39, 95% CI: 1.11–10.3, P = 0.032) were independent determinants of NTDs.Conclusion and RecommendationIn this study, NTDs were associated to several determinant factors in the area, including residential area, history of spontaneous abortion, severe anemia, fever/cold, antibiotic use before or during early pregnancy, and exposure to agrochemicals. Addressing the identified determinants is critical in averting the incidence of NTDs in the study area. Moreover, more research is needed to investigate women’s dietary practices as well as the practice of preconception folic acid supplementation for pregnant women in Ethiopia’s current health care system.

The association of preconceptional folic acid supplementation with gestational age and preterm birth risk in twin pregnancies: a prospective cohort study in China.

This study aims to explore the association of maternal preconceptional folic acid (FA) supplementation with gestational age and preterm birth in twin pregnancies, and whether the association varies by chorionicity or conception mode. From November 2018 to December 2021, the information of FA supplementation and pregnancy outcomes were collected in twin pregnant women. The linear regression models and the logistic regression were used to test the association of preconceptional FA supplementation with gestational age at delivery and preterm birth and premature rupture of membranes (PROM). A total of 416 twin pregnancies were included. Compared with no use in twins, maternal preconceptional FA use was associated with a 0.385-week longer gestational age (95% CI 0.019-0.751) and lower risk of preterm birth < 36weeks (adjusted OR 0.519; 95% CI 0.301-0.895) and PROM (adjusted OR 0.426; 95% CI 0.215-0.845). The protective effect on preterm birth < 36weeks and PROM is similar whether taking FA supplements alone or multivitamins. However, the associations varied by chorionicity and conception mode of twins or compliance with supplementation. The positive associations between preconceptional FA use and gestational age only remained significant among twins via assisted reproductive technology or dichorionic diamniotic twins. Significant protective effects on preterm birth < 36weeks and PROM were only found among women who took FA at least 4 times a week before conception. Maternal preconceptional FA supplementation was associated with longer gestation duration and lower risk of preterm birth < 36weeks and PROM in twin pregnancies. To improve the success of their pregnancies, reproductive women should start taking FA supplements well before conception and with good compliance.

Study of pre-conception care (PCC) amongst women in the first trimester coming to the obstetrics and gynaecology (OBGY) outpatient department (OPD) of a hospital in a rural area.

Pre-conception care (PCC) is a set of interventions that aim to identify and modify biomedical, behavioural and social risks to women's health and pregnancy outcomes. It was an observational descriptive cross-sectional study conducted in the obstetrics and gynaecology (OBGY) outpatient department (OPD) of a tertiary care teaching institute in a rural set-up. Two hundred women in the first trimester of pregnancy were interviewed using a pre-designed and pretested questionnaire following informed verbal consent. The study was conducted between May and September 2019. The study excluded women in the 2nd or 3rd trimester of pregnancy, inpatient department (IPD) patients and those unwilling to participate. The study revealed that 25.5% of the women had conceived between 14 and 19 years of age. Fifty-four percent of the pregnancies were unplanned. Merely 14.5% had consulted and 15% had their laboratory investigations performed before pregnancy. Only 11% had received pre-conception folic acid supplementation. Pregnancies with birth spacing <2 years accounted for 15%. The proportion of women with known risk factors was 38% being underweight, 9.5% being overweight, 8% being of short stature (height ≤145 cm), 63% having anaemia (haemoglobin <12 g/dL), 10% with a previous history of abortion, 3.5% with systemic diseases, 4.5% with poor oral hygiene, 1% with domestic violence, 3% with medication, 3% with tobacco addiction and 4.5% with radiation/environmental toxin exposure. One percent had the hepatitis B vaccine and 0.5% had the influenza vaccine. From our study, we conclude that the PCC services are meagre, and unhealthy women who conceive without adequate PCC are prone to maternal and foetal health complications.

