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Caut C, Schoenaker D, McIntyre E, Vilcins D, Gavine A, Steel A. Relationships between Women's and Men's Modifiable Preconception Risks and Health Behaviors and Maternal and Offspring Health Outcomes: An Umbrella Review. Semin Reprod Med 2022; 40:170-183. [PMID: 35830867 DOI: 10.1055/s-0042-1744257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Parental health before conception effects maternal and offspring health outcomes. Preconception care provides healthcare to prospective parents addressing modifiable preconception risks and health behaviors. This umbrella review aimed to consolidate evidence on women's and men's modifiable preconception risks or health behaviors associated with maternal and offspring health outcomes. MEDLINE, EMBASE, Maternity and Infant Care, CINAHL, and PsycINFO were searched from March 4, 2010, to March 4, 2020. Eligible studies were systematic reviews or meta-analyses of observational studies examining associations between modifiable preconception risks or health behaviors and maternal and offspring health outcomes. Screening, data extraction, and methodological quality assessment (AMSTAR 2) occurred independently by two reviewers. Degree of overlap was examined. Findings were summarized for evidence synthesis. Twenty-seven systematic reviews were included. Modifiable preconception risks and health behaviors were identified across categories: body composition (e.g., overweight, obesity), lifestyle behaviors (e.g., caffeine, smoking), nutrition (e.g., micronutrients), environmental exposures (e.g., radiation), and birth spacing (e.g., short interpregnancy intervals). Outcomes associated with exposures affected embryo (e.g., embryonic growth), maternal (e.g., gestational diabetes mellitus), fetal/neonate (e.g., preterm birth), and child (e.g., neurocognitive disorders) health. For real-world practice and policy relevance, evidence-based indicators for preconception care should include body composition, lifestyle, nutrition, environmental, and birth spacing.
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Affiliation(s)
| | - Danielle Schoenaker
- School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Erica McIntyre
- Australian Research Centre in Complementary and Integrative Medicine, School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.,Institute for Sustainable Futures, University of Technology Sydney, Sydney, Australia
| | - Dwan Vilcins
- Children's Health Environmental Program (CHEP), Child Health Research Centre, University of Queensland, South Brisbane, Australia
| | - Anna Gavine
- School of Nursing and Health Sciences, University of Dundee, Dundee, Scotland, United Kingdom
| | - Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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2
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Campbell F, Salam S, Sutton A, Jayasooriya SM, Mitchell C, Amabebe E, Balen J, Gillespie BM, Parris K, Soma-Pillay P, Chauke L, Narice B, Anumba DO. Interventions for the prevention of spontaneous preterm birth: a scoping review of systematic reviews. BMJ Open 2022; 12:e052576. [PMID: 35568487 PMCID: PMC9109033 DOI: 10.1136/bmjopen-2021-052576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/04/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Globally, 11% of babies are born preterm each year. Preterm birth (PTB) is a leading cause of neonatal death and under-five mortality and morbidity, with lifelong sequelae in those who survive. PTB disproportionately impacts low/middle-income countries (LMICs) where the burden is highest. OBJECTIVES This scoping review sought to the evidence for interventions that reduce the risk of PTB, focusing on the evidence from LMICs and describing how context is considered in evidence synthesis. DESIGN We conducted a scoping review, to describe this wide topic area. We searched five electronic databases (2009-2020) and contacted experts to identify relevant systematic reviews of interventions to reduce the risk of PTB. We included published systematic reviews that examined the effectiveness of interventions and their effect on reducing the risk of PTB. Data were extracted and is described narratively. RESULTS 139 published systematic reviews were included in the review. Interventions were categorised as primary or secondary. The interventions where the results showed a greater effect size and consistency across review findings included treatment of syphilis and vaginal candidiasis, vitamin D supplementation and cervical cerclage. Included in the 139 reviews were 1372 unique primary source studies. 28% primary studies were undertaken in LMIC contexts and only 4.5% undertaken in a low-income country (LIC) Only 10.8% of the reviews sought to explore the impact of context on findings, and 19.4% reviews did not report the settings or the primary studies. CONCLUSION This scoping review highlights the lack of research evidence derived from contexts where the burden of PTB globally is greatest. The lack of rigour in addressing contextual applicability within systematic review methods is also highlighted. This presents a risk of inappropriate and unsafe recommendations for practice within these contexts. It also highlights a need for primary research, developing and testing interventions in LIC settings.
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Affiliation(s)
| | - Shumona Salam
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | | | | | - Caroline Mitchell
- Academic Unit of Primary Medical Care, The University of Sheffield, Sheffield, UK
| | - Emmanuel Amabebe
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Julie Balen
- ScHARR, The University of Sheffield, Sheffield, UK
| | - Bronwen M Gillespie
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Kerry Parris
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Priya Soma-Pillay
- Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Lawrence Chauke
- Department of Obstetrics and Gynaecology, University of Witwatersrand, Johannesburg, South Africa
| | - Brenda Narice
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Dilichukwu O Anumba
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
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Influence of Maternal Microbiome and Inflammatory Response in Preterm Birth: Recent Aspects of the Prevention of Preterm Birth. MICROBIOLOGY RESEARCH 2021. [DOI: 10.3390/microbiolres13010001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Preterm birth (PTB) is a global health issue and one of the most challenging problems affecting 12.9 million births worldwide. PTB is a multi-etiological disease and remains incompletely understood. The major cause of PTB is infection or inflammation and disruption of the vaginal microbiome, which affects the maternal immunologic response leading to PTB. The vaginal microbiome composition changes by a shift in the community are typically dominated by Lactobacillus during pregnancy. There are complex interactions between the maternal microbiome in pregnancy and the development of PTB, therefore, researchers have struggled to connect the maternal microbiome with the dysregulation of the maternal immune response in cases of PTB. The host microbiome affects alterations of the microorganisms with external stimuli such as disease, nutrition, immunity, and behavior. In this review, we discuss the complex association between the maternal microbiome and the risk of PTB and also focus on recent aspects of the prevention of PTB.
