Tube Defects In Offspring Research Articles

Maternal occupation and the risk of neural tube defects in offspring

ABSTRACTWe evaluated the association between maternal occupation and the risk of neural tube defects (NTDs) in offspring. Data for 491 nonsyndromic cases were obtained from the Texas Birth Defects Registry for deliveries between 1999 and 2009. We randomly selected 2,291 controls among all live births in Texas during this time. Maternal occupations were classified using automated software and manual assignment. Multivariable logistic regression analyses were used to examine the relationship between maternal occupation and risk for any NTD, adjusting for maternal race/ethnicity, any diabetes, and maternal body mass index. These analyses were repeated for spina bifida specifically. Some maternal occupations, particularly those related to business/finance, health care practice, and cleaning/maintenance, were significantly associated with increased risk of spina bifida and/or any NTD. Further research is needed to identify the specific occupational exposures related to NTD risk.

Association of essential trace metals in maternal hair with the risk of neural tube defects in offspring.

The relationship between essential trace metals (ETMs) and the risk of neural tube defects (NTDs) is still unclear. One of the challenges is to evaluate the intake of ETMs of women during their early period of pregnancy. We proposed the hypothesis that an ETM deficiency in women during their early period of pregnancy is associated with an elevated risk of NTDs in offspring. We recruited 191 women with NTD-affected pregnancies (case group) and 261 women who delivered healthy infants (control group). Nine ETMs in hair sections grown during maternal early pregnancy were analyzed: iron (Fe), zinc (Zn), copper (Cu), cobalt (Co), manganese (Mn), chromium (Cr), nickel (Ni), molybdenum (Mo), and stannum (Sn). Information on maternal dietary habits were collected by questionnaire. We observed a significant decreasing trend in the dose-response relationships between the Ni and Mo concentrations in hair and NTD risks. A Zn deficiency was only associated with an elevated risk of spina bifida, and a Sn deficiency was only associated with anencephaly. The Ni and Zn concentrations in hair were positively correlated with the frequency of consumption of fresh green vegetables and fresh fruits, while the Zn concentration was also associated with fish or meat consumption. We concluded that maternal intakes of the four ETMs (Ni, Mo, Zn, and Sn) played an important role in the formation of NTDs in our study population, and that this intake is related to maternal dietary habits.Birth Defects Research 109:234-243, 2017.© 2016 Wiley Periodicals, Inc.

Association between titanium and silver concentrations in maternal hair and risk of neural tube defects in offspring: A case-control study in north China

Increasing uses of titanium and silver in various products raise concerns for their potential adverse effects on pregnancy outcomes. We aimed to examine the associations between titanium and silver concentrations in maternal hair growing during the periconception period and the risk of neural tube defects (NTDs) in offspring. Our case–control study recruited 191 women with NTD-affected pregnancies and 261 women delivering healthy infants. Metal concentrations in maternal hair were measured by inductively coupled plasma-mass spectrometry. The adjusted odds ratios (AOR) of titanium concentration above the median were 1.46 (95% confidence interval (CI), 0.99–2.13) for total NTDs and 2.10 (95% CI, 1.12–3.94) for anencephaly, while OR of silver wasn't statistically significant. Titanium concentration was positively correlated with consumptions of vegetables and fruits. Maternal exposure to titanium during the periconception period was associated with an increased NTD risk in offspring, which may be partly mediated through maternal dietary habits.

Maternal obesity and the risk of neural tube defects in offspring: A meta-analysis

The aim of this was to access maternal obesity and the risk of neural tube defects (NTDs) in offspring, and establishes a nonlinear dose-response relationship between maternal body mass index (BMI) and risk of NTDs in offspring. PubMed and Web of Science were systematically searched. We compared NTDs risk difference in maternal obesity group vs. normal weight group+overweight group, and maternal obesity group vs. normal weight group. We also examined the dose-response relationship between maternal body mass index and the risk of NTDs in offspring. A total of 22 studies with 1,758,832 patients included in the meta-analysis. The results showed obesity maternal obesity is an important risk factor for NTDs in offspring. When maternal obesity group compared with normal weight group+overweight group, the summary OR of NTDs was 1.632 (95% CI 1.473-1.808; Z=9.37, P<0.00001); when maternal obesity group compared with normal weight group, the summary OR was 1.682 (95% CI 1.510-1.873; Z=9.44, P<0.00001). No publication biases were found. Dose-response meta-analysis showed statistically significant association between maternal BMI and risk of NTDs in offspring (model χ2=41.49, <0.00001). In linear model, the OR of NTDs in offspring was 1.040 (95% CI 1.027-1.051) for every 1kg/m2 BMI increase in mother. In spline model, the OR of NTDs in offspring risk increased rapidly along with maternal BMI, especially when BMI >30kg/m2. Sensitivity analyses by only included the studies reported adjusted OR showed the result was robust. Our meta-analysis indicated that maternal obesity is an important risk factor for neural tube defects in offspring.