Nutritional deficiency and MTHFR gene polymorphism in obstetrics

: This study was carried out to determine the association of folic acid deficiency, vitamin B12 deficiency, hyperhomocysteinemia and methylenetetrahydrofolate reductase (MTHFR) gene polymorphism with obstetrical events linked to folic acid deficiency like neural tube defects (NTD); unexplained abruption placentae (AP), recurrent pregnancy loss (RPL) and preterm labour(PTL).: In the present study 87 pregnant females with past or present history of either neural tube defect (NTD), abruptio placentae, recurrent pregnancy loss (RPL) or preterm labour and 100 pregnant females without any such history were enrolled. Serum levels of folic acid, vitamin B12 and homocysteine in these females were estimated using chemiluminescence and Polyacrylamide gel electrophoresis (PAGE) was used to detect MTHFR gene polymorphism.: No significant association was observed between serum folic acid levels and NTD (p = 0.495), RPL (p = 0.832) or preterm labour (p = 0.724). However, folic acid deficiency had significant association with the occurrence of abruptio placenta (p = 0.001). Serum vit B12 deficiency was found to be a significant risk factor only in patients with RPL. Increased homocysteine revealed significant association with RPL (p= 0.024), abruption placentae (p=0.002) and preterm labour (0.015). No polymorphism in MTHFR gene could be revealed in the above pregnancy complications.: In the present study, deficiency of folic acid was uncommon probably due to its routine supplementation throughout the first trimester. However, preconceptional folic acid supplementation still needs to be emphasized to build up adequate folic acid levels required during embryogenesis. The relationship between vit B12 and RPL needs studies on larger number to establish the association before supplementation is suggested. MTHFR677 gene polymorphism may have remained undetected due to small sample size.

Prevalence, Pattern, and Outcome of Congenital Anomalies Admitted to a Neonatal Unit in a Low-Income Country—a Ten-Year Retrospective Study

ObjectiveThe incidence of congenital abnormalities is highest in low-and-middle-income countries. However, the prevalence, spectrum, trends of neonatal congenital anomalies and their admission outcomes have not been well explored. This study was a 10 year retrospective hospital-based research in a low-income country to address the above.MethodsAll infants hospitalized in the Special Care Baby Unit at the Cape Coast Teaching Hospital in Ghana, between 1st January 2010 and 31st December 2019, had their demographic, obstetric, and clinical data recorded.ResultsOver the decade, 236 neonates with congenital abnormalities were admitted to the unit, accounting for 2.8% of total neonatal admissions and 8.6 per 1000 births. Mortality occurred in 33.2% of neonates with congenital abnormalities, corresponding to 4.6% of all neonatal deaths. Mortality was significantly associated with place of delivery and gravidity of more than five. The commonest anomalies were in the nervous system, particularly neural tube defects, followed by suspected chromosomal abnormalities and then cardiac defects. Neonates with cardiac defects had a higher chance of dying. Health center/clinic delivery proffered a better survival than hospital delivery, but this should be interpreted with caution.ConclusionNeural tube defects were the most predominant anomalies; hence, intensification of preconception and antenatal folic acid supplementation is pivotal towards their reduction. Making prenatal screening for early detection of fetal anomalies an integral part of routine antenatal care is also essential. This research was conducted in a single center and did not include stillbirths and abortions so cannot give an accurate estimation of the number of congenital abnormalities in the population. A national registry of congenital anomalies is recommended.

Prevalence and determinants of folic acid uptake among women of childbearing age in the Ho municipality of the volta region of Ghana

ABSTRACT Folic acid is an essential vitamin that is found in certain green lush vegetables, such as kale, spinach, and cabbage. An estimated 300,000 children are born with NTDs globally each year resulting in the death of approximately 88,000. Studies shows, preconceptional folic acid supplementation reduces the incidence of NTDs by more than 70%, however, adherence to supplementation remains low. This research explores the prevalence and determinants of Folic acid uptake among women of childbearing age in the Ho Municipality of the Volta Region, Ghana. This is a cross-sectional study where a multi-stage probability sampling technique was used in selecting 317 study participants. Chi-square test and multivariate logistic regression models were use to evaluate the effect of selected indicators on the uptake level of respondents on FA. A prevalence of 27.18% was determined. Ethnicity, occupation and availability of NHIS were associated with FA supplementation. Public health education strategies should be used to encourage FA use, increase awareness and knowledge on FA supplementation and pregnancy counseling to reduce the incidence of NTDs.