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Deriba BS. Nutritional-Related Predictors of Preterm Birth in North Shewa Hospitals, Central Ethiopia: A Case-Control Study. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2021; 12:315-324. [PMID: 34262390 PMCID: PMC8275143 DOI: 10.2147/phmt.s319867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/27/2021] [Indexed: 11/23/2022]
Abstract
Background Preterm birth (PTB) is the leading cause of newborn death and the second cause of mortality among under-five children. Globally, about 15 million infants are born preterm every year. However, there is a lack of data on the nutritional-related predictors of preterm birth among Ethiopian women. The objective of the study was to identify nutritional-related predictors of preterm birth among women who gave birth at North Shewa public Hospitals in central Ethiopia. Methods A case–control study was undertaken in public hospitals in the North Shewa zone, central Ethiopia. Interviewer-administered questionnaire was used to gather data, which was then entered into EPI INFO version 7 and then exported to SPSS version 23 for analysis. Data were presented using texts, tables, and proportions. To find predictors of preterm birth, researcher used binary and multiple logistic regression models. The presence of a relationship between PTB and predictor factors was determined using the adjusted odds ratio (AOR), 95% confidence interval (CI), and p-value <0.05. Results A total of 161 cases and 322 controls participated in the study making a response rate of 97.6%. Unable to get iron folic acid (IFA) (AOR=2.26, 95% CI: 1.22, 4.18), not eating additional meals (AOR=2.63, 95% CI: 1.1, 4.62), restriction of foods (AOR=2.85, 95% CI: 1.58, 5.12), not taking dark green leafy vegetables (DGLV), (AOR=4.46, 95% CI: 1.72, 11.61), and mid upper arm circumference of mother (MUAC) <23 centimeters (AOR=3.7, 95% CI: 2.25, 6.11) had statistically significant association with premature birth. Conclusion IFA supplementation, additional meals, food taboo, frequency of DGLV, and MUAC were identified predictors of preterm birth. Encouraging such women to eat additional meals, varieties of diets like vegetables, and fruits during pregnancy, and adhering to culturally appropriate nutrition education to reverse food taboo is compulsory.
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Affiliation(s)
- Berhanu Senbeta Deriba
- Department of Public Health, Salale University College of Health Sciences, Fitche, Ethiopia
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Della Rosa PA, Miglioli C, Caglioni M, Tiberio F, Mosser KHH, Vignotto E, Canini M, Baldoli C, Falini A, Candiani M, Cavoretto P. A hierarchical procedure to select intrauterine and extrauterine factors for methodological validation of preterm birth risk estimation. BMC Pregnancy Childbirth 2021; 21:306. [PMID: 33863296 PMCID: PMC8052693 DOI: 10.1186/s12884-021-03654-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/15/2021] [Indexed: 12/15/2022] Open
Abstract
Background Etiopathogenesis of preterm birth (PTB) is multifactorial, with a universe of risk factors interplaying between the mother and the environment. It is of utmost importance to identify the most informative factors in order to estimate the degree of PTB risk and trace an individualized profile. The aims of the present study were: 1) to identify all acknowledged risk factors for PTB and to select the most informative ones for defining an accurate model of risk prediction; 2) to verify predictive accuracy of the model and 3) to identify group profiles according to the degree of PTB risk based on the most informative factors. Methods The Maternal Frailty Inventory (MaFra) was created based on a systematic review of the literature including 174 identified intrauterine (IU) and extrauterine (EU) factors. A sample of 111 pregnant women previously categorized in low or high risk for PTB below 37 weeks, according to ACOG guidelines, underwent the MaFra Inventory. First, univariate logistic regression enabled p-value ordering and the Akaike Information Criterion (AIC) selected the model including the most informative MaFra factors. Second, random forest classifier verified the overall predictive accuracy of the model. Third, fuzzy c-means clustering assigned group membership based on the most informative MaFra factors. Results The most informative and parsimonious model selected through AIC included Placenta Previa, Pregnancy Induced Hypertension, Antibiotics, Cervix Length, Physical Exercise, Fetal Growth, Maternal Anxiety, Preeclampsia, Antihypertensives. The random forest classifier including only the most informative IU and EU factors achieved an overall accuracy of 81.08% and an AUC of 0.8122. The cluster analysis identified three groups of typical pregnant women, profiled on the basis of the most informative IU and EU risk factors from a lower to a higher degree of PTB risk, which paralleled time of birth delivery. Conclusions This study establishes a generalized methodology for building-up an evidence-based holistic risk assessment for PTB to be used in clinical practice. Relevant and essential factors were selected and were able to provide an accurate estimation of degree of PTB risk based on the most informative constellation of IU and EU factors. Supplementary Information The online version contains supplementary material available at (10.1186/s12884-021-03654-3).
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Affiliation(s)
- Pasquale Anthony Della Rosa
- Neuroradiology Department, IRCCS San Raffaele Hospital and University, via Olgettina 62, Milan, 20132, Italy
| | - Cesare Miglioli
- Research Center for Statistics, University of Geneva, Boulevard du Pont-d'Arve 40, Geneva, 1205, Switzerland
| | - Martina Caglioni
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Hospital and University, via Olgettina 62, Milan, 20132, Italy
| | - Francesca Tiberio
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Hospital and University, via Olgettina 62, Milan, 20132, Italy
| | - Kelsey H H Mosser
- Neuroradiology Department, IRCCS San Raffaele Hospital and University, via Olgettina 62, Milan, 20132, Italy
| | - Edoardo Vignotto
- Research Center for Statistics, University of Geneva, Boulevard du Pont-d'Arve 40, Geneva, 1205, Switzerland
| | - Matteo Canini
- Neuroradiology Department, IRCCS San Raffaele Hospital and University, via Olgettina 62, Milan, 20132, Italy
| | - Cristina Baldoli
- Neuroradiology Department, IRCCS San Raffaele Hospital and University, via Olgettina 62, Milan, 20132, Italy
| | - Andrea Falini
- Neuroradiology Department, IRCCS San Raffaele Hospital and University, via Olgettina 62, Milan, 20132, Italy
| | - Massimo Candiani
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Hospital and University, via Olgettina 62, Milan, 20132, Italy
| | - Paolo Cavoretto
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Hospital and University, via Olgettina 62, Milan, 20132, Italy.
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The association between periconceptional folic acid supplementation and the risk of preterm birth: a population-based retrospective cohort study of 200,000 women in China. Eur J Nutr 2020; 60:2181-2192. [PMID: 33074387 PMCID: PMC8137572 DOI: 10.1007/s00394-020-02409-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/06/2020] [Indexed: 11/01/2022]
Abstract
PURPOSE The aim of this study was to examine the association between periconceptional folic acid (FA) supplementation and risk of preterm birth. METHODS We conducted a retrospective cohort study in women aged 18-49 who participated in the NFPHEP from 2010 to 2018, and had a singleton livebirth in 129 counties in southwest China. Participants were divided into four groups according to the time period starting FA use: no use, after the last menstrual period, at least 1-2 months before the last menstrual period, at least 3 months before the last menstrual period. The outcomes were preterm birth (gestation < 37 weeks) and early preterm birth (gestation < 34 weeks). RESULTS 201,477 women were included and 191,809 (95.2%) had taken FA during periconception. Compared with women who did not take FA, women who started taking FA 1-2 months before their last menstrual period had a 15% lower risk of preterm birth (aOR = 0.85, 95% CI 0.79-0.92), and women who started taking FA at least 3 months before their last menstrual period had a 20% lower risk of preterm birth (aOR = 0.80, 95% CI 0.75-0.87), but women who started taking FA after their last menstrual period did not appear to reduce the risk of preterm birth. CONCLUSIONS In this study of 200,000 Chinese women, periconceptional supplementation with FA was associated with a lower risk of preterm birth. Women who started taking FA at least 3 months before their last menstrual period were more likely to reduce the risk of preterm birth.