Maternal plasma folate, vitamin B12 levels and multivitamin supplementation during pregnancy and risk of Autism Spectrum Disorder in the Boston Birth Cohort

BackgroundThe role of preconception/prenatal nutrition in the development of Autism Spectrum Disorder (ASD) is under-studied. Maternal adequate folate intake is important in protecting against neural tube defects in offspring, but uncertainty remains on its role in ASD. ObjectiveTo understand the relationship between maternal multivitamin supplementation during pregnancy and maternal plasma biomarkers of folate and vitamin B12 measured 24–72 hours after delivery and risk of later Autism Spectrum Disorder in children. MethodsData are from the Boston Birth Cohort, an ongoing longitudinal prospective birth cohort study that recruited low-income urban, primarily minority mother-offspring pairs (n=1,391) at the Boston Medical Center and followed them from birth through childhood between 1998–2013. Based on electronic medical records, children were diagnosed as having ASD (n=107) or categorized as ‘typical’ (n=1284). Prenatal multivitamin supplement intake data and maternal blood samples were collected 24–72 ho...

The green tea polyphenol EGCG alleviates maternal diabetes–induced neural tube defects by inhibiting DNA hypermethylation

Maternal diabetes increases the risk of neural tube defects in offspring. Our previous study demonstrated that the green tea polyphenol, Epigallocatechin gallate, inhibits high glucose-induced neural tube defects in cultured embryos. However, the therapeutic effect of Epigallocatechin gallate on maternal diabetes-induced neural tube defects is still unclear. We aimed to examine whether Epigallocatechin gallate treatment can reduce maternal diabetes-induced DNA methylation and neural tube defects. Nondiabetic and diabetic pregnant mice at embryonic day 5.5 were given drinking water with or without 1 or 10 μM Epigallocatechin gallate. At embryonic day 8.75, embryos were dissected from the visceral yolk sac for the measurement of the levels and activity of DNA methyltransferases, the levels of global DNA methylation, and methylation in the CpG islands of neural tube closure essential gene promoters. embryonic day 10.5 embryos were examined for neural tube defect incidence. Epigallocatechin gallate treatment did not affect embryonic development because embryos from nondiabetic dams treated with Epigallocatechin gallate did not exhibit any neural tube defects. Treatment with 1 μM Epigallocatechin gallate did not reduce maternal diabetes-induced neural tube defects significantly. Embryos from diabetic dams treated with 10 μM Epigallocatechin gallate had a significantly lower neural tube defect incidence compared with that of embryos without Epigallocatechin gallate treatment. Epigallocatechin gallate reduced neural tube defect rates from 29.5% to 2%, an incidence that is comparable with that of embryos from nondiabetic dams. Ten micromoles of Epigallocatechin gallate treatment blocked maternal diabetes-increased DNA methyltransferases 3a and 3b expression and their activities, leading to the suppression of global DNA hypermethylation. Additionally, 10 μM Epigallocatechin gallate abrogated maternal diabetes-increased DNA methylation in the CpG islands of neural tube closure essential genes, including Grhl3, Pax3, and Tulp3. Epigallocatechin gallate reduces maternal diabetes-induced neural tube defects formation and blocks the enhanced expression and activity of DNA methyltransferases, leading to the suppression of DNA hypermethylation and the restoration of neural tube closure essential gene expression. These observations suggest that Epigallocatechin gallate supplements could mitigate the teratogenic effects of hyperglycemia on the developing embryo and prevent diabetes-induced neural tube defects.