Women’s knowledge, attitudes and views of preconception health and intervention delivery methods: a cross-sectional survey

BackgroundSeveral preconception exposures have been associated with adverse pregnancy, birth and postpartum outcomes. However, few studies have investigated women’s knowledge of and attitudes towards preconception health, and the acceptability of potential intervention methods.MethodsSeven primary care centres in the West of England posted questionnaires to 4330 female patients aged 18 to 48 years. Without providing examples, we asked women to list maternal preconception exposures that might affect infant and maternal outcomes, and assessed their knowledge of nine literature-derived risk factors. Attitudes towards preconception health (interest, intentions, self-efficacy and perceived awareness and importance) and the acceptability of intervention delivery methods were also assessed. Multivariable multilevel regression examined participant characteristics associated with these outcomes.ResultsOf those who received questionnaires, 835 (19.3%) responded. Women were most aware of the preconception risk factors of diet (86.0%) and physical activity (79.2%). Few were aware of weight (40.1%), folic acid (32.9%), abuse (6.3%), advanced age (5.9%) and interpregnancy intervals (0.2%), and none mentioned interpregnancy weight change or excess iron intake. After adjusting for demographic and reproductive covariates, women aged 18–24-years (compared to 40–48-year-olds) and nulligravid women were less aware of the benefit of preconception folic acid supplementation (adjusted odds ratios (aOR) for age: 4.30 [2.10–8.80], gravidity: aOR 2.48 [1.70–3.62]). Younger women were more interested in learning more about preconception health (aOR 0.37 [0.21–0.63]) but nulligravid women were less interested in this (aOR 1.79 [1.30–2.46]). Women with the lowest household incomes (versus the highest) were less aware of preconception weight as a risk factor (aOR: 3.11 [1.65–5.84]) and rated the importance of preconception health lower (aOR 3.38 [1.90–6.00]). The most acceptable information delivery methods were websites/apps (99.5%), printed healthcare materials (98.6%), family/partners (96.3%), schools (94.4%), television (91.9%), pregnancy tests (91.0%) and doctors, midwives and nurses (86.8–97.0%). Dentists (23.9%) and hairdressers/beauticians (18.1%) were the least acceptable.ConclusionsOur findings demonstrate a need to promote awareness of preconception risk factors and motivation for preconception health changes, particularly amongst younger and nulligravid women and women with lower incomes. Interventions to improve preconception health should focus on communication from healthcare professionals, schools, family members, and digital media.

Knowledge, Attitude and Practices (KAP) of Preconceptional Folic Acid supplementation among pregnant women (18-45years) attending antenatal clinic in Alex Ekwueme Federal University Teaching hospital Abakaliki, Ebonyi State, Nigeria

