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Akwaa Harrison O, Ifie I, Nkwonta C, Dzandu BA, Gattor AO, Adimado EE, Odoi KK, Aziavor B, Saalia FK, Steiner-Asiedu M. Knowledge, awareness, and use of folic acid among women of childbearing age living in a peri-urban community in Ghana: a cross-sectional survey. BMC Pregnancy Childbirth 2024; 24:241. [PMID: 38580949 PMCID: PMC10996122 DOI: 10.1186/s12884-024-06408-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 03/11/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Folic acid, a water-soluble B-complex vitamin, plays a crucial role in DNA synthesis and maintenance, making it particularly significant during reproduction. Its well-known ability to reduce the risk of congenital anomalies during the periconceptional period underscores its importance. The increased requirement for folate during pregnancy and lactation is essential to support the physiological changes of the mother and ensure optimal growth and development of the foetus and offspring. This study assessed the knowledge, awareness, and use of folic acid among pregnant and lactating women of reproductive age residing in Dodowa in the Shai Osu-Doku District, Accra, Ghana. METHODS The study was a cross-sectional design that involved 388 randomly selected participants (97 pregnant and 291 lactating women). Structured questionnaires were administered to gather information on the socioeconomic demographic characteristics, knowledge, awareness, and use of folic acid of the participants. Dietary intake was assessed using a food frequency questionnaire. The data were analysed using descriptive statistics and Pearson's chi-square analysis tests and are presented as frequencies and percentages, means, standard deviations, bar graphs, and pie charts. The significance of the results was determined at a 95% confidence interval. RESULTS The mean age of the participants was 31 ± 5.0 years. Among the study participants, 46.1% demonstrated knowledge of folic acid deficiency, while approximately 68.3% had a high awareness of folic acid supplementation. Approximately 75% of the participants indicated that they had not used folic acid supplements within the week, and 15.5% reported consuming folic acid-fortified food per week. CONCLUSIONS The women exhibited high awareness but poor knowledge regarding the usage of folic acid supplementation during pregnancy and lactation. Consequently, this lack of knowledge influenced the low use of folic acid supplements and low intake of folate-rich foods among pregnant and lactating mothers.
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Affiliation(s)
- Obed Akwaa Harrison
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana.
| | - Idolo Ifie
- Department of Food Science, University of Leeds, Leeds, England
| | - Chikere Nkwonta
- Department of Food Science, University of Leeds, Leeds, England
| | - Bennett Atta Dzandu
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Albert Owusu Gattor
- Faculty of Chemistry and Pharmacy, Medicinal Chemistry II, University of Regensburg, Regensburg, Germany
| | | | - Kofi Kafui Odoi
- Institutional Care Division, Ghana Health Services, Accra, Ghana
| | | | - Firibu Kwesi Saalia
- Department of Food Process Engineering, University of Ghana, Legon, Accra, Ghana
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2
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Finnell RH, Zhu H. Periconceptional maternal folate supplementation impacts a diverse range of congenital malformations. Pediatr Res 2024; 95:880-882. [PMID: 38030827 DOI: 10.1038/s41390-023-02935-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/11/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Richard H Finnell
- Center for Precision Environmental Health, Departments of Molecular and Cellular Biology, Molecular and Human Genetics and Medicine, Baylor College of Medicine, Houston, TX, 77030, USA.
- To Cure A Rose Foundation, Austin, TX, 78701, USA.
| | - Huiping Zhu
- To Cure A Rose Foundation, Austin, TX, 78701, USA
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3
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Ulschmid CM, Sun MR, Jabbarpour CR, Steward AC, Rivera-González KS, Cao J, Martin AA, Barnes M, Wicklund L, Madrid A, Papale LA, Joseph DB, Vezina CM, Alisch RS, Lipinski RJ. Disruption of DNA methylation-mediated cranial neural crest proliferation and differentiation causes orofacial clefts in mice. Proc Natl Acad Sci U S A 2024; 121:e2317668121. [PMID: 38194455 PMCID: PMC10801837 DOI: 10.1073/pnas.2317668121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/14/2023] [Indexed: 01/11/2024] Open
Abstract
Orofacial clefts of the lip and palate are widely recognized to result from complex gene-environment interactions, but inadequate understanding of environmental risk factors has stymied development of prevention strategies. We interrogated the role of DNA methylation, an environmentally malleable epigenetic mechanism, in orofacial development. Expression of the key DNA methyltransferase enzyme DNMT1 was detected throughout palate morphogenesis in the epithelium and underlying cranial neural crest cell (cNCC) mesenchyme, a highly proliferative multipotent stem cell population that forms orofacial connective tissue. Genetic and pharmacologic manipulations of DNMT activity were then applied to define the tissue- and timing-dependent requirement of DNA methylation in orofacial development. cNCC-specific Dnmt1 inactivation targeting initial palate outgrowth resulted in OFCs, while later targeting during palatal shelf elevation and elongation did not. Conditional Dnmt1 deletion reduced cNCC proliferation and subsequent differentiation trajectory, resulting in attenuated outgrowth of the palatal shelves and altered development of cNCC-derived skeletal elements. Finally, we found that the cellular mechanisms of cleft pathogenesis observed in vivo can be recapitulated by pharmacologically reducing DNA methylation in multipotent cNCCs cultured in vitro. These findings demonstrate that DNA methylation is a crucial epigenetic regulator of cNCC biology, define a critical period of development in which its disruption directly causes OFCs, and provide opportunities to identify environmental influences that contribute to OFC risk.
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Affiliation(s)
- Caden M. Ulschmid
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI53706
| | - Miranda R. Sun
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI53706
| | - Christopher R. Jabbarpour
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI53706
| | - Austin C. Steward
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI53706
| | - Kenneth S. Rivera-González
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI53706
- Molecular and Environmental Toxicology Training Program, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI53706
| | - Jocelyn Cao
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI53706
| | - Alexander A. Martin
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI53706
| | - Macy Barnes
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI53706
| | - Lorena Wicklund
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI53706
| | - Andy Madrid
- Neurological Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI53706
| | - Ligia A. Papale
- Neurological Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI53706
| | - Diya B. Joseph
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI53706
| | - Chad M. Vezina
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI53706
- Molecular and Environmental Toxicology Training Program, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI53706
| | - Reid S. Alisch
- Neurological Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI53706
| | - Robert J. Lipinski
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI53706
- Molecular and Environmental Toxicology Training Program, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI53706
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Wang S, Shi J, Liu C, Wang P, Wang M, Li W, Zhou R, Zheng H, Jiang J, Li N, Li J, Zhou Z, Zhu H, Wu Y, Jia Z, Wu T, Hu Y, Beaty TH. Evidence of the folate-mediated one-carbon metabolism pathway genes in controlling the non-syndromic oral clefts risks. Oral Dis 2023; 29:1080-1088. [PMID: 34739175 DOI: 10.1111/odi.14068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/21/2021] [Accepted: 10/26/2021] [Indexed: 02/05/2023]
Abstract
The folate-mediated one-carbon metabolism pathway is thought to play an important role in the etiology of non-syndromic oral clefts (NSOFC), although none of the genes in this pathway has shown significant signals in genome-wide association studies (GWAS). Recent evidence indicated that enhanced understanding could be gained by aggregating multiple SNPs effect simultaneously into polygenic risk score (PRS) to assess its association with disease risks. This study is aimed to assess the association between the genetic effect of folate-mediated one-carbon metabolism pathway and NSOFC risks using PRS based on a case-parent trio design. A total of 297 SNPs mapped from 18 genes in the folate-mediated one-carbon metabolism pathway were aggregated from a GWAS of 2458 case-parent trios recruited from an international consortium. We found a PRS based on the folate-mediated one-carbon metabolism pathway was significant among all NSOFC trios (OR = 1.95, 95% CI: 1.66-2.28, p = 2.39 × 10-16 ), as well as two major subtypes, non-syndromic cleft lip with or without cleft palate (NSCL/P) trios (OR = 1.71, 95% CI: 1.50-1.96, p = 7.66 × 10-15 ) and non-syndromic cleft palate only (NSCPO) trios (OR = 1.51, 95% CI: 1.36-1.68, p = 2.1 × 10-14 ). Similar results were also observed in further subgroup analyses stratified into Asian and European trios. The averaged PRS of the folate-mediated one-carbon metabolism pathway varied between the NSOFC case group and its comparison group (p < 0.05) with higher average PRS in the cases. Moreover, the top 5% pathway PRS group had 2.25 (95% CI: 1.85-2.73) times increased NSOFC risk, also 3.09 (95% CI: 2.50-3.81) and 2.06 (95% CI: 1.39-3.02) times increased risk of NSCL/P and NSCPO compared to the remainder of the distribution. The results of our study confirmed the folate-mediated one-carbon metabolism pathway was important in controlling risk to NSOFC and this study enhanced evidence towards understanding the genetic risks of NSOFC.