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7
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Parris KM, Amabebe E, Cohen MC, Anumba DO. Placental microbial-metabolite profiles and inflammatory mechanisms associated with preterm birth. J Clin Pathol 2020; 74:10-18. [PMID: 32796048 DOI: 10.1136/jclinpath-2020-206536] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 12/27/2022]
Abstract
There is growing emphasis on the potential significance of the placental microbiome and microbiome-metabolite interactions in immune responses and subsequent pregnancy outcome, especially in relation to preterm birth (PTB). This review discusses in detail the pathomechanisms of placental inflammatory responses and the resultant maternal-fetal allograft rejection in both microbial-induced and sterile conditions. It also highlights some potential placental-associated predictive markers of PTB for future investigation. The existence of a placental microbiome remains debatable. Therefore, an overview of our current understanding of the state and role of the placental microbiome (if it exists) and metabolome in human pregnancy is also provided. We critical evaluate the evidence for a placental microbiome, discuss its functional capacity through the elaborated metabolic products and also describe the consequent and more established fetomaternal inflammatory responses that stimulate the pathway to preterm premature rupture of membranes, preterm labour and spontaneous PTB.
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Affiliation(s)
- Kerry M Parris
- Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | | - Marta C Cohen
- Oncology and Metabolism, University of Sheffield, Sheffield, UK.,Histopathology, Sheffield Childrens Hospital NHS Foundation Trust, Sheffield, UK
| | - Dilly O Anumba
- Oncology and Metabolism, University of Sheffield, Sheffield, UK
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8
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Li B, Zhang X, Peng X, Zhang S, Wang X, Zhu C. Folic Acid and Risk of Preterm Birth: A Meta-Analysis. Front Neurosci 2019; 13:1284. [PMID: 31849592 PMCID: PMC6892975 DOI: 10.3389/fnins.2019.01284] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/12/2019] [Indexed: 12/22/2022] Open
Abstract
The results from epidemiologic studies linking blood folate concentrations, folic acid supplementation, or dietary folate to the risk of preterm birth are inconsistent. In this study, we aimed to summarize the available evidence on these associations. A systematic search of the PubMed/MEDLINE, Google Scholar, Web of Science, and Cochrane Library databases up to October 20, 2018 was performed and reference lists of retrieved articles were screened. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) for the highest vs. the lowest levels of folate concentrations, folic acid supplementation, and dietary folate were calculated using random-effects models. Subgroup analyses and univariate meta-regression were performed to explore the sources of heterogeneity. Ten studies (six prospective cohort studies and four case-control studies) were included on folate concentrations, 13 cohort studies were included about folic acid supplementation, and 4 cohort studies were included regarding dietary folate intake. Higher maternal folate levels were associated with a 28% reduction in the risk of preterm birth (OR 0.72, 95% CI 0.56–0.93). Higher folic acid supplementation was associated with 10% lower risk of preterm birth (OR 0.90, 95% CI 0.85–0.95). In addition, a significant negative association was observed between dietary folate intake and the risk of preterm birth (OR 0.68, 95% CI 0.55–0.84), but no significant relation was seen between dietary folate and the risk of spontaneous preterm birth (OR 0.89, 95% CI 0.57–1.41). In the subgroup analysis, higher maternal folate levels in the third trimester were associated with a lower risk of preterm birth (OR 0.58, 95% CI 0.36–0.94). To initiate taking folic acid supplementation early before conception was adversely associated with preterm birth risk (OR 0.89, 95% CI 0.83–0.95). In conclusion, higher maternal folate levels and folic acid supplementation were significantly associated with a lower risk of preterm birth. The limited data currently available suggest that dietary folate is associated with a significantly decreased risk of preterm birth.
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Affiliation(s)
- Bingbing Li
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, China
| | - Xiaoli Zhang
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, China
| | - Xirui Peng
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, China
| | - Shan Zhang
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, China
| | - Xiaoyang Wang
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, China.,Perinatal Center, Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Changlian Zhu
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, China.,Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
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9
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Martín-Calvo N, Mínguez-Alarcón L, Gaskins AJ, Nassan FL, Williams PL, Souter I, Hauser R, Chavarro JE. Paternal preconception folate intake in relation to gestational age at delivery and birthweight of newborns conceived through assisted reproduction. Reprod Biomed Online 2019; 39:835-843. [PMID: 31564651 DOI: 10.1016/j.rbmo.2019.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/20/2019] [Accepted: 07/09/2019] [Indexed: 01/16/2023]
Abstract
RESEARCH QUESTION Studies in rodents have shown that paternal folate intake prior to conception is associated with pregnancy and offspring outcomes. The aim of this study was to assess whether those associations might apply to humans as well. DESIGN Between 2007 and 2017, the study prospectively analysed data from 108 couples participating in a preconception cohort of couples undergoing fertility treatment using their own gametes, whose treatment resulted in 113 pregnancies during the course of the study. Paternal and maternal preconception folate intake was assessed using a validated food frequency questionnaire. Linear mixed models were used to assess whether paternal preconception folate intake was associated with gestational age at delivery and gestational age-specific birthweight, while accounting for correlated data and potential confounders. RESULTS In a multivariable-adjusted model, a 400 μg/day increase in preconception paternal folate intake was associated with a 2.6-day longer gestation (95% confidence interval 0.8-4.3) after adjusting for potential confounders, including maternal folate intake. Similar associations were found for folate from food and supplements. Maternal folate intake was not associated with gestational age at delivery. Neither paternal nor maternal folate intake was associated with gestational-age-specific birthweight. CONCLUSIONS Higher paternal preconception folate intake was associated with slightly longer gestation among live births achieved through assisted reproduction. The results suggest that preconception exposures of the father may have an impact on the health of his offspring, and therefore that preconception care should shift from a woman-centric to a couple-based approach.
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Affiliation(s)
- Nerea Martín-Calvo
- University of Navarra, Department of Preventive Medicine and Public Health, Instituto de Investigación Sanitaria de Navarra (IdISNA), Pamplona, Spain; CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Carlos III Institute of Health, Madrid, Spain
| | - Lidia Mínguez-Alarcón
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston MA, USA
| | - Audrey J Gaskins
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 25 Shattuck Street, Boston MA, USA; Department of Epidemiology, University of Emory. Atlanta GA, USA
| | - Feiby L Nassan
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston MA, USA
| | - Paige L Williams
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston MA, USA
| | - Irene Souter
- Vincent Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston MA, USA
| | - Russ Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston MA, USA; Vincent Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston MA, USA
| | - Jorge E Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 25 Shattuck Street, Boston MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston MA, USA.