Background: Folate deficiency is associated with poor pregnancy outcomes and is one of the most common vitamin deficiencies in women, especially those of reproductive age. Folic acid intake prior to, and during, the first months of pregnancy significantly reduces the risk of fetal neural tube defects. Maternal folate status has been associated with other adverse pregnancy outcomes such as preeclampsia, malformations (orofacial clefts, Neural tube defects, anencephaly and encephalocele resulting from incomplete neural tube closure during early embryogenesis), spontaneous abortion, fetal death, fetal growth restriction and preterm delivery. Methods: The study embraced a cross-sectional study that assess Knowledge, Attitude and Practice of preconceptional folic acid supplementation among pregnant women (18-45years) attending antenatal clinic in Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State. 152 women attending antenatal clinics in Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State were interviewed using structured questionnaire. Data collected were analyzed using SPSS version 21 for frequency and percentage at P &lt; 0.05 significance level. Results: 98.7% of the participants had heard about folic acid, but an analysis of data shows that 26.6% of them knew that folic acid is a vitamin. In addition, very few (29.6%) knew that folic acid could prevent neural tube defects. The main source of information about folic acid supplementation among the surveyed women were through the health workers. Incidence of at least one episode of adverse pregnancy outcome was noted in about 35.5% of the population under study though a majority indicated the form for their loss were miscarriage and stillbirth. Finding showed that 37.5% of the respondent claimed to have used folic acid before pregnancy while 40.1% of the women in this study were aware of the right time to start using folic acid. 46% of the women took folic acid during Antenatal care and their reason were attributed to late presentation for antenatal care, delayed prescription of the folic acid for women during pregnancy, unplanned pregnancy while others claimed they are getting enough folate from food. Approximately 40.8% of the respondents had started supplementation on antenatal booking and from analysis of data on the preferred/normal booking time of the respondents it shows that a high percentage of them attended antenatal from the third month of pregnancy this shows that the majority of the respondents started supplementation too late which is inconsistent with the ideal time to start folic acid supplementation in prevention of neural tube defect. In this study it has been revealed that 48% of the respondents could identify green leafy vegetable as the only source of folate in local foods and 0.7% could identify other food sources like legumes and fruits as sources of folate. Conclusion: There is a low overall level of awareness of folic acid among pregnant women including lack of understanding of its natural sources, usefulness in preventing Neural Tube Defects and preconceptional intake recommendation. Health education regarding the preconceptional use of folic acid among women of reproductive age is recommended.

Association between maternal prepregnancy diabetes mellitus and preconception folic acid supplement use by Hispanic ethnicity: Findings from Georgia, New York City, and Puerto Rico PRAMS 2016–2018

AbstractBackgroundMaternal ethnicity, prepregnancy diabetes, and preconception folic acid intake, are all associated with increased risk of neural tube defects in the United States. We assessed the association between prepregnancy diabetes and preconception folic acid use by Hispanic ethnicity.MethodsWe used population‐based, cross‐sectional survey data from New York City, Georgia and Puerto Rico's 2016–2018 Pregnancy Risk Assessment Monitoring System (PRAMS). Prepregnancy Type 1 or Type 2 diabetes was self‐reported. Adequate preconception folic acid intake was defined as intake of a multivitamin, a prenatal vitamin, or a folic acid vitamin 4–7 times/week during the month before pregnancy. Multivariable logistic regression was used to calculate adjusted prevalence odds ratio (aPORs) and 95% confidence intervals (CI), stratified by Hispanic ethnicity.ResultsPrepregnancy diabetes was reported by 2.9% of Hispanic and 3.6% of non‐Hispanic participants. Adequate preconception folic acid use was reported by 25.9% and 39.9% of Hispanics and non‐Hispanics, respectively. There was an inverse association between prepregnancy diabetes and preconception folic acid use among Hispanics (aPOR = 0.75; 95% CI = 0.31, 1.81), while the association was positive among non‐Hispanics (aPOR = 1.26; 95% CI = 0.70, 2.26); however, the 95% confidence intervals for both groups contained the null value.ConclusionsThe association between prepregnancy diabetes and folic acid intake varied by Hispanic ethnicity. Our hypothesis that reproductive‐aged women with prepregnancy diabetes may receive timely diabetic care, including health counseling to take preconception folic acid, was not supported by our study data. Future studies should examine the association in additional PRAMS sites. Preconception health screening, and folic acid intake among Hispanics, should be strengthened.

Current state of preconception care in sub-Saharan Africa: A systematic scoping review.