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Affiliation(s)
- Siyue Wang
- Peking University Health Science Center, Beijing, China
| | - Jiayu Shi
- Division of Growth and Development and Section of Orthodontics, School of Dentistry, University of California, Los Angeles, USA
| | | | - Ping Wang
- Peking University Health Science Center, Beijing, China
| | - Mengying Wang
- Peking University Health Science Center, Beijing, China
| | - Wenyong Li
- Peking University Health Science Center, Beijing, China
| | - Ren Zhou
- Peking University Health Science Center, Beijing, China
| | | | - Jin Jiang
- Peking University Health Science Center, Beijing, China
| | - Nan Li
- Peking University School of Stomatology, Beijing, China
| | - Jing Li
- Peking University School of Stomatology, Beijing, China
| | - Zhibo Zhou
- Peking University School of Stomatology, Beijing, China
| | - Hongping Zhu
- Peking University School of Stomatology, Beijing, China
| | - Yiqun Wu
- Peking University Health Science Center, Beijing, China
| | - Zhonglin Jia
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of cleft lip and palate, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Tao Wu
- Peking University Health Science Center, Beijing, China
- Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing, China
| | - Yonghua Hu
- Peking University Health Science Center, Beijing, China
| | - Terri H Beaty
- School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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5
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Mikhail S, Chattopadhyay L, DiBona M, Steppling C, Kwadjo D, Ramamonjisoa A, Gallardo W, Almendarez F, Sylvester B, Rosales S, Nthalika I, Collier ZJ, Magee W 3rd, Auslander A. The effect of short-term preoperative nutritional intervention for cleft surgery eligibility. BMC Nutr 2023; 9:47. [PMID: 36918940 DOI: 10.1186/s40795-023-00704-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/06/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Children with orofacial clefts are highly susceptible to malnutrition, with severe malnutrition restricting their eligibility to receive safe surgery. Ready-to-use therapeutic foods (RUTF) are an effective treatment for malnutrition; however, the effectiveness has not been demonstrated in this patient population prior to surgery. We studied the effectiveness of short-term RUTF use in transitioning children with malnutrition, who were initially ineligible for surgery, into surgical candidates. METHODS A cohort of patients from Ghana, Honduras, Malawi, Madagascar, Nicaragua, and Venezuela enrolled in a nutrition program were followed by Operation Smile from June 2017 to January 2020. Age, weight, and length/height were tracked at each visit. Patients were included until they were sufficiently nourished (Z > = -1) with a secondary outcome of receiving surgery. The study was part of a collaborative program between Operation Smile (NGO), Birdsong Peanuts (peanut shellers and distributors), and MANA Nutrition (RUTF producer). RESULTS A total of 556 patients were recruited between June 2017 and January 2020. At baseline 28.2% (n = 157) of patients were diagnosed with severe, 21.0% (n = 117) moderate, and 50.7% (n = 282) mild malnutrition. 324 (58.3%) presented for at least one return visit. Of those, 207 (63.7%) reached optimal nutrition status. By visit two, the mean z-score increased from -2.5 (moderate) to -1.7 (mild) (p < 0·001). The mean time to attain optimal nutrition was 6 weeks. There was a significant difference in the proportion of patients who improved by country(p < 0.001). CONCLUSION Malnutrition prevents many children with orofacial clefts in low- and middle-income countries from receiving surgical care even when provided for free. This creates an even larger disparity in access to surgery. In an average of 6 weeks with an approximate cost of $25 USD per patient, RUTF transitioned over 60% of patients into nutritionally eligible surgical candidates, making it an effective, short-term preoperative nutritional intervention. Through unique partnerships, the expansion of cost-effective, large-scale nutrition programs can play a pivotal role in ensuring those at the highest risk of living with unrepaired orofacial clefts receive timely and safe surgical care.
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Lipinski RJ, Krauss RS. Gene-environment interactions in birth defect etiology: Challenges and opportunities. Curr Top Dev Biol 2023; 152:1-30. [PMID: 36707208 PMCID: PMC9942595 DOI: 10.1016/bs.ctdb.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Birth defects are relatively common congenital outcomes that significantly impact affected individuals, their families, and communities. Effective development and deployment of prevention and therapeutic strategies for these conditions requires sufficient understanding of etiology, including underlying genetic and environmental causes. Tremendous progress has been made in defining the genetic basis of familial and syndromic forms of birth defects. However, the majority of birth defect cases are considered nonsyndromic and thought to result from multifactorial gene-environment interactions. While substantial advances have been made in elucidating the genetic landscape of these etiologically complex conditions, significant biological and technical constraints have stymied progress toward a refined knowledge of environmental risk factors. Defining specific gene-environment interactions in birth defect etiology is even more challenging. However, progress has been made, including demonstration of critical proofs of concept and development of new conceptual and technical approaches for resolving complex gene-environment interactions. In this review, we discuss current views of multifactorial birth defect etiology, comparing them with other diseases that also involve gene-environment interactions, including primary immunodeficiency and cancer. We describe how various model systems have illuminated mechanisms of multifactorial etiology and these models' individual strengths and weaknesses. Finally, suggestions for areas of future emphasis are proposed.
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Affiliation(s)
- Robert J. Lipinski
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI, United States,Corresponding authors: ;
| | - Robert S. Krauss
- Department of Cell, Developmental, and Regenerative Biology, Icahn School of Medicine at Mount Sinai, New York, NY, United States,Corresponding authors: ;
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7
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Fitriasari S, Trainor PA. Gene-environment interactions in the pathogenesis of common craniofacial anomalies. Curr Top Dev Biol 2022; 152:139-168. [PMID: 36707210 DOI: 10.1016/bs.ctdb.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Craniofacial anomalies often exhibit phenotype variability and non-mendelian inheritance due to their multifactorial origin, involving both genetic and environmental factors. A combination of epidemiologic studies, genome-wide association, and analysis of animal models have provided insight into the effects of gene-environment interactions on craniofacial and brain development and the pathogenesis of congenital disorders. In this chapter, we briefly summarize the etiology and pathogenesis of common craniofacial anomalies, focusing on orofacial clefts, hemifacial microsomia, and microcephaly. We then discuss how environmental risk factors interact with genes to modulate the incidence and phenotype severity of craniofacial anomalies. Identifying environmental risk factors and dissecting their interaction with different genes and modifiers is central to improved strategies for preventing craniofacial anomalies.
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Affiliation(s)
| | - Paul A Trainor
- Stowers Institute for Medical Research, Kansas City, MO, United States; Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, KS, United States.
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8
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Crider KS, Qi YP, Yeung LF, Mai CT, Head Zauche L, Wang A, Daniels K, Williams JL. Folic Acid and the Prevention of Birth Defects: 30 Years of Opportunity and Controversies. Annu Rev Nutr 2022; 42:423-452. [PMID: 35995050 PMCID: PMC9875360 DOI: 10.1146/annurev-nutr-043020-091647] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
For three decades, the US Public Health Service has recommended that all persons capable of becoming pregnant consume 400 μg/day of folic acid (FA) to prevent neural tube defects (NTDs). The neural tube forms by 28 days after conception. Fortification can be an effective NTD prevention strategy in populations with limited access to folic acid foods and/or supplements. This review describes the status of mandatory FA fortification among countries that fortify (n = 71) and the research describing the impact of those programs on NTD rates (up to 78% reduction), blood folate concentrations [red blood cell folate concentrations increased ∼1.47-fold (95% CI, 1.27, 1.70) following fortification], and other health outcomes. Across settings, high-quality studies such as those with randomized exposures (e.g., randomized controlled trials, Mendelian randomization studies) are needed to elucidate interactions of FA with vitamin B12 as well as expanded biomarker testing.
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Affiliation(s)
- Krista S Crider
- Neural Tube Defects Surveillance and Prevention Team, Infant Outcomes Monitoring, Research, and Prevention Branch, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;
| | - Yan Ping Qi
- Neural Tube Defects Surveillance and Prevention Team, Infant Outcomes Monitoring, Research, and Prevention Branch, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;
| | - Lorraine F Yeung
- Neural Tube Defects Surveillance and Prevention Team, Infant Outcomes Monitoring, Research, and Prevention Branch, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;
| | - Cara T Mai
- Neural Tube Defects Surveillance and Prevention Team, Infant Outcomes Monitoring, Research, and Prevention Branch, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;
| | - Lauren Head Zauche
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Arick Wang
- Neural Tube Defects Surveillance and Prevention Team, Infant Outcomes Monitoring, Research, and Prevention Branch, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;
| | | | - Jennifer L Williams
- Neural Tube Defects Surveillance and Prevention Team, Infant Outcomes Monitoring, Research, and Prevention Branch, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;
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Alade A, Ismail W, Nair R, Schweizer M, Awotoye W, Oladayo A, Ryckman K, Butali A. Periconceptional use of vitamin A and the risk of giving birth to a child with nonsyndromic orofacial clefts-A meta-analysis. Birth Defects Res 2022; 114:467-477. [PMID: 35357092 PMCID: PMC9321711 DOI: 10.1002/bdr2.2005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 02/03/2022] [Accepted: 03/16/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND We conducted a meta-analysis of observational epidemiological studies to evaluate the association between periconceptional use of vitamin A and the risk of giving birth to a child with nonsyndromic orofacial clefts (NSOFCs). METHODS We carried out a systematic literature search of Embase, PubMed, Web of Science, Google Scholar, and OpenGrey from inception to June 30, 2021. Two reviewers independently evaluated the studies that met the inclusion criteria and filled out an abstraction form for each study. Study quality was assessed using the Newcastle-Ottawa Assessment Scale (NOS). Adjusted estimates were pooled with an inverse variance weighting using a random-effects model. Heterogeneity and publication bias were assessed using the Cochran's Q test and funnel plot, respectively. RESULTS A total of six case-control studies with moderate risk of bias were included. The pooled OR showed a 20% reduction in the risk of NSOFCs for periconceptional use of vitamin A which was not statistically significant (OR = .80; 95% CI .54-1.17, p = .25). For nonsyndromic cleft lip with or without cleft palate (NSCL/P), the studies were homogenous, and the pooled estimate showed a 13% risk reduction, which was significant (OR = .87; 95% CI .77-.99, p = .03). For nonsyndromic cleft palate only (NSCPO), the pooled estimate showed a 33% lower likelihood, which was not statistically significant (OR = .67; 95% CI .42-1.08, p = .10). CONCLUSION Our results suggest a possible protective effect for the periconceptional use of vitamin A on the risk of NSCL/P. This finding should be investigated further in prospective studies across multiple populations.