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10
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Bulloch RE, Lovell AL, Jordan VMB, McCowan LME, Thompson JMD, Wall CR. Maternal folic acid supplementation for the prevention of preeclampsia: A systematic review and meta-analysis. Paediatr Perinat Epidemiol 2018; 32:346-357. [PMID: 29882975 DOI: 10.1111/ppe.12476] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Preeclampsia is a significant contributor to maternal and neonatal morbidity and mortality. Folic acid supplementation is recommended periconceptionally for the prevention of neural tube defects. Epidemiological evidence suggests that maternal folic acid supplementation may play a role in preventing other adverse birth outcomes. This systematic review aimed to investigate the effect of maternal folic acid supplementation during pregnancy on risk of preeclampsia and gestational hypertension. METHODS Multiple scientific databases and grey literature were searched for relevant studies. Studies were reviewed according to pre-specified inclusion and exclusion criteria. Study characteristics were summarised and study quality was assessed. A meta-analysis of observational studies was conducted to examine the effect of maternal folic acid supplementation on preeclampsia risk. RESULTS Meta-analysis of eight observational studies showed significantly lower odds of preeclampsia with folic acid supplementation in comparison to no folic acid supplementation: OR = 0.78 (95% CI 0.63, 0.98), with moderately high heterogeneity between studies. Subgroup analysis showed no significant subgroup difference between folic acid supplementation taken by itself, in comparison to folic acid taken in or alongside a multivitamin. CONCLUSION Low level evidence is available for a modest association between maternal folic acid supplementation and reduction in preeclampsia risk. Future studies should differentiate between early and late onset and mild vs severe preeclampsia, and should control for relevant confounders including the presence of multivitamin supplements. The protocol for this systematic review was prospectively registered with PROSPERO (CRD42015029310).
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Affiliation(s)
- Rhodi E Bulloch
- The Discipline of Nutrition and Dietetics, School of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Amy L Lovell
- The Discipline of Nutrition and Dietetics, School of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Vanessa M B Jordan
- The Department of Obstetrics and Gynaecology, School of Medicine, The University of Auckland, Auckland, New Zealand
| | - Lesley M E McCowan
- The Department of Obstetrics and Gynaecology, School of Medicine, The University of Auckland, Auckland, New Zealand
| | - John M D Thompson
- The Department of Paediatrics, Child and Youth Health, School of Medicine, The University of Auckland, Auckland, New Zealand
| | - Clare R Wall
- The Discipline of Nutrition and Dietetics, School of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Savard C, Lemieux S, Lafrenière J, Laramée C, Robitaille J, Morisset AS. Validation of a self-administered web-based 24-hour dietary recall among pregnant women. BMC Pregnancy Childbirth 2018; 18:112. [PMID: 29685127 PMCID: PMC5913813 DOI: 10.1186/s12884-018-1741-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 04/12/2018] [Indexed: 01/11/2023] Open
Abstract
Background The use of valid dietary assessment methods is crucial to analyse adherence to dietary recommendations among pregnant women. This study aims to assess the relative validity of a self-administered Web-based 24-h dietary recall, the R24W, against a pen-paper 3-day food record (FR) among pregnant women. Methods Sixty (60) pregnant women recruited at 9.3 ± 0.7 weeks of pregnancy in Quebec City completed, at each trimester, 3 R24W and a 3-day FR. Mean energy and nutrient intakes reported by both tools were compared using paired Student T-Tests. Pearson correlations were used to analyze the association between both methods. Agreement between the two methods was evaluated using cross-classification analyses, weighted kappa coefficients and Bland-Altman analyses. Results Pearson correlation coefficients were all significant, except for vitamin B12 (r = 0.03; p = 0.83) and ranged from 0.27 to 0.76 (p < 0.05). Differences between mean intakes assessed by the R24W and the FR did not exceed 10% in 19 variables and were not significant for 16 out of 26 variables. In cross-classification analyses, the R24W ranked, on average, 79.1% of participants in the same or adjacent quartiles as the FR. Conclusions Compared to a 3-day FR, the R24W is a valid method to assess intakes of energy and most nutrients but may be less accurate in the evaluation of intakes of fat (as a proportion of energy intake), vitamin D, zinc and folic acid. During pregnancy, the R24W was a more accurate tool at a group-level than at an individual-level and should, therefore, be used in an epidemiological rather than a clinical setting. The R24W may be particularly valuable as a tool used in cohort studies to provide valid information on pregnant women’s dietary intakes and facilitate evaluation of associations between diet and adverse pregnancy outcomes. Electronic supplementary material The online version of this article (10.1186/s12884-018-1741-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Claudia Savard
- École de nutrition de l'Université Laval, Pavillon Paul-Comtois, Université Laval, 2425, rue de l'Agriculture, local 2412, Québec, G1V 0A6, Canada.,Axe d'endocrinologie et de néphrologie du Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada.,Institut sur la nutrition et les aliments fonctionnels, Université Laval, Québec, QC, Canada
| | - Simone Lemieux
- École de nutrition de l'Université Laval, Pavillon Paul-Comtois, Université Laval, 2425, rue de l'Agriculture, local 2412, Québec, G1V 0A6, Canada.,Institut sur la nutrition et les aliments fonctionnels, Université Laval, Québec, QC, Canada
| | - Jacynthe Lafrenière
- École de nutrition de l'Université Laval, Pavillon Paul-Comtois, Université Laval, 2425, rue de l'Agriculture, local 2412, Québec, G1V 0A6, Canada.,Institut sur la nutrition et les aliments fonctionnels, Université Laval, Québec, QC, Canada
| | - Catherine Laramée
- Institut sur la nutrition et les aliments fonctionnels, Université Laval, Québec, QC, Canada
| | - Julie Robitaille
- École de nutrition de l'Université Laval, Pavillon Paul-Comtois, Université Laval, 2425, rue de l'Agriculture, local 2412, Québec, G1V 0A6, Canada.,Axe d'endocrinologie et de néphrologie du Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada.,Institut sur la nutrition et les aliments fonctionnels, Université Laval, Québec, QC, Canada
| | - Anne-Sophie Morisset
- École de nutrition de l'Université Laval, Pavillon Paul-Comtois, Université Laval, 2425, rue de l'Agriculture, local 2412, Québec, G1V 0A6, Canada. .,Axe d'endocrinologie et de néphrologie du Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada. .,Institut sur la nutrition et les aliments fonctionnels, Université Laval, Québec, QC, Canada.