BackgroundPreconception care (PCC) utilisation is essential to extend and complete the health continuum. However, these services are not yet incorporated into many low-income countries’ existing maternal health services.AimThis study aims to review the current literature on the knowledge, utilisation and provision of PCC.SettingThis included women and healthcare workers (HCWs) in Sub-Saharan African (SSA) countries.MethodsArksey and O’Malley’s scoping review methodology framework is used in this study. The following databases, Google Scholar, Science Direct, PubMed, Scopus and Dissertation via ProQuest, were searched. Articles that met the eligibility criteria were included in this study.ResultsOut of the 451 retrieved articles, 39 were relevant. In most studies, women’s utilisation and HCW’s provision of PCC were considered limited. Their knowledge, however, varies between studies, and there were a few studies conducted among women with chronic conditions. Several factors influenced women and HCWs’ knowledge, utilisation and provision of PCC, including age, level of education, employment, practice area, resources and knowledge. Preconception care interventions most commonly identified, utilised and provided were HIV testing, counselling and family planning, while preconception folic acid supplementation was the least.ConclusionThe estimates of knowledge and utilisation were suboptimal among women, while provision was the worst affected among HCWs. Gaps exist between the HCW knowledge and practice of PCC. There is a need to promote, prioritise, integrate and optimise the opportunistic provision of PCC in SSA. There is also a need for more studies on PCC provision and utilisation among women with chronic medical conditions.

Trend and burden of neural tube defects among cohort of pregnant women in Ethiopia: Where are we in the prevention and what is the way forward?

Neural tube defect is one of the top five most serious birth defects in the world. In Ethiopia an accurate estimate of the trend and burden of neural tube defects is still unknown. There hasn't been much research done on the prevalence and trend of neural tube defects in Eastern Ethiopia. To complement previous efforts of studies, the purpose of this study is to estimate the trend and burden of neural tube defects in Eastern Ethiopia as well as to investigate the epidemiological implications of the findings. A facility-based retrospective cohort study was carried out from cohort pregnant women who delivered in selected hospitals. File records of all babies who were found to have neural tube defects could be reached between 2017 and 2019. A structured checklist was used to collect data. The incidence of each case was calculated by dividing the number of cases per year by the total number of live births in each hospital. To determine the linear trend of neural tube defects over time, linear trend of Extended Mantel-Haenszel chi-square was performed. Data were presented using frequencies and percentages. Data were analyzed using SPSS for windows version 25. A total of 48,750 deliveries were recorded during the three years of the study considered for analyses with 522 women having neural tube defect giving an incidence rate of 107.5 per 10,000 live births in the three years. The most common types of neural tube defects found in the area were anencephaly and spina bifida accounting for 48.1% and 22.6%, respectively. The distribution of neural tube defects varied across the study hospitals, with Adama Medical College Hospital having the highest proportion (46.6%). Over half of the mothers (56.7%) live in cities. Mothers in the age group 25-34 (46.9%) and multigravida mothers had higher proportions (64.4%).of neural tube defects. None of the mothers took folic acid before conception, and only 19% took iron folic acid supplementation during their pregnancy. The findings showed that an increasing trend and burden of neural tube defects and preconception folic acid supplementation is insignificant in the region which showed that where we are in the prevention of neural tube defects. The finding suggests that preconception folic acid supplementation in conjunction with health care services should be considered to reduce the risk of neural tube defects in the region. Aside from that, intensive prevention efforts for long-term folate intake through dietary diversification and appropriate public health interventions are required. Furthermore, data must be properly recorded in order to address disparities in neonatal death due to neural tube defects, and the determinants of neural tube defects should be investigated using large scale prospective studies with biomarkers.

Dietary folate intake and fecundability in two preconception cohorts.