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Affiliation(s)
- Azeez Alade
- Department of Epidemiology, College of Public HealthUniversity of IowaIowa CityIowaUSA
- Iowa Institute of Oral Health ResearchUniversity of IowaIowa CityIowaUSA
| | - Wesam Ismail
- College of PharmacyUniversity of IowaIowa CityIowaUSA
| | - Rajeshwari Nair
- University of Iowa Hospitals and ClinicsUniversity of IowaIowa CityIowaUSA
- Center for Access and Delivery Research and EvaluationIowa City VA Health Care SystemIowa CityIowaUSA
| | - Marin Schweizer
- Department of Epidemiology, College of Public HealthUniversity of IowaIowa CityIowaUSA
- University of Iowa Hospitals and ClinicsUniversity of IowaIowa CityIowaUSA
- Center for Access and Delivery Research and EvaluationIowa City VA Health Care SystemIowa CityIowaUSA
| | - Waheed Awotoye
- Iowa Institute of Oral Health ResearchUniversity of IowaIowa CityIowaUSA
| | - Abimbola Oladayo
- Iowa Institute of Oral Health ResearchUniversity of IowaIowa CityIowaUSA
| | - Kelli Ryckman
- Department of Epidemiology, College of Public HealthUniversity of IowaIowa CityIowaUSA
| | - Azeez Butali
- Iowa Institute of Oral Health ResearchUniversity of IowaIowa CityIowaUSA
- Department of Oral Pathology, Radiology and Medicine, College of DentistryUniversity of IowaIowa CityIowaUSA
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10
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Goida J, Pilmane M. The Evaluation of FGFR1, FGFR2 and FOXO1 in Orofacial Cleft Tissue. Children 2022; 9:children9040516. [PMID: 35455561 PMCID: PMC9032315 DOI: 10.3390/children9040516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 11/21/2022]
Abstract
Although cleft lip with or without cleft palate (CL/P) is one of the most common congenital anomalies worldwide, the morphopathogenesis of non-syndromic orofacial clefts is still unclear. Many candidate genes have been proposed to play a causal role; however, only a few have been confirmed, leaving many still to be assessed. Taking into account the significance of FGFR1, FGFR2 and FOXO1 in embryogenesis, the aim of this work was to detect and compare the three candidate genes in cleft-affected lip and palatine tissue. Ten soft tissue samples were taken during cheiloplasty and veloplasty. The signals of the candidate genes were visualized using chromogenic in situ hybridization and analyzed using a semi-quantitative method. No statistically important difference in the distribution of FGFR1, FGFR2 and FOXO1 between neither the patients’ lip and vomer mucosa nor the control group was observed. Statistically significant very strong and strong correlations were found between genes in the lip and palatine tissue. The expression of FGFR1, FGFR2 and FOXO1 in cleft-affected lip and palatine tissue seems to be highly individual. Numerous intercorrelations between the genes do not exclude their role in the possible complex morphopathogenesis of orofacial clefts.
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11
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Suazo J. Environmental factors in non-syndromic orofacial clefts: A review based on meta-analyses results. Oral Dis 2022; 28:3-8. [PMID: 33872445 DOI: 10.1111/odi.13880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 10/21/2022]
Abstract
Non-syndromic orofacial clefts (NSOFCs) are prevalent birth defects with a complex etiology where several interacting genetic and environmental factors have been observed. This narrative review describes maternal exposures that have been significantly associated with protective effects or risk factors. The statistically significant information reported here was found in meta-analysis studies, taking advantage of their precision in defining intervention effects and their management of heterogeneity between studies. In addition, I propose a hypothesis explaining the biological basis for the results of the meta-analyses. This review aims to improve the evidence available in parent counseling, to prevent the occurrence of orofacial clefts by suggesting lifestyle changes.
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Affiliation(s)
- José Suazo
- Institute for Research in Dental Sciences, School of Dentistry, Universidad de Chile, Santiago, Chile
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12
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Jabaiti S, Salah B, Al-Lawama M, AlRyalat SA, Jabaiti O, Al-Mikhi B, Alsmady DM, Al-Basti H. Impact of Parental Consanguinity on the Frequency of Orofacial Clefts in Jordan. J Craniofac Surg 2021. [PMID: 34669683 DOI: 10.1097/SCS.0000000000008294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Orofacial clefts (OFCs) are the most common craniofacial congenital anomalies, and its prevalence is highest among Asian populations. The aim of this retrospective case-control study is to evaluate the effect of parental consanguinity on the frequency of OFCs at Jordan University Hospital over a 15-year-period. The study group consists of all patients with OFCs presented to the major tertiary referral center in Jordan during the last 15 years, along with age and gender-matched controls. The authors analyzed the risk of different predictors, including consanguinity, on the development of OFCs, both cleft lip with or without cleft palate (CL/P) and cleft palate only. A total of 332 participants were included in this study, with a mean age of 74.36 (±48.75) months. The authors included 129 (38.9%) OFCs, and 203 (61.1%) controls. The percentage of parental consanguinity among OFCs group was 41.1%, compared to only 24.1% for controls, a difference that was statistically significant (P = 0.001). On logistic regression analysis, the authors found that parental consanguinity is a significant predictor for the occurrence of OFCs (P = 0.007), where people with consanguineous marriage have 2 times higher risk (odds ratio of 0.504, with 95% confidence interval 0.306-0.830) to have offspring with OFCs. Moreover, lower birth weight babies are also significantly more associated with OFCs (P = 0.014), with an odds ratio of 1.819 (95% confidence interval 1.131 2.926). Among the Jordanian population, the authors found that consanguinity and lower birth weight were the only variables significantly associated with the development of OFCs.
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13
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Qin J, Li J, Li F, Sun M, Wang T, Diao J, Zhang S, Luo L, Li Y, Chen L, Huang P, Zhu P. Association of maternal folate use and reduced folate carrier gene polymorphisms with the risk of congenital heart disease in offspring. Eur J Pediatr 2021; 180:3181-3190. [PMID: 33913025 DOI: 10.1007/s00431-021-04087-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/18/2021] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
Abstract
Although it is generally recognized that genetic and environmental factors are associated with the risk of congenital heart disease (CHD), the mechanism remains largely uncertain. This study aimed to investigate the association of maternal folate use, the time when folate use was started, and polymorphisms of the reduced folate carrier (RFC1) gene with the risk of CHD in offspring of Chinese descent, which can help provide new insight into the etiology of folate-related birth defects. A case-control study of 683 mothers of CHD patients and 740 mothers of healthy children was performed. The present study showed that mothers who did not use folate were at a significantly increased risk of CHD (OR=2.04; 95% CI: 1.42-2.93). When compared with those who started using folate prior to conception, mothers who started using folate from the first trimester of pregnancy (OR=1.90; 95% CI: 1.43-2.54) or from the second trimester of pregnancy (OR=8.92; 95% CI: 4.20-18.97) had a significantly higher risk of CHD. Maternal RFC1 gene polymorphisms at rs2236484 (AG vs AA: OR=1.79 [95% CI: 1.33-2.39]; GG vs AA: OR=1.64 [95% CI: 1.15-2.35]) and rs2330183 (CT vs CC: OR=1.54 [95% CI: 1.14-2.09]) were also significantly associated with CHD risk. Additionally, the risk of CHD was significantly decreased among mothers who had variant genotypes but used folate when compared with those who had variant genotypes and did not use folate.Conclusion: In those of Chinese descent, maternal folate use and the time when use started are significantly associated with the risk of CHD in offspring. Furthermore, maternal folate supplementation may help to offset some of the risks of CHD in offspring due to maternal RFC1 genetic variants. What is Known: • Folate use could help prevent CHD, but the relationship between the time when folate use is started and CHD has not received sufficient attention. • Studies have assessed the associations of folate metabolism-related genes with CHD, but genes involved in cellular transportation of folate, such as the RFC1 gene, have not garnered enough attention. What is New: • In those of Chinese descents, the time when folate use is started is significantly associated with the risk of CHD in offspring. • Maternal RFC1 polymorphisms were significantly associated with the risk of CHD. • Folate supplementation may help to offset some risks of CHD due to RFC1 genetic variants.
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Affiliation(s)
- Jiabi Qin
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510100, Guangdong, China.,Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.,NHC Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Jinqi Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Fang Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Mengting Sun
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Tingting Wang
- NHC Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Jingyi Diao
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Senmao Zhang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Liu Luo
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Yihuan Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Letao Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Peng Huang
- Hunan Children's Hospital, 86 Ziyuan Road, Changsha, 410007, Hunan, China.
| | - Ping Zhu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510100, Guangdong, China.