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Castaño E, Caviedes L, Hirsch S, Llanos M, Iñiguez G, Ronco AM. Folate Transporters in Placentas from Preterm Newborns and Their Relation to Cord Blood Folate and Vitamin B12 Levels. PLoS One 2017; 12:e0170389. [PMID: 28103309 PMCID: PMC5245900 DOI: 10.1371/journal.pone.0170389] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 01/04/2017] [Indexed: 02/01/2023] Open
Abstract
Folate deficiency during pregnancy has been related to low birth weight, preterm (PT) birth and other health risks in the offspring; however, it is unknown whether prematurity is related to low folate transport through the placenta due to altered expression of specific folate transporters. We determined placental expression (mRNA and protein concentrations by RT-qPCR and WB respectively) of specific folate transporters: RFC, PCFT/HCP1 and FOLR1 in chorionic (fetal) and basal (maternal) plates of placentas of PT pregnancies (PT, 32–36 weeks, n = 51). Term placentas were used as controls (T, 37–41 weeks, n = 47). Folates and vitamin B12 levels were measured by electrochemiluminescence in umbilical cord blood of newborns. FOLR1 mRNA expression was lower and protein concentration higher in PT placentas (both plates) relative to the control group (p <0.05). In addition, gestational age was positively correlated with mRNA expression (Rho = 0.7), and negatively with protein concentration (Rho = -0.7 for chorionic and -0.43 for basal plate). PCFT/HCP1 mRNA was lower in PT placentas, without changes in protein levels. RFC did not differ in PT placentas compared to controls. PT newborns presented higher cord blood folate level (p = 0.049) along with lower vitamin B12 concentration compared to controls (p = 0.037).In conclusion, placental FOLR1 mRNA was positively associated with gestational age. Conversely, FOLR1 protein concentrations along with folate/vitamin B12 ratio in cord blood were negatively associated with gestational age. Placental FOLR1 is likely the main placental folate transporter to the fetus in newborns.
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Affiliation(s)
- Erika Castaño
- Laboratory of Nutrition and Metabolic Regulation, Human Nutrition Unit, Institute of Nutrition and Food Technology, Dr. Fernando Monckeberg Barros (INTA), University of Chile, Santiago, Chile
| | - Lorena Caviedes
- Laboratory of Nutrition and Metabolic Regulation, Human Nutrition Unit, Institute of Nutrition and Food Technology, Dr. Fernando Monckeberg Barros (INTA), University of Chile, Santiago, Chile
| | - Sandra Hirsch
- Laboratory of Nutrition and Metabolic Regulation, Human Nutrition Unit, Institute of Nutrition and Food Technology, Dr. Fernando Monckeberg Barros (INTA), University of Chile, Santiago, Chile
| | - Miguel Llanos
- Laboratory of Nutrition and Metabolic Regulation, Human Nutrition Unit, Institute of Nutrition and Food Technology, Dr. Fernando Monckeberg Barros (INTA), University of Chile, Santiago, Chile
| | - Germán Iñiguez
- Mother and Child Research Institute, Division of Medical Sciences, School of Medicine, University of Chile, Santiago, Chile
| | - Ana María Ronco
- Laboratory of Nutrition and Metabolic Regulation, Human Nutrition Unit, Institute of Nutrition and Food Technology, Dr. Fernando Monckeberg Barros (INTA), University of Chile, Santiago, Chile
- * E-mail:
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13
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Maisonneuve E. Mode de vie et règles hygiénodiététiques pour la prévention de la prématurité spontanée chez la femme enceinte asymptomatique. ACTA ACUST UNITED AC 2016; 45:1231-1246. [DOI: 10.1016/j.jgyn.2016.09.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 09/16/2016] [Indexed: 12/27/2022]
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Rosener SE, Barr WB, Frayne DJ, Barash JH, Gross ME, Bennett IM. Interconception Care for Mothers During Well-Child Visits With Family Physicians: An IMPLICIT Network Study. Ann Fam Med 2016; 14:350-5. [PMID: 27401423 PMCID: PMC4940465 DOI: 10.1370/afm.1933] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 01/04/2016] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Interconception care (ICC) is recommended to improve birth outcomes by targeting maternal risk factors, but little is known about its implementation. We evaluated the frequency and nature of ICC delivered to mothers at well-child visits and maternal receptivity to these practices. METHODS We surveyed a convenience sample of mothers accompanying their child to well-child visits at family medicine academic practices in the IMPLICIT (Interventions to Minimize Preterm and Low Birth Weight Infants Through Continuous Improvement Techniques) Network. Health history, behaviors, and the frequency of the child's physician addressing maternal depression, tobacco use, family planning, and folic acid supplementation were assessed, along with maternal receptivity to advice. RESULTS Three-quarters of the 658 respondents shared a medical home with their child. Overall, 17% of respondents reported a previous preterm birth, 19% reported a history of depression, 25% were smoking, 26% were not using contraception, and 58% were not taking folic acid. Regarding advice, 80% of mothers who smoked were counseled to quit, 59% reported depression screening, 71% discussed contraception, and 44% discussed folic acid. Screening for depression and family planning was more likely when the mother and child shared a medical home (P <.05). Most mothers, nearly 95%, were willing to accept health advice from their child's physician regardless of whether a medical home was shared (P >.05). CONCLUSIONS Family physicians provide key elements of ICC at well-child visits, and mothers are highly receptive to advice from their child's physician even if they receive primary care elsewhere. Routine integration of ICC at these visits may provide an opportunity to reduce maternal risk factors for adverse subsequent birth outcomes.
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Affiliation(s)
- Stephanie E Rosener
- Middlesex Hospital Family Medicine Residency Program, Middletown, Connecticut
| | - Wendy B Barr
- Lawrence Family Medicine Residency Program, Lawrence, Massachusetts
| | - Daniel J Frayne
- MAHEC Family Medicine Residency Program, Asheville, North Carolina
| | - Joshua H Barash
- Department of Family & Community Medicine, Jefferson Medical College, Philadelphia, Pennsylvania
| | | | - Ian M Bennett
- Department of Family Medicine, University of Washington, Seattle, Washington
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15
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Association between ALDH1L1 gene polymorphism and neural tube defects in the Chinese Han population. Neurol Sci 2016; 37:1049-54. [DOI: 10.1007/s10072-016-2527-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 02/17/2016] [Indexed: 01/08/2023]
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16
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Caviedes L, Iñiguez G, Hidalgo P, Castro JJ, Castaño E, Llanos M, Hirsch S, Ronco AM. Relationship between folate transporters expression in human placentas at term and birth weights. Placenta 2015; 38:24-8. [PMID: 26907378 DOI: 10.1016/j.placenta.2015.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 12/04/2015] [Accepted: 12/14/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Adequate folate levels are essential for successful pregnancy outcomes. We aimed to study the relationship between placental mRNA and protein levels of folate transporters to birth weight. METHODS Placental folate transporters (FOLR1, RFC1 and HCP1/PCFT) mRNA and protein levels in basal (BP) and chorionic plate (CP) of small (SGA), appropriate (AGA) and large (LGA) for gestational age term infants (≥37 weeks gestation, n = 111) were determined by real-time PCR and Western blot respectively. RESULTS FOLR1 and HCP1/PCFT mRNA were lower in both plates of SGA and LGA placentas compared to AGA (p < 0.01) and RFC1 mRNA was lower only in CP (p < 0.02). RFC1 protein levels were lower in BP of SGA (p < 0.05) and LGA (p < 0.01), and FOLR1 protein levels were lower in CP of SGA (p < 0.02) and LGA (p < 0.01) groups compared to AGA. HCP1/PCFT protein levels remained unchanged in all groups. CONCLUSION Placentas of SGA and LGA groups showed a reduced mRNA expression and protein levels of folate transporters, with some differences depending on the location within the placenta (BP or CP). This suggests the presence of specific placental regulation mechanisms in gene expression that may be associated to birth weight.