To what extent is dietary folate intake and total folate intake (dietary and supplemental intakes) associated with fecundability, the per cycle probability of conception? Preconception dietary folate intake was positively associated with fecundability in a monotonic pattern. Supplemental folic acid has been associated with improved fertility, but little is known about the relation between dietary folate and fecundability. A prospective cohort study including 9559 women trying to conceive without fertility treatment and enrolled in the period 2013-2020. We used data from two internet-based prospective cohort studies of pregnancy planners from Denmark, where folic acid fortification is not performed (SnartForældre.dk (SF); n = 3755) and North America, where the food supply is fortified with folic acid (Pregnancy Study Online (PRESTO); n = 5804). Women contributed menstrual cycles at risk until they reported conception or experienced a censoring event. We used proportional probabilities regression models to compute fecundability ratios (FRs) and 95% CI, adjusting for potential confounders. Compared with a dietary folate intake ≥400 µg/day, the adjusted FRs for women in SF were 0.92 (95% CI: 0.85-0.99) for intake 250-399 µg/day, and 0.80 (95% CI: 0.68-0.94) for intake of <250 µg/day. The corresponding FRs in PRESTO were 0.95 (95% CI: 0.89-1.01) and 0.81 (95% CI: 0.65-1.00). Compared with the highest level of total folate intake (diet folate ≥400 µg/day plus folic acid supplementation), in both cohorts fecundability was lowest among women with the lowest dietary intake <250 µg/day dietary folate and no supplementation (FR: 0.76, 95% CI: 0.59-0.98 [SF] and 0.49, 95% CI: 0.31-0.77 [PRESTO]). Further, total intake dietary folate <250 µg/day plus supplementation was associated with reduced fecundability for SF participants (FR; 0.79, 95% CI: 0.65-0.98) and for PRESTO participants (FR; 0.92, 95% CI: 0.72-1.16). It is unknown whether dietary folate and folic acid intake affect fecundability on its own or if there is an interaction with other micronutrients provided in healthy diet. Thus, the observed associations may not reflect dietary folate intake alone, but overall healthy diet. Recommendations for preconception dietary folate intake and folic acid supplementation are of importance not only to prevent neural tube defects but also to enhance fecundability. The study was supported by the National Institute of Child Health and Human Development (R01-HD086742). The authors report no competing interests. N/A.

New Born Children with NTD

Background: The aim of the study was to describe epidemiological aspects and clinical characteristics of these patients, as well as diagnostic work-up, comprehensive management and updated follow-up. Methods: In a 4-years’ period, 6 female and 4 male fetuses were diagnosed with NTD in Department of OBG at Victoria Hospital, BMCRI, Bangalore. Analyzed data were related to familiar and/or maternal risk factors (consanguinity, maternal preexisting and/or gestational diseases, exposure to teratogen/infectious agents, lack of preconception folic acid supplement), demographic (ethnicity/origin, residence) and clinical features (eventual use of assisted reproduction techniques, prenatal diagnosis, gestational age, fetal presentation, type of delivery, birth weight, preoperative imaging, antibiotics and analgesics use, description of the surgery intervention, length of hospital stay, comorbidities, complications), and follow-up. Results: Among 10 cases, 6 female and 4 male fetuses were diagnosed with NTD. All 10 fetuses had Anencephaly and other associated anomalies. The diagnosis was made by prenatal ultrasonography. Among ten mothers one was over-aged. Medical history revealed that only 2 mothers used folic acid (FA), -tablets containing 5 mg folic acid, once daily, beginning after being aware of the pregnancy- neither initiated preconceptionally, nor consumed regularly. The remaining 8 mothers did not use any supplements. No mothers used any kind of drugs during pregnancy, and 2 were diabetic. All patients had normal thyroid, liver and renal function tests. Abdominal ultrasonography revealed no abnormality.

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.

Level of Awareness and Knowledge of Folic Acid Intake among Women in the Reproductive Age in ARAR Region, Saudi Arabia

Background: Folic acid reduces the risk of neural tube defects. As approximately 50% of pregnancies are unintended, women of reproductive age should be aware of the importance of folic acid. This study aims to assess the level of awareness and knowledge among childbearing female on the importance of preconception folic acid supplementation in preventing neural tube defects (NTDs) in Arar city.&#x0D; Methodology: A population-based cross-sectional study was conducted in Arar city, Norther Saudi Arabia on included Saudi women in reproductive age. A pre-designed online questionnaire was used for data collection. Data was entered and analyzed using statistical package for Social Sciences Program, version 20 (SPSS Inc., Chicago, Illinois, USA). The results were displayed as counts, percentages. Appropriate statistical tests will be used for comparisons. P ≤ 0.05 is considered significant.&#x0D; Results: The sample consisted of 428 women in reproductive age, 60.1% aged between 30 to 40 years, 39% aged between 20 to 30 years and only 0.9% aged between 18 to 20 years old. 91.8% were married. 85% of participants reported that their doctor prescribed folic pills for them before. 95.1% think that women should take folic acid pills in pregnancy while 75.2% think that it is necessary to take folic pills pre-pregnancy. 85.3% had taken folic acid pills in previous pregnancy. 31.3% think that it should be stopped after pregnancy. 84.6% think that folate deficiency causes fetal abnormalities. Only 8.4% of studied women reported attending seminar or lecture on folic acid importance.&#x0D; Conclusion: The results of the current study affirmed good knowledge of folic acid supplementation usage during pregnancy among women in Arar, KSA. There was a significant association between knowledge of folic acid taking importance during pregnancy with marital status, number of children, and educational level of participants.