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14
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Liu J, Zhang Y, Zhang L, Wang L, Jin L, Greene NDE, Li Z, Ren A. Orofacial Clefts in High Prevalence Area of Birth Defects - Five Counties, Shanxi Province, China, 2000-2020. China CDC Wkly 2021; 3:773-777. [PMID: 34594988 PMCID: PMC8441179 DOI: 10.46234/ccdcw2021.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 09/01/2021] [Indexed: 11/14/2022] Open
Abstract
WHAT IS ALREADY KNOWN ON THIS TOPIC? The prevalence of structural birth defects, especially neural tube defects, decreased after national folic acid (FA) supplementation initiation. WHAT IS ADDED BY THIS REPORT? The prevalence of orofacial clefts (OFCs) in five counties of Shanxi Province in northern China, including most subtypes except cleft palate, showed a downward trend in the past two decades. In this study, pre-perinatal prevalence increased due to earlier detection. WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE? Periconceptional supplementation with FA may contribute to the decline in OFCs prevalence, while the effect on the OFCs subtype needs further investigation. Continuing to advocate for earlier supplementation (3 months before conception) and increased supplementation frequency (daily consumption) could promote further reduction in the prevalence of OFCs. Specific surveillance of this effect in the era of universal three-child policy is warranted.
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Affiliation(s)
- Jufen Liu
- Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health, National Health Commission of the People’s Republic of China, Peking University, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yali Zhang
- Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health, National Health Commission of the People’s Republic of China, Peking University, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Le Zhang
- Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health, National Health Commission of the People’s Republic of China, Peking University, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Linlin Wang
- Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health, National Health Commission of the People’s Republic of China, Peking University, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Lei Jin
- Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health, National Health Commission of the People’s Republic of China, Peking University, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Nicholas D E Greene
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Zhiwen Li
- Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health, National Health Commission of the People’s Republic of China, Peking University, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Aiguo Ren
- Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health, National Health Commission of the People’s Republic of China, Peking University, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
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15
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Inostroza V, Salamanca C, Recabarren AS, Pantoja R, Leiva N, Pardo R, Suazo J. Maternal genotypes of folate/one-carbon metabolism gene variants and nonsyndromic cleft lip with or without cleft palate risk in Chile. Eur J Oral Sci 2021; 129:e12813. [PMID: 34289180 DOI: 10.1111/eos.12813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 12/27/2022]
Abstract
The aim of this study was to evaluate, in a case-control design, the association between maternal genotypes for variants in 23 genes involved in folate/one-carbon metabolism and nonsyndromic cleft lip with or without cleft palate (NSCL/P) in a Chilean population. After applying several filters to an Illumina array, we extracted 175 single nucleotide polymorphisms (SNPs) from 150 mothers of NSCL/P cases and 150 control women. Association was evaluated using computed odds ratio (OR) with a 95% confidence interval (95% CI) in additive, recessive, and dominant models. After multiple comparison correction, only SNP rs4451422 (A>C), located 237 bp downstream of the gene encoding the human folylpolyglutamate synthetase (FPGS), maintained a significant association with NSCL/P in the offspring (OR 3.03; 95% CI 1.69-5.26). The variant rs4451422 is associated with a decrease in FPGS expression according to database annotation. Our results lead to a new hypothesis that a lower activity of FPGS enzyme reduces intracellular folate levels and increases the risk of an offspring having NSCL/P.
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Affiliation(s)
- Verónica Inostroza
- Department of Anatomy, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos Salamanca
- Institute for Research in Dental Sciences, School of Dentistry, Universidad de Chile, Santiago, Chile.,Research Center in Dental Sciences (CICO), Dental School, Universidad de La Frontera, Temuco, Chile.,Universidad Adventista de Chile, Chillán, Chile
| | - Andrea S Recabarren
- Institute for Research in Dental Sciences, School of Dentistry, Universidad de Chile, Santiago, Chile
| | - Roberto Pantoja
- Unit of Oral and Maxillofacial Surgery, Hospital Clínico San Borja-Arriaran, Santiago, Chile.,Department of Oral and Maxillofacial Surgery, School of Dentistry, Universidad de Chile, Santiago, Chile
| | - Noemí Leiva
- Unit of Maxillofacial Malformations, School of Dentistry, Universidad de Chile, Santiago, Chile
| | - Rosa Pardo
- Section of Genetics, Hospital Clínico Universidad de Chile, Santiago, Chile.,Unit of Neonatology, Hospital Clínico Universidad de Chile, Santiago, Chile.,Unit of Genetics, Hospital Dr. Sótero del Río, Santiago, Chile
| | - José Suazo
- Institute for Research in Dental Sciences, School of Dentistry, Universidad de Chile, Santiago, Chile
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16
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Xu W, Yi L, Deng C, Zhao Z, Ran L, Ren Z, Zhao S, Zhou T, Zhang G, Liu H, Dai L. Maternal periconceptional folic acid supplementation reduced risks of non-syndromic oral clefts in offspring. Sci Rep 2021; 11:12316. [PMID: 34112890 PMCID: PMC8192944 DOI: 10.1038/s41598-021-91825-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 06/01/2021] [Indexed: 11/15/2022] Open
Abstract
Maternal periconceptional folic acid supplementation (FAS) has been documented to be associated with decreased risk of nonsyndromic oral clefts (NsOC). However, the results remain inconclusive. In this population-based case–control study of 807 singletons affected by NsOC and 8070 healthy neonates who were born between October 2010 and September 2015 in Chengdu, China, we examined the association of maternal FAS with the risk of nonsyndromic cleft lip with or without cleft palate (NsCL/P), and cleft palate (NsCP). Unconditional logistic regression analysis was used to estimate the crude and adjusted odds ratios (ORs) and 95% confidential intervals (CI). Significant associations were found between maternal periconceptional FAS and decreased risk of NsCL/P (aOR = 0.41, 95% CI 0.33–0.51). This protective effect was also detected for NsCL (aOR = 0.42, 95% CI 0.30–0.58) and NsCLP (aOR = 0.41, 95% CI 0.31–0.54). Both maternal FAS started before and after the last menstrual period (LMP) were inversely associated with NsCL/P (before LMP, aOR = 0.43, 95% CI 0.33–0.56; after LMP, aOR = 0.41, 95% CI 0.33–0.51). The association between NsCP and maternal FAS initiating before LMP was also found (aOR = 0.52, 95% CI 0.30–0.90). The findings suggest that maternal periconceptional FAS can reduce the risk of each subtype of NsCL/P in offspring, while the potential effect on NsCP needs further investigations.
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Affiliation(s)
- Wenli Xu
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, 610041, Sichuan, China
| | - Ling Yi
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, 610041, Sichuan, China
| | - Changfei Deng
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, 610041, Sichuan, China
| | - Ziling Zhao
- Sichuan Provincial Hospital for Women and Children, Affiliated Women and Children's Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Longrong Ran
- Chengdu Women's & Children's Central Hospital, Chengdu, Sichuan, China
| | - Zhihong Ren
- Chengdu Women's & Children's Central Hospital, Chengdu, Sichuan, China
| | - Shunxia Zhao
- Chengdu Women's & Children's Central Hospital, Chengdu, Sichuan, China
| | - Tianjin Zhou
- Sichuan Provincial Hospital for Women and Children, Affiliated Women and Children's Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Gang Zhang
- Sichuan Provincial Hospital for Women and Children, Affiliated Women and Children's Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Hanmin Liu
- Pediatric Department, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, 610041, Sichuan, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China. .,Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan, China.
| | - Li Dai
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, 610041, Sichuan, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China. .,Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan, China.
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17
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Maldonado E, Martínez-Sanz E, Partearroyo T, Varela-Moreiras G, Pérez-Miguelsanz J. Maternal Folic Acid Deficiency Is Associated to Developing Nasal and Palate Malformations in Mice. Nutrients 2021; 13:251. [PMID: 33467180 PMCID: PMC7830789 DOI: 10.3390/nu13010251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 12/25/2020] [Accepted: 01/14/2021] [Indexed: 11/25/2022] Open
Abstract
Craniofacial development requires extremely fine-tuned developmental coordination of multiple specialized tissues. It has been evidenced that a folate deficiency (vitamin B9), or its synthetic form, folic acid (FA), in maternal diet could trigger multiple craniofacial malformations as oral clefts, tongue, or mandible abnormalities. In this study, a folic acid-deficient (FAD) diet was administered to eight-week-old C57/BL/6J female mouse for 2-16 weeks. The head symmetry, palate and nasal region were studied in 24 control and 260 experimental fetuses. Our results showed a significant reduction in the mean number of fetuses per litter according to maternal weeks on FAD diet (p < 0.01). Fetuses were affected by cleft palate (3.8%) as well as other severe congenital abnormalities, for the first time related to maternal FAD diet, as head asymmetries (4.6%), high arched palate (3.5%), nasal septum malformed (7.3%), nasopharynx duct shape (15%), and cilia and epithelium abnormalities (11.2% and 5.8%). Dysmorphologies of the nasal region were the most frequent, appearing at just four weeks following a maternal FAD diet. This is the first time that nasal region development is experimentally related to this vitamin deficiency. In conclusion, our report offers novel discoveries about the importance of maternal folate intake on midface craniofacial development of the embryos. Moreover, the longer the deficit lasts, the more serious the consequent effects appear to be.