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Affiliation(s)
- Lorena Caviedes
- Laboratorio de Nutrición y Regulación Metabólica, Unidad de Nutrición Humana, Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Chile
| | - Germán Iñiguez
- Instituto de Investigaciones Materno-Infantil (IDIMI), División Ciencias Médicas Centro, Facultad de Medicina, Universidad de Chile, Chile
| | - Paulina Hidalgo
- Laboratorio de Nutrición y Regulación Metabólica, Unidad de Nutrición Humana, Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Chile
| | - Juan José Castro
- Instituto de Investigaciones Materno-Infantil (IDIMI), División Ciencias Médicas Centro, Facultad de Medicina, Universidad de Chile, Chile
| | - Erika Castaño
- Laboratorio de Nutrición y Regulación Metabólica, Unidad de Nutrición Humana, Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Chile
| | - Miguel Llanos
- Laboratorio de Nutrición y Regulación Metabólica, Unidad de Nutrición Humana, Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Chile
| | - Sandra Hirsch
- Laboratorio de Nutrición y Regulación Metabólica, Unidad de Nutrición Humana, Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Chile
| | - Ana María Ronco
- Laboratorio de Nutrición y Regulación Metabólica, Unidad de Nutrición Humana, Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Chile.
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17
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Wang Y, Cao Z, Peng Z, Xin X, Zhang Y, Yang Y, He Y, Xu J, Ma X. Folic acid supplementation, preconception body mass index, and preterm delivery: findings from the preconception cohort data in a Chinese rural population. BMC Pregnancy Childbirth 2015; 15:336. [PMID: 26670558 PMCID: PMC4681173 DOI: 10.1186/s12884-015-0766-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 12/02/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Folic acid (FA) supplementation before and during the first trimester can reduce the risk of occurrence of preterm delivery (PTD). Preconception body mass index (BMI) is also associated with PTD. This study aimed to investigate the combined effect of FA supplements and preconception BMI on the risk of PTD. METHODS The data of a cohort from 2010-2011 that was obtained through a preconception care service in China was used (including 172,206 women). A multivariable regression model was used to investigate the association between maternal preconception conditions and the risk of PTD. The interaction of preconception BMI and FA supplementation was measured by a logistic regression model. RESULTS Taking FA supplements in the preconception period or in the first trimester reduced the risk of PTD (odds ratio [OR] = 0.58 and OR = 0.61, respectively). Women with an abnormal BMI had an increased risk of PTD (OR = 1.09, OR = 1.10, and OR = 1.17 for underweight, overweight, and obese, respectively). Preconception BMI showed an interaction with the protective effect of FA supplementation for PTD. With regard to the interaction of FA supplementation, the adjusted odds ratio (aOR) was 0.57 (95% CI: 0.51, 0.64) in underweight women, 0.85 (95% CI: 0.73, 0.98) in overweight women, and 0.77 (95% CI, 0.65, 0.91) in obese women. Preconception BMI also showed an interaction with the time of FA supplementation. Women with a normal BMI who began to take FA supplements in the preconception period had the lowest risk of PTD (aORs: 0.58 vs. 0.65 beginning in the first trimester). The aORs at preconception and the first trimester in the underweight group were 0.56 vs. 0.60. The aORs at preconception and the first trimester were 0.94 vs. 0.65 and 1.15 vs. 0.60 in the overweight and obesity groups, respectively. CONCLUSIONS In our study, FA supplements reduced the risk of PTD, while abnormal BMI raised the risk of PTD, although higher BMI categories did not have this higher risk once adjusted analysis was conducted. The protective effect of FA supplementation for PTD was reduced in women with overweight or obesity. To get better protection of FA supplementation, women with normal BMI or underweight should begin to use in preconception, while women with overweight or obesity should begin to use after conception.
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Affiliation(s)
- Yuanyuan Wang
- National Research Institute for Family Planning, No. 12, Dahuisi Road, Haidian District, Beijing, 100081, China.
- Graduate School of Peking Union Medical College, No. 9, Dongdansantiao, Dongcheng District, Beijing, 100730, China.
| | - Zongfu Cao
- National Research Institute for Family Planning, No. 12, Dahuisi Road, Haidian District, Beijing, 100081, China.
- Graduate School of Peking Union Medical College, No. 9, Dongdansantiao, Dongcheng District, Beijing, 100730, China.
| | - Zuoqi Peng
- National Research Institute for Family Planning, No. 12, Dahuisi Road, Haidian District, Beijing, 100081, China.
| | - Xiaona Xin
- National Research Institute for Family Planning, No. 12, Dahuisi Road, Haidian District, Beijing, 100081, China.
- Graduate School of Peking Union Medical College, No. 9, Dongdansantiao, Dongcheng District, Beijing, 100730, China.
| | - Ya Zhang
- National Research Institute for Family Planning, No. 12, Dahuisi Road, Haidian District, Beijing, 100081, China.
| | - Ying Yang
- National Research Institute for Family Planning, No. 12, Dahuisi Road, Haidian District, Beijing, 100081, China.
| | - Yuan He
- National Research Institute for Family Planning, No. 12, Dahuisi Road, Haidian District, Beijing, 100081, China.
| | - Jihong Xu
- National Research Institute for Family Planning, No. 12, Dahuisi Road, Haidian District, Beijing, 100081, China.
| | - Xu Ma
- National Research Institute for Family Planning, No. 12, Dahuisi Road, Haidian District, Beijing, 100081, China.
- Graduate School of Peking Union Medical College, No. 9, Dongdansantiao, Dongcheng District, Beijing, 100730, China.