Maternal Coffee Consumption During Pregnancy and Neural Tube Defects in Offspring: A Meta-Analysis

ABSTRACTPurpose To examine the association between maternal coffee consumption during pregnancy and the occurrence of neural tube defects (NTDs) in offspring. Methods PubMed, Springer Link and Elsevier databases were searched up to August, 2014. Case-control and cohort studies published on the association between maternal coffee consumption during pregnancy and the occurrence of NTDs in offspring were included. Meta-analysis was applied to calculate the pooled effect estimates and their 95% confidence intervals (CIs) using a random-effects model. Results A total of six case-control studies and one cohort study were included. The pooled effect estimate of maternal coffee consumption during pregnancy was 0.86 for total NTDs (95% CI: 0.51– 1.45) and 1.30 (95% CI: 0.67– 2.52) for NTDs subtype of spina bifida. Conclusions Our findings suggested that maternal coffee consumption during pregnancy was not significantly associated with the occurrence of total NTD or the spina bifida subtype of NTD.

Maternal periconceptional alcohol consumption and the risk of neural tube defects in offspring: a meta-analysis

Objective: Several studies have been conducted to examine the association between alcohol consumption during pregnancy and risk of neural tube defects (NTDs), while the results are inconsistent. In the present study, we aimed to clarify the relationship between maternal periconceptional alcohol consumption and NTDs risk in offspring.Methods: PubMed, Springer Link, and Elsevier databases were searched up to November, 2014. All case–control and cohort studies of maternal alcohol consumption during pregnancy with risk of NTDs were included. The pooled odds ratios (ORs) and their 95% confidence intervals (CIs) for highest versus lowest category of alcohol consumption were calculated using a fixed- or random-effects model.Results: The pooled ORs of maternal periconceptional alcohol consumption were 1.01 (95% CI: 0.71–1.45) for total NTDs and 1.03 (95% CI: 0.65–1.64) for NTDs subtype of spina bifida. Specifically, the pooled ORs of maternal alcohol consumption in the first trimester and binge drinking were 1.01 (95% CI: 0.71–1.43), and 1.07 (95% CI: 0.81–1.41), respectively.Conclusions: Our findings suggested no association between maternal periconceptional alcohol consumption and NTDs risk in offspring.

Poor sleep during the periconceptional period increases risk for neural tube defects in offspring.

Poor sleep has been studied in relation to various diseases. Few studies have investigated the effect of poor sleep on birth defects. We examined the association of maternal poor sleep during periconceptional period and the risk of neural tube defects (NTDs) in offspring based on a large case-control study in northern China. The subjects included 629 NTD cases and 858 normal controls investigated between 2002 and 2007. Maternal sleep status was collected by health workers within first week after delivery. Logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI) of NTDs in association with poor sleep. The proportion of mothers with frequent poor sleep (≥4 days/week on average) was markedly higher in NTDs group (5.9%) than in control group (1.2%). In the multivariate analysis, frequent poor sleep was significantly associated with an increased risk of total NTDs (adjusted OR, 4.1; 95% CI, 1.9-8.8) and spina bifida subtype (adjusted OR, 6.4; 95% CI, 2.8-14.5). Frequent poor sleep showed a significant interaction with body mass index (BMI). Relative to women who reported poor sleep <4 days/week and with BMI < 24, frequent poor sleep showed a markedly higher increased risk of NTDs among overweight or obese women (adjusted OR, 11.8; 95% CI, 1.4-97.6) than women with BMI < 24 (adjusted OR, 2.5; 95% CI,1.1-5.9). Maternal frequent poor sleep during the periconceptional period may increase the risk for all NTDs and spina bifida. The association appears to be independent of some lifestyle factors that are closely associated with sleep quality.

Maternal consumption of non-staple food in the first trimester and risk of neural tube defects in offspring.

To study the associations between maternal consumption of non-staple food in the first trimester and risk of neural tube defects (NTDs) in offspring. Data collected from a hospital-based case-control study conducted between 2006 and 2008 in Shandong/Shanxi provinces including 459 mothers with NTDs-affected births and 459 mothers without NTDs-affected births. Logistic regression models were used to examine the associations between maternal consumption of non-staple food in the first trimester and risk of NTDs in offspring. The effects were evaluated by odds ratio (OR) and 95% confidence intervals (95% CIs) with SAS9.1.3.software. Maternal consumption of milk, fresh fruits and nuts in the first trimester were protective factors for total NTDs. Compared with consumption frequency of ˂1 meal/week, the ORs for milk consumption frequency of 1–2, 3–6, ≥7 meals/week were 0.50 (95% CI: 0.28–0.88), 0.56 (0.32–0.99), and 0.59 (0.38–0.90), respectively; the ORs for fresh fruits consumption frequency of 1–2, 3–6, ≥7 meals/week were 0.29 (95% CI: 0.12–0.72), 0.22 (0.09–0.53), and 0.32 (0.14–0.71), respectively; the ORs for nuts consumption frequency of 1–2, 3–6, ≥7 meals/week were 0.60 (95% CI: 0.38–0.94), 0.49 (0.31–0.79), and 0.63 (0.36–1.08), respectively. Different effects of above factors on NTDs were found for subtypes of anencephaly and spina bifida. Maternal non-staple food consumption of milk, fresh fruits and nuts in the first trimester was associated with reducing NTDs risk in offspring.