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Affiliation(s)
- Estela Maldonado
- Departamento de Anatomía y Embriología, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain; (E.M.-S.); (J.P.-M.)
- Grupo UCM de Investigación nº 920202 “Investigación en Desarrollo del Paladar y Fisura Palatina. Desarrollo Craneofacial”, Facultad de Odontología, Plaza de Ramón y Cajal, 3, 28040 Madrid, Spain
| | - Elena Martínez-Sanz
- Departamento de Anatomía y Embriología, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain; (E.M.-S.); (J.P.-M.)
- Grupo UCM de Investigación nº 920202 “Investigación en Desarrollo del Paladar y Fisura Palatina. Desarrollo Craneofacial”, Facultad de Odontología, Plaza de Ramón y Cajal, 3, 28040 Madrid, Spain
| | - Teresa Partearroyo
- Departamento de Ciencias Farmacéuticas y de la Salud, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, Alcorcón, 28925 Madrid, Spain; (T.P.); (G.V.-M.)
- Grupo USP-CEU de Excelencia “Nutrición para la vida (Nutrition for life)”, ref: E02/0720, Alcorcón, 28925 Madrid, Spain
| | - Gregorio Varela-Moreiras
- Departamento de Ciencias Farmacéuticas y de la Salud, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, Alcorcón, 28925 Madrid, Spain; (T.P.); (G.V.-M.)
- Grupo USP-CEU de Excelencia “Nutrición para la vida (Nutrition for life)”, ref: E02/0720, Alcorcón, 28925 Madrid, Spain
| | - Juliana Pérez-Miguelsanz
- Departamento de Anatomía y Embriología, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain; (E.M.-S.); (J.P.-M.)
- Grupo UCM de Investigación nº 911308 “Mecanismos Moleculares Cronobiológicos”, Plaza de Ramón y Cajal, s/n, 28040 Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), C/ del Prof. Martín Lagos, s/n, 28040 Madrid, Spain
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18
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Abstract
Cleft lip (CL) with/without cleft palate (CP) (hereafter CL/P) is the second most common congenital birth defect, affecting 7.94 to 9.92 children per 10,000 live births worldwide, followed by Down syndrome. An increasing number of genes have been identified as affecting susceptibility and/or as causative genes for CL/P in mouse genetic and chemically-induced CL and CP studies, as well as in human genome-wide association studies and linkage analysis. While marked progress has been made in the identification of genetic and environmental risk factors for CL/P, the interplays between these factors are not yet fully understood. This review aims to summarize our current knowledge of CL and CP from genetically engineered mouse models and environmental factors that have been studied in mice. Understanding the regulatory mechanism(s) of craniofacial development may not only advance our understanding of craniofacial developmental biology, but could also provide approaches for the prevention of birth defects and for tissue engineering in craniofacial tissue regeneration.
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Affiliation(s)
- Junichi Iwata
- Department of Diagnostic & Biomedical Sciences, The University of Texas Health Science Center at Houston, School of Dentistry, Houston, Texas, 77054 USA.,Center for Craniofacial Research, The University of Texas Health Science Center at Houston, School of Dentistry, Houston, Texas, 77054 USA.,Pediatric Research Center, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, 77030 USA.,MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, 77030 USA
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19
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Bo Y, Zhu Y, Tao Y, Li X, Zhai D, Bu Y, Wan Z, Wang L, Wang Y, Yu Z. Association Between Folate and Health Outcomes: An Umbrella Review of Meta-Analyses. Front Public Health 2020; 8:550753. [PMID: 33384976 PMCID: PMC7770110 DOI: 10.3389/fpubh.2020.550753] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 11/06/2020] [Indexed: 12/14/2022] Open
Abstract
Background: There is no study that has systematically investigated the breadth and validity of the associations of folate and multiple health outcomes. We aimed to evaluate the quantity, validity, and credibility of evidence regarding associations between folate and multiple health outcomes by using umbrella review of meta-analysis. Methods: We searched the MEDLINE, EMBASE, and Cochrane Library databases from inception to May 20, 2018, to identify potential meta-analyses that examined the association of folate with any health outcome. For each included meta-analysis, we estimated the summary effect size and their 95% confidence interval using the DerSimonian and Laird random-effects model. We used the AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) to assess methodological quality and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation working group classification) to assess the quality of evidence for each outcome included in the umbrella review. Results: Overall, 108 articles reporting 133 meta-analyses of observational studies and 154 meta-analyses of randomized controlled trials (RCTs) were included in the study. Among them, 108 unique exposure-outcome-population triplets (referred to as unique meta-analyses hereafter) of RCTs and 87 unique meta-analyses of observational studies were reanalyzed. Beneficial effects of folate were observed in the all-cause mortality rate and in a number of chronic diseases, including several birth/pregnancy outcomes, several cancers, cardiovascular disease and metabolic-related outcomes, neurological conditions, and several other diseases. However, adverse effects of folate were observed for prostate cancer, colorectal adenomatous lesions, asthma or wheezing, and wheezing as an isolated symptom and depression. Conclusions: Current evidence allows for the conclusion that folate is associated with decreased risk of all-cause mortality and a wide range of chronic diseases. However, folate may be associated with an increased risk of prostate cancer. Further research is warranted to improve the certainty of the estimates.
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Affiliation(s)
- Yacong Bo
- School of Public Health, Xinxiang Medical University, Xinxiang, China
| | - Yongjian Zhu
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuchang Tao
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xue Li
- School of Public Health, Xinxiang Medical University, Xinxiang, China.,Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Desheng Zhai
- School of Public Health, Xinxiang Medical University, Xinxiang, China
| | - Yongjun Bu
- School of Public Health, Xinxiang Medical University, Xinxiang, China
| | - Zhongxiao Wan
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Ling Wang
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yuming Wang
- Department of Administration, Henan University People's Hospital, Zhengzhou, China
| | - Zengli Yu
- School of Public Health, Xinxiang Medical University, Xinxiang, China
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20
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Raterman ST, Metz JR, Wagener FADTG, Von den Hoff JW. Zebrafish Models of Craniofacial Malformations: Interactions of Environmental Factors. Front Cell Dev Biol 2020; 8:600926. [PMID: 33304906 PMCID: PMC7701217 DOI: 10.3389/fcell.2020.600926] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/23/2020] [Indexed: 11/13/2022] Open
Abstract
The zebrafish is an appealing model organism for investigating the genetic (G) and environmental (E) factors, as well as their interactions (GxE), which contribute to craniofacial malformations. Here, we review zebrafish studies on environmental factors involved in the etiology of craniofacial malformations in humans including maternal smoking, alcohol consumption, nutrition and drug use. As an example, we focus on the (cleft) palate, for which the zebrafish ethmoid plate is a good model. This review highlights the importance of investigating ExE interactions and discusses the variable effects of exposure to environmental factors on craniofacial development depending on dosage, exposure time and developmental stage. Zebrafish also promise to be a good tool to study novel craniofacial teratogens and toxin mixtures. Lastly, we discuss the handful of studies on gene–alcohol interactions using mutant sensitivity screens and reverse genetic techniques. We expect that studies addressing complex interactions (ExE and GxE) in craniofacial malformations will increase in the coming years. These are likely to uncover currently unknown mechanisms with implications for the prevention of craniofacial malformations. The zebrafish appears to be an excellent complementary model with high translational value to study these complex interactions.
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Affiliation(s)
- S T Raterman
- Radboud Institute of Molecular Life Sciences, Nijmegen, Netherlands.,Department of Dentistry-Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, Netherlands.,Department of Animal Ecology and Physiology, Institute for Water and Wetland Research, Radboud University, Nijmegen, Netherlands
| | - J R Metz
- Department of Animal Ecology and Physiology, Institute for Water and Wetland Research, Radboud University, Nijmegen, Netherlands
| | - Frank A D T G Wagener
- Radboud Institute of Molecular Life Sciences, Nijmegen, Netherlands.,Department of Dentistry-Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Johannes W Von den Hoff
- Radboud Institute of Molecular Life Sciences, Nijmegen, Netherlands.,Department of Dentistry-Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, Netherlands
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21
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Bendahan ZC, Escobar LM, Castellanos JE, González-Carrera MC. Effect of folic acid on animal models, cell cultures, and human oral clefts: a literature review. Egypt J Med Hum Genet 2020. [DOI: 10.1186/s43042-020-00108-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Folate is a naturally occurring, water-soluble B vitamin. The synthetic form of this compound is folic acid (FA), the deficiency of which is linked to neural tube disorders (NTD), which can be prevented by consuming it before, or during the early months of, pregnancy. However, the effect of FA on oral cleft formation remains controversial. The aim of the present study was to review the evidence concerning the effect of FA on the formation of cleft lip and palate (CLP) in both animals and humans, as well as its impact on different cell types. A search was conducted on various databases, including MEDLINE, EMBASE, and Central, for articles published until January 2020.
Main body
Current systematic reviews indicate that FA, alone or in combination with other vitamins, prevents NTD; however, there is no consensus on whether its consumption can prevent CLP formation. Conversely, the protective effect of FA on palatal cleft (CP) induction has been inferred from animal models; additionally, in vitro studies enumerate a cell-type and dose-dependent effect of FA on cell viability, proliferation, and differentiation, hence bolstering evidence from epidemiological studies.