Women with epilepsy before and during pregnancy: a case series of outpatient counseling in atertiary epilepsy center

Data of large pregnancy registries have improved the recommendations for women with epilepsy before pregnancy. Monotherapy containing antiepileptic drugs with alow malformation rate (lamotrigine or levetiracetam) is recommended as well as preconceptional folic acid supplementation, while valproic acid should be avoided. The practicability of these recommendations remains controversial. Retrospective case series of 160women with epilepsy over aperiod of 5years who were advised in our outpatient department before and during pregnancy. Only 18.9% of women presented with valproic acid. Even without valproic acid, complications or emergency admissions rarely occurred under specialist supervision. In our case series, lamotrigine proved to be less effective and less controllable than other drugs during pregnancy. Levetiracetam also has alow malformation rate, but showed abetter effect on seizure outcome during pregnancy than lamotrigine. Only 12% of women who wanted to have children took folic acid. This case series comes from atertiary center; the referred women were mainly accompanied by neurologists with special expertise in epileptology. In this group valproate could be avoided in most cases. Lamotrigine is probably less effective due to the drop in blood levels during pregnancy. Levetiracetam seems to be agood alternative, working well against focal and generalized seizures. Folic acid may be taken later than recommended.

Folates, folic acid and preconception care - a review.

SummaryThe link between folate deficiency and congenital spina bifida defects was first suggested in the 1960s. Although the prevention of these defects by preconception folic acid supplementation was confirmed in a large multi-centre controlled trial in 1991, its subsequent implementation as health education advice has made very little difference. North America’s policy of folic acid fortification of flour and bread has had a beneficial impact. No European country has implemented fortification due to concern over possible adverse effects on older subjects, but a recent review shows these to be largely hypothetical and far outweighed by beneficial effects. Recent research by Menezo et al. has, however, shown that folic acid is ineffective for some women with severe fertility problems including recurrent miscarriage and failed in vitro fertilisation. There is a genetically determined bottleneck (677TT) in their folate metabolism that can be successfully overridden by going straight to the next step in the metabolic pathway and taking 5-methylytetrahydrofolate, as a preconception supplement. Menezo suggests that all women with fertility problems should be tested for 677TT. If fortification of flour and bread is to be implemented in the UK, there should be monitoring for possible adverse effects including the incidence of colorectal cancers and cognitive decline. In conclusion, whilst there are concerns that fortification could have a detrimental effect on these conditions, there is sound evidence that it would have much greater beneficial effects.

Open Neural Tube Defects: A Case Presentation of 30-year-old Secundigravida with Spina Bifida of the Fetus

Spina bifida is a neural tube defect that occurs in about 1 in 1,500 pregnancies. Open spinal defects are associated with paralysis, incontinence and hydrocephalus requiring postnatal shunting of the cerebrospinal fluid. Neural tube defects are preventable through preconceptional folic acid supplementation. Occasionally, the diagnosis is made during routine anomaly scan at 18-20 weeks of gestation, as the earliest signs of the anomaly can be seen at the end of first trimester. The information provided by ultrasound plays a crucial role in patient counseling and pregnancy management. The authors report a case of prenatal diagnosis of spina bifida aperta with focus on detailed ultrasound presentation and difficulties in consulting in relation to the prognosis for the newborns.