Markers of macromolecular oxidative damage in maternal serum and risk of neural tube defects in offspring

Neural tube defects (NTDs) are among the most common and severe congenital malformations. To examine the association between markers of macromolecular oxidative damage and risk of NTDs, we measured levels of 8-hydroxy-2′-deoxyguanosine (8-OHdG), protein carbonyl (PC), and 8-iso-prostaglandin F2α (8-iso-PGF2α) in maternal serum samples of 117 women with NTD-affected pregnancies and 121 women with healthy term newborns. We found higher levels of 8-OHdG and PC in the NTD group than in the control group; however, we did not observe a statistically significant difference in 8-iso-PGF2α levels between the NTD and the control groups. NTD risk increased with increasing quartiles of 8-OHdG [odds ratio (OR)=1.17; 95% confidence interval (CI) 0.39–3.51; OR=2.19; 95% CI, 0.68–7.01; OR=3.70; 95% CI, 1.30–10.51, for the second, third, and fourth quartile relative to the lowest quartile, respectively; P=0.009], and with increasing quartiles of PC (OR=2.26; 95% CI, 0.66–7.69; OR=3.86; 95% CI, 1.17–12.80; OR=5.98; 95% CI, 1.82–19.66, for the second, third, and fourth quartile relative to the lowest quartile, respectively; P=0.002]. Serum levels of 8-OHdG were higher in women who did not take folic acid supplements during the periconceptional period. These results suggest that oxidative stress is present in women carrying pregnancies affected by NTDs.

Levels of polycyclic aromatic hydrocarbons in maternal serum and risk of neural tube defects in offspring.

Polycyclic aromatic hydrocarbons (PAHs) are ubiquitous environmental pollutants, and have been reported to be a risk factor for human neural tube defects (NTDs). We investigated the relationship between PAH concentrations in maternal serum and NTD risk in offspring using a case-control study design, and explored the link between PAH concentrations to household energy usage characteristics and life styles. One hundred and seventeen women who had NTD-affected pregnancies (cases) and 121 women who delivered healthy infants (controls) were recruited in Northern China. Maternal blood samples were collected at pregnancy termination or at delivery. Twenty-seven PAHs were measured by gas chromatography–mass spectrometry. The concentrations of 13 individual PAHs detected were significantly higher in the cases than in the controls. Clear dose–response relationships between concentrations of most individual PAHs and the risk of total NTDs or subtypes were observed, even when potential covariates were adjusted for. High-molecular-weight PAHs (H-PAHs) showed higher risk than low-molecular-weight PAHs (L-PAHs). No associations between PAH concentrations and indoor life styles and energy usage characteristics were observed. It was concluded that maternal exposure to PAHs was associated with an increased risk of NTDs, and H-PAHs overall posed a higher risk for NTDs than L-PAHs.

Association between maternal single nucleotide polymorphisms in genes regulating glucose metabolism and risk for neural tube defects in offspring.

Maternal pregestational hyperglycemia, diabetes, and obesity are well-established risk factors for neural tube defects (NTDs). As a common underlying mechanism, the imbalance of glucose homeostasis is directly related to the development of NTDs. Polymorphisms in genes regulating glucose metabolism in women may impact their chance of having an NTD-affected pregnancy. We conducted a two-stage case-control study to investigate the association between maternal genetic variants in genes regulating glucose metabolism and risk for NTDs. The cases were 547 women who gave birth to a child with an NTD (anencephaly, spina bifida, or encephalocele); the controls were 543 women who gave birth to a full-term healthy infant. In the first stage, 12 single nucleotide polymorphisms were genotyped in 160 cases and 162 controls. In the second stage, five single nucleotide polymorphisms found in the first stage and potentially associated with NTD risk were genotyped for validation, in an additional 387 cases and 381 controls. Combined analysis of data from the two stages showed an association between maternal AA genotype of GCKR rs780094 and increased risk for total NTDs [odds ratio, 1.73; 95% confidence interval, 1.16-2.59) and spina bifida subtype [odds ratio, 1.83; 95% confidence interval, 1.16-2.88). No association was found between the other four single nucleotide polymorphisms (LEPR rs1137100, HK1 rs748235, HHEX rs5015480, KCNQ1 rs2237892) and NTD risk. The AA genotype in maternal GCKR rs780094 is associated with an increased risk for NTDs and spina bifida in the Chinese population.