Conclusions
Meta-analysis, animal models, and in vitro studies demonstrated the protective effect of FA against isolated CP; however, the heterogeneity of treatment protocols, doses, and FA administration method, as well as the different cell types used in in vitro studies, does not conclusively establish whether FA prevents CLP formation.
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Cáceres-Rojas G, Salamanca C, Krause BJ, Recabarren AS, Recabarren PA, Pantoja R, Leiva N, Pardo R, Santos JL, Suazo J. Nonsyndromic orofacial clefts in Chile: LINE-1 methylation and MTHFR variants. Epigenomics 2020; 12:1783-1791. [PMID: 33147056 DOI: 10.2217/epi-2020-0021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To evaluate the risk of nonsyndromic orofacial clefts (NSOFCs) associated with LINE-1 methylation, as a marker of global DNA methylation, and the effect of MTHFR functional variants on this variable. Patients & methods: LINE-1 methylation was evaluated by bisulfite modification coupled to DNA pyrosequencing in 95 NSOFC cases and 95 controls. In these subjects, MTHFR genotypes for variants c.C677T (rs1801133) and c.A1298C (rs1801131) were obtained. Results: Middle levels (second tertile) of LINE-1 methylation increase the risk of NSOFCs. In addition, LINE-1 methylation depends on c.A1298C genotypes in controls but not in cases. Conclusion: A nonlinear association between global DNA methylation and NSOFCs was detected in this Chilean population, which appears to be influenced by MTHFR functional variants.
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Affiliation(s)
- Gabriela Cáceres-Rojas
- Institute for Research in Dental Sciences, School of Dentistry, Universidad de Chile, Santiago, Chile
| | - Carlos Salamanca
- Institute for Research in Dental Sciences, School of Dentistry, Universidad de Chile, Santiago, Chile.,Research Centre in Dental Sciences (CICO), Dental School, Universidad de La Frontera, Chile.,Universidad Adventista de Chile, Chillán, Chile
| | - Bernardo J Krause
- Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile
| | - Andrea S Recabarren
- Institute for Research in Dental Sciences, School of Dentistry, Universidad de Chile, Santiago, Chile
| | - Pamela A Recabarren
- Institute for Research in Dental Sciences, School of Dentistry, Universidad de Chile, Santiago, Chile
| | - Roberto Pantoja
- Maxillofacial Surgery Service, Cleft Lip & Palate Unit, Hospital Clínico San Borja-Arriaran. Santiago de Chile, Chile.,Department of Oral & Maxillofacial Surgery, School of Dentistry, Universidad de Chile, Santiago, Chile
| | - Noemi Leiva
- Unit of Maxillofacial Malformations, School of Dentistry, Universidad de Chile, Santiago, Chile
| | - Rosa Pardo
- Section of Genetics, Hospital Clínico Universidad de Chile, Santiago, Chile.,Unit of Neonatology, Hospital Clínico Universidad de Chile, Santiago, Chile.,Unit of Genetics, Hospital Dr Sótero del Río, Santiago, Chile
| | - José Luis Santos
- Department of Nutrition, Diabetes & Metabolism, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José Suazo
- Institute for Research in Dental Sciences, School of Dentistry, Universidad de Chile, Santiago, Chile
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23
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Zhou Y, Sinnathamby V, Yu Y, Sikora L, Johnson CY, Mossey P, Little J. Folate intake, markers of folate status and oral clefts: An updated set of systematic reviews and meta-analyses. Birth Defects Res 2020; 112:1699-1719. [PMID: 33118705 DOI: 10.1002/bdr2.1827] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/04/2020] [Accepted: 10/11/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND There has been a longstanding debate about the role of folate in the etiology of orofacial clefts (OFCs). Studies of different measures of nutritional intake or folate status have been done to investigate the possible role of folate in the prevention of OFC. Only one knowledge synthesis has attempted to bring together different types of evidence. The aim of the present work was to update it. METHODS Evidence for associations between OFC and dietary folate, supplement use, folic acid fortification, biomarkers of folate status, and variants of MTHFR (C677T and A1298C) were included. Potentially eligible articles were systematically identified from PubMed, Medline, Embase, and Web of Science (2007-2020) and combined using random-effects meta-analysis when appropriate. Quality assessments were conducted using the Newcastle-Ottawa scale and Cochrane's risk of bias tool. RESULTS Sixty-four studies published since the previous knowledge synthesis were identified, with eight of these identified through a supplementary search from October, 2018 to August, 2020. There was an inverse association between folic acid-containing supplement use before or during pregnancy and cleft lip with or without cleft palate (CL/P) (OR 0.60, 95% CI 0.51-0.69), with considerable between-study heterogeneity. The prevalence of CL/P showed a small decline post-folic acid fortification in seven studies (OR 0.94, 95% CI 0.86-1.02). No association was found between OFC and genetic markers of folate status. The coronavirus-19 pandemic has threatened food availability globally and therefore there is a need to maintain and even enhance surveillance concerning maternal intake of folate and related vitamins. CONCLUSIONS The risk of non-syndromic OFC was reduced among pregnant women with folic acid-containing supplements during the etiologically relevant period. However, high heterogeneity between included studies, incomplete reporting of population characteristics and variation in timing of exposure and supplement types mean that conclusions should be drawn with caution.
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Affiliation(s)
- Yulai Zhou
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ontario, Canada
| | | | - Yamei Yu
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ontario, Canada
| | - Candice Y Johnson
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
| | - Peter Mossey
- School of Dentistry, University of Dundee, Dundee, Scotland.,WHO Collaborating Centre for Craniofacial Anomalies, Dundee, Scotland
| | - Julian Little
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ontario, Canada
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24
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Machado RA, de Oliveira Silva C, Martelli-Junior H, das Neves LT, Coletta RD. Machine learning in prediction of genetic risk of nonsyndromic oral clefts in the Brazilian population. Clin Oral Investig 2020; 25:1273-1280. [PMID: 32617779 DOI: 10.1007/s00784-020-03433-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 06/24/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Genetic variants in multiple genes and loci have been associated with the risk of nonsyndromic cleft lip with or without cleft palate (NSCL ± P). However, the estimation of risk remains challenge, because most of these variants are population-specific rendering the identification of the underlying genetic risk difficult. Herein we examined the use of machine learning network in previously reported single nucleotide polymorphisms (SNPs) to predict risk of NSCL ± P in the Brazilian population. MATERIALS AND METHODS Random forest and neural network methods were applied in 72 SNPs in a case-control sample composed by 722 NSCL ± P and 866 controls for discrimination of NSCL ± P risk. SNP-SNP interactions and functional annotation biological processes associated with the identified NSCL ± P risk genes were verified. RESULTS Supervised random forest decision trees revealed high scores of importance for the SNPs rs11717284 and rs1875735 in FGF12, rs41268753 in GRHL3, rs2236225 in MTHFD1, rs2274976 in MTHFR, rs2235371 and rs642961 in IRF6, rs17085106 in RHPN2, rs28372960 in TCOF1, rs7078160 in VAX1, rs10762573 and rs2131960 in VCL, and rs227731 in 17q22, with an accuracy of 99% and an error rate of approximately 3% to predict the risk of NSCL ± P. Those same 13 SNPs were considered the most important for the neural network to effectively predict NSCL ± P risk, with an overall accuracy of 94%. Multivariate regression model revealed significant interactions among all SNPs, with an exception of those in FGF12 and MTHFD1. The most significantly biological processes for selected genes were those involved in tissue and epithelium development; neural tube closure; and metabolism of methionine, folate, and homocysteine. CONCLUSIONS Our results provide novel clues for genetic mechanism studies of NSCL ± P and point out for a machine learning model composed by 13 SNPs that is capable of predicting NSCL ± P risk. CLINICAL RELEVANCE Although validation is necessary, this genetic panel can be useful in the near future to assist in NSCL ± P genetic counseling.
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Affiliation(s)
- Renato Assis Machado
- Department of Oral Diagnosis, School of Dentistry, University of Campinas, Piracicaba, São Paulo, CEP 13414-018, Brazil
- Post-Graduation Program in Rehabilitation Sciences, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | - Carolina de Oliveira Silva
- Department of Oral Diagnosis, School of Dentistry, University of Campinas, Piracicaba, São Paulo, CEP 13414-018, Brazil
| | - Hercílio Martelli-Junior
- Stomatology Clinic, Dental School, State University of Montes Claros, Montes Claros, Minas Gerais, Brazil
- Center for Rehabilitation of Craniofacial Anomalies, Dental School, University of José Rosario Vellano, Alfenas, Minas Gerais, Brazil
| | - Lucimara Teixeira das Neves
- Post-Graduation Program in Rehabilitation Sciences, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Ricardo D Coletta
- Department of Oral Diagnosis, School of Dentistry, University of Campinas, Piracicaba, São Paulo, CEP 13414-018, Brazil.