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Navarrete-Muñoz EM, Valera-Gran D, García de la Hera M, Gimenez-Monzo D, Morales E, Julvez J, Riaño I, Tardón A, Ibarluzea J, Santa-Marina L, Murcia M, Rebagliato M, Vioque J. Use of high doses of folic acid supplements in pregnant women in Spain: an INMA cohort study. BMJ Open 2015; 5:e009202. [PMID: 26603248 PMCID: PMC4663411 DOI: 10.1136/bmjopen-2015-009202] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES We examined the use of low (<400 μg/day, including no use) and high folic acid supplement (FAS) dosages (≥1000 μg/day) among pregnant women in Spain, and explored factors associated with the use of these non-recommended dosages. DESIGN Population-based cohort study. SETTING Spain. PARTICIPANTS We analysed data from 2332 pregnant women of the INMA study, a prospective mother-child cohort study in Spain. MAIN OUTCOME MEASURES We assessed usual dietary folate and the use of FAS from preconception to the 3rd month (first period) and from the 4th to the 7th month (second period), using a validated food frequency questionnaire. We used multinomial logistic regression to estimate relative risk ratios (RRRs). RESULTS Over a half of the women used low dosages of FAS in the first and second period while 29% and 17% took high dosages of FAS, respectively. In the first period, tobacco smoking (RRR=1.63), alcohol intake (RRR=1.40), multiparous (RRR=1.44), unplanned pregnancy (RRR=4.20) and previous spontaneous abortion (RRR=0.58, lower use of high FAS dosages among those with previous abortions) were significantly associated with low FAS dosages. Alcohol consumption (RRR=1.42), unplanned pregnancy (RRR=2.66) and previous spontaneous abortion (RRR=0.68) were associated with high dosage use. In the second period, only tobacco smoking was significantly associated with high FAS dosage use (RRR=0.67). CONCLUSIONS A high proportion of pregnant women did not reach the recommended dosages of FAS in periconception and a considerable proportion also used FAS dosages ≥1000 μg/day. Action should be planned by the Health Care System and health professionals to improve the appropriate periconceptional use of FAS, taking into consideration the associated factors.
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Affiliation(s)
- Eva María Navarrete-Muñoz
- Departamento Salud Pública, Universidad Miguel Hernández, San Juan de Alicante, Spain CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Desirée Valera-Gran
- Departamento Salud Pública, Universidad Miguel Hernández, San Juan de Alicante, Spain
| | - Manoli García de la Hera
- Departamento Salud Pública, Universidad Miguel Hernández, San Juan de Alicante, Spain CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Daniel Gimenez-Monzo
- Departamento Salud Pública, Universidad Miguel Hernández, San Juan de Alicante, Spain
| | - Eva Morales
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - Jordi Julvez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - Isolina Riaño
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain Servicio de Pediatria, Hospital San Agustin-Aviles, Asturias, Spain
| | - Adonina Tardón
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain Universidad de Oviedo, Asturias, Spain
| | - Jesus Ibarluzea
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain Subdirección de Salud Pública y Adicciones de Gipuzkoa, San Sebastian, Spain Instituto de Investigación Sanitaria BIODONOSTIA, San Sebastián, Spain
| | - Loreto Santa-Marina
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain Subdirección de Salud Pública y Adicciones de Gipuzkoa, San Sebastian, Spain Instituto de Investigación Sanitaria BIODONOSTIA, San Sebastián, Spain
| | - Mario Murcia
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO/CSISP), Public Health, Valencia, Spain
| | - Marisa Rebagliato
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain Departamento de Medicina, Universitat Jaume I, Castellón de la Olana, Spain
| | - Jesus Vioque
- Departamento Salud Pública, Universidad Miguel Hernández, San Juan de Alicante, Spain CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
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Immune response in infants after universal high-dose hepatitis B vaccination: A community-based study in Beijing, China. Vaccine 2015; 33:5878-5883. [PMID: 26117148 DOI: 10.1016/j.vaccine.2015.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 05/10/2015] [Accepted: 06/02/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Vaccination of infants beginning at birth is recommended to prevent Hepatitis B virus (HBV) infection in China. Compared to 5 μg/dose vaccine administered in other regions in China, a three-dose HB recombinant yeast vaccine at 10 μg/dose has been administered for infants within 24h after birth, 1 month and 6 months of age in Beijing since 2006. In a community-based retrospective cohort study, factors influencing immunologic vaccine response were evaluated. METHODS A total of 3670 infants who completed a 3-dose 10 μg recombinant HB vaccine regimen and born to hepatitis B antigen negative mothers were included. The effect on anti-HBs titers of maternal nutrient status, infants' birth condition, growth factors, timeliness of vaccination, dosing interval and the interval until post-vaccination serologic testing (PVST) were evaluated. RESULTS A total of 3666 infants with no markers of HBV infection were included in analysis. The mean anti-HB titers were 1767.17 mIU/ml. Only 16.9% of the infants completed their PVST within 30-59 days after the final dose of vaccination. Multivariate linear regression analysis showed that delay in PVST (β=-0.097, p<0.0001) and maternal folic acid supplementation (β=0.067, p=0.002) were associated with log-transformed anti-HB titers. Also a trend toward significant association was observed between the calcium supplementation of infants and log-transformed anti-HBs titers (β=0.062, p=0.057). Longer interval between dose 2 and dose 3 was not observed to increase the anti-HB titers after cofactors adjustment. CONCLUSIONS Our findings illustrate the importance of timing of PVST to avoid unnecessary revaccination. Multi-center large cohort studies should verify the effect and magnitude of folate and calcium supplementation on HB vaccine response.
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Saccone G, Sarno L, Roman A, Donadono V, Maruotti GM, Martinelli P. 5-Methyl-tetrahydrofolate in prevention of recurrent preeclampsia. J Matern Fetal Neonatal Med 2015; 29:916-20. [PMID: 25777577 DOI: 10.3109/14767058.2015.1023189] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To evaluate the efficacy of 5-methyl-tetrahydrofolate (5-MTHF) supplementation in prevention of recurrent preeclampsia. METHODS Retrospective cohort of women who received daily oral 5-MTHF 15 mg supplementation as prophylactic treatment since first trimester for recurrent preeclampsia were compared with women who did not. All asymptomatic singleton gestations with prior preeclampsia (in the previous pregnancy) were included. Women with chronic hypertension were excluded. The primary outcome was the incidence of preeclampsia. RESULTS Three hundred and three singleton gestation met the inclusion criteria: 157 received 5-MTHF, while 146 did not (control group). Women who received 5-MTHF had a significantly lower incidence of recurrent overall preeclampsia (21.7% versus 39.7%; odds ratio (OR) 0.57, 95% confidence interval (CI) 0.25, 0.69), severe preeclampsia (3.2% versus 8.9%; OR 0.44, 95% CI 0.12-0.97) and early-onset preeclampsia (1.9% versus 7.5%; OR 0.34, 95% CI 0.07-0.87) compared to control. The intervention group delivered about 10 d after the control and had higher birth weight. CONCLUSION This retrospective study showed that women with prior preeclampsia who received daily oral 5-MTHF 15 mg supplementation had a significantly lower incidence of overall preeclampsia, severe preeclampsia and early-onset preeclampsia. Randomized controlled trials are needed to confirm our findings.