Variants in maternal COMT and MTHFR genes and risk of neural tube defects in offspring

Methylenetetrahydrofolate reductase (MTHFR) C677T and catechol-O-Methyltransferase (COMT) G158A are associated with a risk of neural tube defects (NTDs) in offspring. This study examined the effect of a MTHFR × COMT interaction on the risk of NTDs in a Chinese population with a high prevalence of NTDs. A total of 576 fetuses or newborns with NTDs and 594 controls were genotyped for MTHFRrs1801133, MTHFRrs1801131, and COMTrs4680 and COMTrs737865. Information on maternal sociodemographic characteristics, reproductive history, and related behavior was collected through face-to-face interviews. Possible interactions between genetic variants of MTHFR and COMT were examined. MTHFR C677T homozygous TT was associated with an elevated risk of total NTDs (odds ratio [OR] = 1.37, 95 % confidence interval [CI] = 0.93-2.03) and of anencephaly (OR = 1.67, 95 % CI = 0.98-2.84) compared with the CC genotype. There was a COMT rs737865 CC × MTHFR rs1801133 TT interaction for total NTDs (OR = 3.02, 95 % CI = 1.00-9.14) and for anencephaly (OR = 3.39, 95 % CI = 0.94-12.18). No interaction was found between COMT rs4680 AA/AG and MTHFR CT/TT genotypes for total NTDs or any subtype of NTD. The interaction of COMT rs737865 and MTHFR C677T was associated with an increased risk of NTDs, especially anencephaly, in a Chinese population with a high prevalence of NTDs.

Organochlorine pesticide levels in maternal serum and risk of neural tube defects in offspring in Shanxi Province, China: A case–control study

Organochlorine pesticides (OCPs) in placental tissue have been reported to be associated with an increased risk for fetal neural tube defects (NTDs). Our case–control study was performed to explore the association between maternal serum OCP concentration and NTD risk in offspring. Serum samples were collected from 117 mothers who delivered NTD infants (case group) and 121 mothers who delivered healthy infants (control group). Only three of the 25 OCPs were detected in more than half of the maternal serum samples. The median concentration of total OCPs in the case group was significantly higher than that of the control group. However, no dose–response relationships between higher levels of any individual OCPs or total OCPs and the risk of NTDs or subtypes were observed in either the unadjusted binary unconditional logistic regression model or the model adjusted by potential confounders. We conclude that no clear association between maternal serum OCP residues and NTD risk in offspring was observed in this population. CapsuleNo clear association between maternal serum levels of organochlorine pesticides and risk of neural tube defects in offspring was observed for a Chinese population.

Maternal passive smoking during pregnancy and neural tube defects in offspring: a meta-analysis

This study aims to examine the association between maternal passive smoking during pregnancy and the occurrence of neural tube defects (NTDs) in offspring. We retrieved studies published on the association between maternal passive smoking during pregnancy and the occurrence of NTDs in offspring. Meta-analysis was applied to calculate the pooled effect estimates and their 95% confidence intervals (CIs) using data from 10 case-control studies. The publication bias was assessed by the Egger's regression asymmetry test and Begg's rank correlation test with Begg's funnel plot. The pooled effect estimate of maternal passive smoking was 1.82 (95% CI 1.46-2.27) for total NTDs; the effect estimates were 1.72 (95% CI 1.44-2.06), 1.52 (95% CI 1.29-1.79), and 2.32 (95% CI 1.34-4.01) for NTDs subtypes of anencephaly, spina bifida and encephalocele, respectively. Stratified by geographic region of the studies, the pooled effect estimates were 2.11 (95% CI 1.46-3.06), 1.65 (95% CI 1.16-2.34), 1.25 (95% CI 0.41-3.80) in China, USA and Iran, respectively. This meta-analysis suggested that maternal passive smoking during pregnancy was associated with an increased risk of total NTDs and three NTDs subtypes in offspring. Specifically, the associations were also found to be significantly positive both in China and USA.