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25
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Sato Y, Yoshioka E, Saijo Y, Miyamoto T, Sengoku K, Azuma H, Tanahashi Y, Ito Y, Kobayashi S, Minatoya M, Bamai YA, Yamazaki K, Itoh S, Miyashita C, Araki A, Kishi R. Population Attributable Fractions of Modifiable Risk Factors for Nonsyndromic Orofacial Clefts: A Prospective Cohort Study From the Japan Environment and Children's Study. J Epidemiol 2020; 31:272-279. [PMID: 32336698 PMCID: PMC7940975 DOI: 10.2188/jea.je20190347] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Population impact of modifiable risk factors on orofacial clefts is still unknown. This study aimed to estimate population attributable fractions (PAFs) of modifiable risk factors for nonsyndromic cleft lip with or without cleft palate (CL±P) and cleft palate only (CP) in Japan. Methods We conducted a prospective cohort study using data from the Japan Environment and Children’s Study, which recruited pregnant women from 2011 to 2014. We estimated the PAFs of maternal alcohol consumption, psychological distress, maternal active and passive smoking, abnormal body mass index (BMI) (<18.5 and ≥25 kg/m2), and non-use of a folic acid supplement during pregnancy for nonsyndromic CL±P and CP in babies. Results A total of 94,174 pairs of pregnant women and their single babies were included. Among them, there were 146 nonsyndromic CL±P cases and 41 nonsyndromic CP cases. The combined adjusted PAF for CL±P of the modifiable risk factors excluding maternal alcohol consumption was 34.3%. Only maternal alcohol consumption was not associated with CL±P risk. The adjusted PAFs for CL±P of psychological distress, maternal active and passive smoking, abnormal BMI, and non-use of a folic acid supplement were 1.4% (95% confidence interval [CI], −10.7 to 15.1%), 9.9% (95% CI, −7.0 to 26.9%), 10.8% (95% CI, −9.9 to 30.3%), 2.4% (95% CI, −7.5 to 14.0%), and 15.1% (95% CI, −17.8 to 41.0%), respectively. We could not obtain PAFs for CP due to the small sample size. Conclusions We reported the population impact of the modifiable risk factors on CL±P, but not CP. This study might be useful in planning the primary prevention of CL±P.
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Affiliation(s)
- Yukihiro Sato
- Division of Public Health and Epidemiology, Department of Social Medicine, Asahikawa Medical University
| | - Eiji Yoshioka
- Division of Public Health and Epidemiology, Department of Social Medicine, Asahikawa Medical University
| | - Yasuaki Saijo
- Division of Public Health and Epidemiology, Department of Social Medicine, Asahikawa Medical University
| | | | - Kazuo Sengoku
- Department of Obstetrics and Gynecology, Asahikawa Medical University
| | - Hiroshi Azuma
- Department of Pediatrics, Asahikawa Medical University
| | | | - Yoshiya Ito
- Faculty of Nursing, Japanese Red Cross Hokkaido College of Nursing
| | | | | | - Yu Ait Bamai
- Center for Environmental and Health Sciences, Hokkaido University
| | - Keiko Yamazaki
- Center for Environmental and Health Sciences, Hokkaido University
| | - Sachiko Itoh
- Center for Environmental and Health Sciences, Hokkaido University
| | | | - Atsuko Araki
- Center for Environmental and Health Sciences, Hokkaido University
| | - Reiko Kishi
- Center for Environmental and Health Sciences, Hokkaido University
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26
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Malic CC, Lam M, Donelle J, Richard L, Vigod SN, Benchimol EI. Incidence, Risk Factors, and Mortality Associated With Orofacial Cleft Among Children in Ontario, Canada. JAMA Netw Open 2020; 3:e1921036. [PMID: 32049294 DOI: 10.1001/jamanetworkopen.2019.21036] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Orofacial cleft (OFC) is one of the most common congenital malformations, with a wide variation in incidence worldwide. However, population-based studies on the incidence of OFC in North America are lacking. OBJECTIVES To examine the incidence of OFC in Ontario, Canada, and to compare risk factors and mortality associated with children with OFC vs children without OFC. DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective cohort study used health administrative data from the province of Ontario, Canada. Children with OFC who were born from April 1, 1994, to March 31, 2017, in Ontario were each matched to 5 children without OFC based on sex, date of birth (±30 days), and mother's age (±5 years). Analyses were conducted from September 2018 to January 2019. EXPOSURES Children born with OFC. MAIN OUTCOMES AND MEASURES Incidence of OFC over time and regional variation. Risk factors for OFC were assessed using 1-way analysis of variance for means, Kruskal-Wallis for medians, and χ2 tests for categorical variables. Adjusted Cox regression models were used to assess mortality. RESULTS From 1994 to 2017, 3262 children were born with OFC in Ontario, Canada, and they were matched to 15 222 children born without OFC. Incidence of OFC in Ontario was 1.12 cases per 1000 live births, with wide geographic variation and a lower incidence from 2004 to 2017 compared with 1994 to 2003 (1.02 vs 1.13 cases per 1000 live births; P = .002), especially for the subgroup with cleft palate (0.52 vs 0.44 cases per 1000 live births; P = .006). Children with OFC, compared with children without OFC, were more likely to be born prematurely (406 children [13.3%] vs 1086 children [7.1%]; P < .001; standardized difference, 0.21) and had lower mean (SD) birth weight (3215.3 [687.6] g vs 3382.6 [580.0] g; P < .001; standardized difference, 0.26). The mortality rate among children with OFC was higher than among matched children without OFC (hazard ratio, 10.60; 95% CI, 7.79-14.44; P < .001). When mortality was adjusted for the presence of congenital or chromosomal anomalies, the risk of death was not significantly different between children with OFC and those without OFC (hazard ratio, 1.35; 95% CI, 0.73-2.72). CONCLUSIONS AND RELEVANCE These findings suggest that incidence of OFC In Ontario, Canada, decreased from 1994 to 2017. Mortality in children with OFC was high, especially in the first 2 years of life, and was predominantly associated with the presence of other congenital or chromosomal anomalies. Further research is required to better understand the causes of wide geographical variations of OFC incidence and improve the survival of these patients.
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Affiliation(s)
- Claudia C Malic
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Jessy Donelle
- ICES uOttawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Simone N Vigod
- Division of Equity, Gender and Population, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's Mental Health Research, Women's College Hospital and Research Institute, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Eric I Benchimol
- ICES uOttawa, Ottawa, Ontario, Canada
- Department of Pediatrics, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Health Information Technology Program, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
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27
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Sarper SE, Inubushi T, Kurosaka H, Ono Minagi H, Murata Y, Kuremoto KI, Sakai T, Taniuchi I, Yamashiro T. Anterior cleft palate due to Cbfb deficiency and its rescue by folic acid. Dis Model Mech 2019; 12:dmm.038851. [PMID: 31171577 PMCID: PMC6602316 DOI: 10.1242/dmm.038851] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/08/2019] [Indexed: 02/06/2023] Open
Abstract
Core binding factor β (Cbfb) is a cofactor of the Runx family of transcription factors. Among these transcription factors, Runx1 is a prerequisite for anterior-specific palatal fusion. It was previously unclear, however, whether Cbfb served as a modulator or as an obligatory factor in the Runx signaling process that regulates palatogenesis. Here, we report that Cbfb is essential and indispensable in mouse anterior palatogenesis. Palatal fusion in Cbfb mutants is disrupted owing to failed disintegration of the fusing epithelium specifically at the anterior portion, as observed in Runx1 mutants. In these mutants, expression of TGFB3 is disrupted in the area of failed palatal fusion, in which phosphorylation of Stat3 is also affected. TGFB3 protein has been shown to rescue palatal fusion in vitro. TGFB3 also activated Stat3 phosphorylation. Strikingly, the anterior cleft palate in Cbfb mutants is further rescued by pharmaceutical application of folic acid, which activates suppressed Stat3 phosphorylation and Tgfb3 expression in vitro. With these findings, we provide the first evidence that Cbfb is a prerequisite for anterior palatogenesis and acts as an obligatory cofactor in the Runx1/Cbfb-Stat3-Tgfb3 signaling axis. Furthermore, the rescue of the mutant cleft palate using folic acid might highlight potential therapeutic targets aimed at Stat3 modification for the prevention and pharmaceutical intervention of cleft palate. Summary: Epithelial deletion of Cbfb results in an anterior cleft palate with impaired fusion of the palatal process; folic acid application rescues the mutant phenotype with Stat3 activation in vitro.