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Affiliation(s)
- Gabriele Saccone
- a Department of Neuroscience , Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II , Naples , Italy and
| | - Laura Sarno
- a Department of Neuroscience , Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II , Naples , Italy and
| | - Amanda Roman
- b Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , Sidney Kimmel Medical College of Thomas Jefferson University , Philadelphia , PA , USA
| | - Vera Donadono
- a Department of Neuroscience , Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II , Naples , Italy and
| | - Giuseppe Maria Maruotti
- a Department of Neuroscience , Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II , Naples , Italy and
| | - Pasquale Martinelli
- a Department of Neuroscience , Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II , Naples , Italy and
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Ueki N, Takeda S, Koya D, Kanasaki K. The relevance of the Renin-Angiotensin system in the development of drugs to combat preeclampsia. Int J Endocrinol 2015; 2015:572713. [PMID: 26000015 PMCID: PMC4426891 DOI: 10.1155/2015/572713] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 03/28/2015] [Accepted: 03/28/2015] [Indexed: 12/14/2022] Open
Abstract
Preeclampsia is a hypertensive disorder that occurs during pregnancy. It has an unknown etiology and affects approximately 5-8% of pregnancies worldwide. The pathophysiology of preeclampsia is not yet known, and preeclampsia has been called "a disease of theories." The central symptom of preeclampsia is hypertension. However, the etiology of the hypertension is unknown. In this review, we analyze the molecular mechanisms of preeclampsia with a particular focus on the pathogenesis of the hypertension in preeclampsia and its association with the renin-angiotensin system. In addition, we propose potential alternative strategies to target the renin-angiotensin system, which is enhanced during pregnancy.
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Affiliation(s)
- Norikazu Ueki
- Department of Diabetology and Endocrinology, Kanazawa Medical University, Ishikawa 920-0293, Japan
- Department of Obstetrics and Gynecology, Juntendo University, Tokyo 113-8431, Japan
| | - Satoru Takeda
- Department of Obstetrics and Gynecology, Juntendo University, Tokyo 113-8431, Japan
| | - Daisuke Koya
- Department of Diabetology and Endocrinology, Kanazawa Medical University, Ishikawa 920-0293, Japan
- Division of Anticipatory Molecular Food Science and Technology, Medical Research Institute, Kanazawa Medical University, Ishikawa 920-0293, Japan
| | - Keizo Kanasaki
- Department of Diabetology and Endocrinology, Kanazawa Medical University, Ishikawa 920-0293, Japan
- Division of Anticipatory Molecular Food Science and Technology, Medical Research Institute, Kanazawa Medical University, Ishikawa 920-0293, Japan
- *Keizo Kanasaki:
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Sengpiel V, Bacelis J, Myhre R, Myking S, Devold Pay AS, Haugen M, Brantsæter AL, Meltzer HM, Nilsen RM, Magnus P, Vollset SE, Nilsson S, Jacobsson B. Folic acid supplementation, dietary folate intake during pregnancy and risk for spontaneous preterm delivery: a prospective observational cohort study. BMC Pregnancy Childbirth 2014; 14:375. [PMID: 25361626 PMCID: PMC4240839 DOI: 10.1186/s12884-014-0375-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 10/16/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health authorities in numerous countries recommend periconceptional folic acid supplementation to prevent neural tube defects. The objective of this study was to examine the association of dietary folate intake and folic acid supplementation during different periods of pregnancy with the risk of spontaneous preterm delivery (PTD). METHODS The Norwegian Mother and Child Cohort Study is a population-based prospective cohort study. A total of 66,014 women with singleton pregnancies resulting in live births in 2002-2009 were included. Folic acid supplementation was self-reported from 26 weeks before pregnancy until pregnancy week 24. At gestational week 22, the women completed a food frequency questionnaire, which allowed the calculation of their average total folate intake from foods and supplements for the first 4-5 months of pregnancy. Spontaneous PTD was defined as the spontaneous onset of delivery between weeks 22+0 and 36+6 (n = 1,755). RESULTS The median total folate intake was 313 μg/d (interquartile range IQR 167-558) in the overall population and 530 μg/d (IQR 355-636) in the supplement users. Eighty-five percent reported any folic acid supplementation from <8 weeks before to 24 weeks after conception while only 44% initiated folic acid supplementation before pregnancy. Cox regression analysis showed that the amount of dietary folate intake (hazard ratio HR 1.00; confidence interval 95% CI 0.61-1.65) and supplemental folate intake (HR 1.00; CI 1.00-1.00) was not significantly associated with the risk of PTD. The initiation of folic acid supplementation more than 8 weeks before conception was associated with an increased risk for spontaneous PTD (HR 1.18; CI 1.05-1.32) compared to no folic acid supplementation preconception. There was no significant association with PTD when supplementation was initiated within 8 weeks preconception (HR 0.99; CI 0.87-1.13). All analyses were adjusted for maternal characteristics and socioeconomic, health and dietary variables. CONCLUSIONS Our findings do not support a protective effect of dietary folate intake or folic acid supplementation on spontaneous PTD. Preconceptional folic acid supplementation starting more than 8 weeks before conception was associated with an increased risk of spontaneous PTD. These results require further investigation before discussing an expansion of folic acid supplementation guidelines.
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Barua S, Kuizon S, Junaid MA. Folic acid supplementation in pregnancy and implications in health and disease. J Biomed Sci 2014; 21:77. [PMID: 25135350 PMCID: PMC4237823 DOI: 10.1186/s12929-014-0077-z] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 08/11/2014] [Indexed: 12/31/2022] Open
Abstract
Maternal exposure to dietary factors during pregnancy can influence embryonic development and may modulate the phenotype of offspring through epigenetic programming. Folate is critical for nucleotide synthesis, and preconceptional intake of dietary folic acid (FA) is credited with reduced incidences of neural tube defects in infants. While fortification of grains with FA resulted in a positive public-health outcome, concern has been raised for the need for further investigation of unintended consequences and potential health hazards arising from excessive FA intakes, especially following reports that FA may exert epigenetic effects. The objective of this article is to discuss the role of FA in human health and to review the benefits, concerns and epigenetic effects of maternal FA on the basis of recent findings that are important to design future studies.
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Affiliation(s)
- Subit Barua
- Department of Developmental Biochemistry, New York State Institute for Basic Research in Developmental Disabilities, 1050 Forest Hill Road, Staten Island 10314, NY, USA
| | - Salomon Kuizon
- Department of Developmental Biochemistry, New York State Institute for Basic Research in Developmental Disabilities, 1050 Forest Hill Road, Staten Island 10314, NY, USA
| | - Mohammed A Junaid
- Department of Developmental Biochemistry, New York State Institute for Basic Research in Developmental Disabilities, 1050 Forest Hill Road, Staten Island 10314, NY, USA
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