Maternal smoking during pregnancy and neural tube defects in offspring: a meta-analysis

This study aims to examine the association between maternal smoking during pregnancy and neural tube defects (NTDs) in offspring. We retrieved published studies on the association between maternal smoking during pregnancy and NTDs risk in offspring. Meta-analysis was applied to calculate the overall odds ratios (ORs) and their 95% confidence intervals (CIs). The publication bias was assessed by the Egger's regression asymmetry test and Begg's rank correlation test. The overall effect of maternal smoking during pregnancy on NTDs was 1.03 (OR = 1.03, 95% CI = 0.80-1.33). When subgroup analysis was conducted by geographic regions, the overall effects were 1.39 (OR = 1.39, 95% CI = 1.18-1.64), 0.88 (OR = 0.88, 95% CI = 0.66-1.17) in Europe and USA; when subgroup analysis was conducted by NTDs types, the overall effect was 1.55 (OR = 1.55, 95% CI = 1.06-2.26) for spina bifida. Women who smoked during pregnancy had mildly elevated risk of having infants with NTDs.

Periconceptional factors affect the risk of neural tube defects in offspring: a hospital-based case-control study in China

Objective: To explore the periconceptional factors affecting the risk of neural tube defects (NTDs), we carried out a hospital-based case-control study in China.Methods: A 1:1 matched case-control study was conducted. With self-designed questionnaires, we solicited relevant information from 459 case mothers and 459 control mothers selected in two provinces of China through face-to-face interviews. Univariate and multivariate conditional logistic regression analyses were conducted to evaluate the effect values by odds ratios (ORs) and 95% confidence intervals (95%CIs) with SAS9.1.3.software.Results: Daily passive tobacco smoke exposure was a risk factor for total NTDs (OR = 8.688, 95%CI = 2.329–32.404). Diet adjustment in the first trimester (OR = 0.061, 95%CI = 0.014–0.274), periconceptional folic acid intake (OR = 0.059, 95%CI = 0.011–0.321) and health education (OR = 0.251, 95%CI = 0.081–0.781) were protective factors for total NTDs. Differences in factors and their effects on NTDs were found for the three subtypes of NTDs: anencephaly, spina bifida and encephalocele.Conclusions: Daily passive tobacco smoke exposure, diet adjustment in the first trimester, periconceptional folic acid intake and health education were associated with NTDs.

Maternal obesity, folate intake, and neural tube defects in offspring

We investigated the association between maternal obesity (body mass index [BMI] ≥ 30) and the risk of a neural tube defect affected pregnancy (NTD). We also studied relationships between perinatal folate intake from food and the NTD risk by maternal BMI. Data came from a state-wide case-control study conducted between 1992 and 1997 in South Carolina including 179 women with NTD-affected pregnancies and 288 women without NTD-affected births. A majority of case mothers (77%) and controls (86%) were interviewed within 6 months after delivery or pregnancy termination. Logistic regression models were used to examine the association between maternal obesity and the NTD risk after adjusting for maternal race, age, education, smoking, alcohol/drug use, chronic conditions, and multivitamin use within six periconceptional months. Stratified analysis by maternal BMI (≥25 vs. <25) was conducted for the association between food folate and the NTD risk. After adjustment for confounders, obese women (BMI ≥ 30) had twice higher odds of having an NTD-affected pregnancy (odds ratios [OR] = 2.06, 95% confidence interval [CI] = 1.12, 3.81) than normal weight women (BMI: 18.0-24.9). Compared to the lowest quartile of average daily folate intake from food, the upper three quartiles had lower odds of NTDs in offspring. The NTD-protective association was stronger in overweight/obese women (BMI ≥ 25) than in normal/underweight women (BMI < 25). These results support previous studies suggesting maternal obesity as a risk factor for NTDs. Higher intakes of dietary folate were associated with decreased NTD risk that was stronger in overweight and obese women.

Viewpoint: Are there valid concerns for completing a marathon at 39 weeks of pregnancy?

recently, widespread media attention has been given to Amber Danielle Miller, a 27-yr-old woman (163 cm tall), who, at 39 wk of pregnancy, gave birth following her completion of the Chicago Marathon on October 9, 2011 ([17][1], [19][2], [21][3]). She completed the Marathon in 6 h, 25 min, and 50 s