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Affiliation(s)
- Safiye E Sarper
- Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Dentistry, Osaka University, Osaka 565-0871, Japan.,Laboratory of Theoretical Biology, Graduate School of Sciences, Osaka University, Osaka 565-0871, Japan
| | - Toshihiro Inubushi
- Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Dentistry, Osaka University, Osaka 565-0871, Japan
| | - Hiroshi Kurosaka
- Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Dentistry, Osaka University, Osaka 565-0871, Japan
| | - Hitomi Ono Minagi
- Department of Oral-facial Disorders, Osaka University Graduate School of Dentistry, Osaka 565-0871, Japan
| | - Yuka Murata
- Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Dentistry, Osaka University, Osaka 565-0871, Japan
| | - Koh-Ichi Kuremoto
- Department of Advanced Prosthodontics, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan
| | - Takayoshi Sakai
- Department of Oral-facial Disorders, Osaka University Graduate School of Dentistry, Osaka 565-0871, Japan
| | - Ichiro Taniuchi
- Laboratory for Transcriptional Regulation, RIKEN Research Center for Allergy and Immunology, Yokohama 230-0045, Japan
| | - Takashi Yamashiro
- Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Dentistry, Osaka University, Osaka 565-0871, Japan
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28
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Craenen K, Verslegers M, Baatout S, Abderrafi Benotmane M. An appraisal of folates as key factors in cognition and ageing-related diseases. Crit Rev Food Sci Nutr 2019; 60:722-739. [PMID: 30729795 DOI: 10.1080/10408398.2018.1549017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Folic acid (FA) is often consumed as a food supplement and can be found in fortified staple foods in various western countries. Even though FA supplementation during pregnancy is known to prevent severe congenital anomalies in the developing child (e.g., neural tube defects), much less is known about its influence on cognition and neurological functioning. In this review, we address the advances in this field and situate how folate intake during pregnancy, postnatal life, adulthood and in the elderly affects cognition. In addition, an association between folate status and ageing, dementia and other neurodegenerative disorders such as Alzheimer's disease, Parkinson's disease and amyotrophic lateral sclerosis is discussed. While its role in the incidence and severity of these diseases is becoming apparent, the underlying action of folates and related metabolites remains elusive. Finally, the potential of FA as a nutraceutical has been proposed, although the efficacy will highly depend on the interplay with other micronutrients, the disease stage and the duration of supplementation. Hence, the lack of consistent data urges for more animal studies and (pre)clinical trials in humans to ascertain a potential beneficial role for folates in the treatment or amelioration of cognitive decline and ageing-related disorders.
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Affiliation(s)
- Kai Craenen
- Radiobiology Unit, Belgian Nuclear Research Centre SCK•CEN, Mol, Belgium.,Biology Department, Research Group Neural Circuit Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Mieke Verslegers
- Radiobiology Unit, Belgian Nuclear Research Centre SCK•CEN, Mol, Belgium
| | - Sarah Baatout
- Radiobiology Unit, Belgian Nuclear Research Centre SCK•CEN, Mol, Belgium
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29
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Caffrey A, McNulty H, Irwin RE, Walsh CP, Pentieva K. Maternal folate nutrition and offspring health: evidence and current controversies. Proc Nutr Soc 2019; 78:208-20. [PMID: 30585558 DOI: 10.1017/S0029665118002689] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Periconceptional folic acid (FA) is known to have a protective effect in the prevention of neural tube defects (NTD), leading to global recommendations for FA supplementation before and in early pregnancy. Maternal folate throughout pregnancy may have other roles in offspring health, including neurodevelopment and cognitive performance in childhood. Folate is essential for C1 metabolism, a network of pathways involved in several biological processes including nucleotide synthesis, DNA repair and methylation reactions. The evidence reviewed here shows a conclusive role for offspring health of maternal folate nutrition in early pregnancy and probable benefits in later pregnancy. Folate-mediated epigenetic changes in genes related to brain development and function offer a plausible biological basis to link maternal folate with effects in offspring brain, albeit this research is in its infancy. Mandatory FA fortification of food has proven to be highly effective in decreasing NTD cases in populations where it has been implemented, but this policy is controversial owing to concerns related to potential adverse effects of over-exposure to FA. In the absence of population-wide fortification, and given the generally poor compliance with current FA recommendations, optimising folate status of mothers in very early pregnancy for protection against NTD remains challenging. Thus, current policy in the UK, Ireland and elsewhere in Europe for the prevention of NTD (based on periconceptional FA supplementation only), has proven to be largely ineffective. This review addresses the evidence and the controversies that surround this area, as well as identifying the challenges in translating policy into practice.
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30
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Ni W, Tian T, Zhang L, Li Z, Wang L, Ren A. Maternal periconceptional consumption of sprouted potato and risks of neural tube defects and orofacial clefts. Nutr J 2018; 17:112. [PMID: 30486846 DOI: 10.1186/s12937-018-0420-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 11/13/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The association between maternal consumption of sprouted potato during periconceptional period on the development of neural tube defects (NTDs) or orofacial clefts (OFCs) remains unclear. We aimed to examine the association between maternal consumption of sprouted potatoes during periconceptional period and risks of NTDs or OFCs. METHODS Subjects included 622 NTD cases, 135 OFC cases and 858 nonmalformed controls, were recruited from a case-control study in Shanxi Province of northern China between 2002 and 2007. Information on demographics, maternal sprouted potato consumption, lifestyle behaviors and folic acid supplementation was collected. RESULTS Consumption of sprouted potatoes was associated with elevated odds of total NTDs (OR = 2.20; 95% CI, 1.12-4.32) and anencephaly (OR = 2.48; 95% CI, 1.10-5.58); no association for spina bifida or encephalocele. Sprouted potato consumption increased the risk of total OFCs (OR = 3.49; 95% CI, 1.29-9.49) and cleft lip with or without cleft palate (CL ± P) (OR = 4.03; 95% CI, 1.44-11.28). CONCLUSION Maternal consumption of sprouted potatoes during periconceptional period may increase the risks of NTDs and OFCs. Given that potato is commonly consumed around the world, improper preservation and use should be a matter of concern in respect of the potential teratogenicity.
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31
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Wang P, Wu T, Schwender H, Wang H, Shi B, Wang ZQ, Yuan Y, Liu DJ, Wang MY, Li J, Zhou ZB, Zhu HP, Beaty TH. Evidence of interaction between genes in the folate/homocysteine metabolic pathway in controlling risk of non-syndromic oral cleft. Oral Dis 2018; 24:820-828. [PMID: 29356306 DOI: 10.1111/odi.12831] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/20/2017] [Accepted: 01/09/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Little consistent evidence is available for the association between the risk of non-syndromic cleft lip with or without cleft palate (NSCL/P) and any of the individual genes in the folate/homocysteine metabolic pathway. We investigated the genes in the folate pathway to further clarify its potential influence on the risk of NSCL/P considering gene-gene (G×G) interaction. SUBJECTS AND METHODS We selected markers in 18 genes from the pathway and applied Cordell's method to test for G×G interaction using 1,908 NSCL/P case-parent trios ascertained in an international consortium where a genomewide association study (GWAS) of oral clefts was conducted. RESULTS We found intriguing signals among Asian and European ancestry groups for G×G interaction between markers in betaine-homocysteine methyltransferase gene (BHMT/BHMT2) and dimethylglycine dehydrogenase gene (DMGDH) attaining genomewide significance. In the pooled data, the top significant interaction was found between rs13158309 (BHMT) and rs10514154 (DMGDH, p = 1.45 × 10-12 ). CONCLUSIONS Our study illustrated the importance of taking into account potential G×G interaction for genetic association analysis in NSCL/P, and this study suggested both BHMT/BHMT2 and DMGDH should be considered as candidate genes for NSCL/P in future studies.
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Affiliation(s)
- P Wang
- School of Public Health, Peking University, Beijing, China.,Department of Statistics and Information, Beijing Center for Disease Prevention and Control & Beijing Research Center for Preventive Medicine, Beijing, China
| | - T Wu
- School of Public Health, Peking University, Beijing, China.,Key Laboratory of Reproductive Health, Ministry of Health, Beijing, China
| | - H Schwender
- Mathematical Institute, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - H Wang
- School of Public Health, Peking University, Beijing, China
| | - B Shi
- State Key Laboratory of Oral Disease, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Z Q Wang
- School of Public Health, Peking University, Beijing, China
| | - Y Yuan
- School of Public Health, Peking University, Beijing, China
| | - D J Liu
- School of Public Health, Peking University, Beijing, China
| | - M Y Wang
- School of Public Health, Peking University, Beijing, China
| | - J Li
- Pediatric Dentistry, Peking University School of Stomatology, Beijing, China
| | - Z B Zhou
- Oral and Maxillofacial Surgery, Peking University School of Stomatology, Beijing, China
| | - H P Zhu
- Oral and Maxillofacial Surgery, Peking University School of Stomatology, Beijing, China
| | - T H Beaty
- School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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32
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Mangold E, Kreiß M, Nöthen MM. Syndromale und nichtsyndromale orofaziale Spalten. MED GENET-BERLIN 2017; 29:397-412. [DOI: 10.1007/s11825-017-0163-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Zusammenfassung
Orofaziale Spalten sind die zweithäufigste angeborene Fehlbildung. Die beiden häufigen Untergruppen sind die Formen der Lippen-Kiefer-Gaumen-Spalte (LKGS) und der reinen Gaumenspalte (GS). Beide können im Zuge zahlreicher Syndrome auftreten, LKGS sind häufiger nichtsyndromal (ca. 70 %) als GS (ca. 50 %). Nichtsyndromale Spalten sind multifaktoriell und bergen relativ geringe Wiederholungsrisiken für Angehörige. Manche syndromalen Spaltformen beruhen auf Chromosomenaberrationen, die meisten sind jedoch monogen. Das autosomal-dominante Van-der-Woude-Syndrom ist eine wichtige Differenzialdiagnose zu nichtsyndromalen Spaltformen, die sich nur durch Unterlippengrübchen von diesen unterscheidet, aber höhere Risiken für eine Spaltbildung bei Nachkommen birgt. Die Pränataldiagnostik orofazialer Spalten erfolgt sonographisch. Erfahrene Untersucher können LKGS in der 20. Schwangerschaftswoche diagnostizieren; die Detektion von GS ist schwieriger.
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