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Godfrey P Oakley - One of the best experts on this subject based on the ideXlab platform.
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high potential for reducing folic acid preventable spina bifida and Anencephaly and related stillbirth and child mortality in ethiopia
Birth defects research, 2019Co-Authors: Meredith Dixon, Vijaya Kancherla, Tony Magana, Afework Mulugeta, Godfrey P OakleyAbstract:Background Recent surveillance studies in Ethiopia show an epidemic of spina bifida and Anencephaly, two major neural tube birth defects that are severe and life-threatening. Our objective was to estimate proportional reductions in current stillbirth and child mortality rates in Ethiopia through folic acid-based interventions to prevent spina bifida and Anencephaly. Methods Using secondary data from multiple sources, we estimated percent reductions in stillbirth, neonatal, infant, and under-five child mortality rates that would have occurred in Ethiopia in the year 2016 had all folic acid-preventable spina bifida and Anencephaly been prevented; and the contributions of these reductions toward Ethiopia's Year 2030 Every Newborn Action Plan (ENAP) goal on stillbirth, and sustainable development goal (SDG) on child mortality rates. The 2016 prevalence of spina bifida and Anencephaly in Ethiopia was assumed as 13 per 1,000 total births, with the prevention goal reaching 0.5 per 1,000 total births. Results Folic acid interventions in Ethiopia would have prevented about 41,610 cases of folic acid-preventable spina bifida and Anencephaly-affected pregnancies during the year 2016. We estimate that this prevention is associated with reduction of 31,830 stillbirths and 7,335 under-five child deaths annually. The proportional contribution of this prevention toward achieving Ethiopia's ENAP goal is 54% for stillbirth, and toward SDG is 4.5% for neonatal- and 6.8% for under-five mortality. Conclusions Spina bifida and Anencephaly contribute to substantial stillbirths and child death in Ethiopia. Large-scale fortification of foods like wheat flour and salt can help achieve Ethiopia's ENAP and SDG targets addressing preventable stillbirth, neonatal, and under-five mortality.
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high potential for reducing folic acid preventable spina bifida and Anencephaly and related stillbirth and child mortality in ethiopia
Social Science Research Network, 2019Co-Authors: Meredith Dixon, Vijaya Kancherla, Tony Magana, Afework Mulugeta, Godfrey P OakleyAbstract:Background: Recent studies in Ethiopia show a profoundly large epidemic of spina bifida and Anencephaly: two common, severe, and life-threatening birth defects. Reductions can be achieved in stillbirth and child mortality rates in Ethiopia by preventing folic acid-preventable spina bifida and Anencephaly through effective interventions. Methods: We estimated percent reductions in stillbirth, neonatal, infant, and under-five child mortality rates that would have occurred in Ethiopia in year 2016 had all folic acid-preventable spina bifida and Anencephaly been prevented. We also estimated the contributions of these reductions toward Ethiopia's Year 2030 Every Newborn Action Plan goal on stillbirth, and Sustainable Development Goal on child mortality rates. Based on recent data from Ethiopia, we considered the current prevalence of spina bifida and Anencephaly in Ethiopia to be 13 per 1,000 total births, and the preventable rate to be 12·5 per 1,000 total births. Findings: Folic acid interventions would have prevented about 41,610 cases of folic acid-preventable spina bifida and Anencephaly-affected pregnancies and a related 31,830 stillbirths and 7,335 under-five child deaths. These reductions contribute to the reduction in stillbirths needed to achieve Ethiopia's Every Newborn Action Plan goal addressing stillbirth and reductions in neonatal and under-five mortality, needed to achieve the Sustainable Development Goals addressing preventable child mortality. Interpretation: Prevention of spina bifida and Anencephaly can immediately reduce stillbirth and child mortality rates in Ethiopia. Folic acid fortification of wheat, maize, and especially salt, can be highly effective in controlling the current epidemic of spina bifida and Anencephaly. Funding: None. Declaration of Interest: MD, VK, TM, AM, GPO have no financial relationships relevant to this article. Ethical Approval: Not needed.
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a 2017 global update on folic acid preventable spina bifida and Anencephaly
Birth defects research, 2018Co-Authors: Vijaya Kancherla, Quentin Johnson, Kaustubh Wagh, Godfrey P OakleyAbstract:BACKGROUND Spina bifida and Anencephaly are largely preventable birth defects through mandatory folic acid fortification. Our objective was to estimate the proportion of folic acid-preventable spina bifida and Anencephaly (FAP SBA) prevented worldwide through mandatory fortification of wheat and/or maize flour with folic acid during the year 2017. METHODS Using existing data, we identified countries with mandatory fortification policies that added at least 1.0 ppm folic acid to wheat and/or maize flour and had information on percentage of industrially milled flour that is fortified. We assumed mandatory folic acid fortification at 200 μg/day of folic acid fully protects against FAP SBA, reducing the prevalence of spina bifida and Anencephaly to 0.5 per 1,000 live births. RESULTS Overall, 59 countries met our criteria for implementing mandatory folic acid fortification of wheat and/or maize flour in 2017. These countries prevented about 50,270 out of 280,500 FAP SBA births in 2017. Thus, we have only achieved 18% prevention of FAP SBA worldwide. Several countries in Africa and Asia with a high number of FAP SBA-affected births do not have mandatory fortification. CONCLUSION About 230,000 children unnecessarily developed FAP SBA globally in 2017. There is an urgent need for all countries to implement mandatory folic acid fortification, a proven, safe public health intervention that saves money and prevents infant mortality and disability. Prevention of FAP SBA can play an important role in helping countries to achieve their Sustainable Development Goals for health.
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a 2015 global update on folic acid preventable spina bifida and Anencephaly
Birth Defects Research Part A-clinical and Molecular Teratology, 2016Co-Authors: Annelise Arth, Vijaya Kancherla, Helena Pachon, Sarah Zimmerman, Quentin Johnson, Godfrey P OakleyAbstract:Background Spina bifida and Anencephaly are two major neural tube defects. They contribute substantially to perinatal, neonatal, infant, and under-five mortality and life-long disability. To monitor the progress toward the total prevention of folic acid-preventable spina bifida and Anencephaly (FAP SBA), we examined their global status in 2015. Methods Based on existing data, we modeled the proportion of FAP SBA that are prevented in the year 2015 through mandatory folic acid fortification globally. We included only those countries with mandatory fortification that added at least 1.0 ppm folic acid as a fortificant to wheat and maize flour, and had complete information on coverage. Our model assumed mandatory folic acid fortification at 200 μg/day is fully protective against FAP SBA, and reduces the rate of spina bifida and Anencephaly to a minimum of 0.5 per 1000 births. RESULTS Our estimates show that, in 2015, 13.2% (35,500 of approximately 268,700 global cases) of FAP SBA were prevented in 58 countries through mandatory folic acid fortification of wheat and maize flour. Most countries in Europe, Africa, and Asia were not implementing mandatory fortification with folic acid. Conclusion Knowledge that folic acid prevents spina bifida and Anencephaly has existed for 25 years, yet only a small fraction of FAP SBA is being prevented worldwide. Several countries still have 5- to 20-fold epidemics of FAP SBA. Implementation of mandatory fortification with folic acid offers governments a proven and rapid way to prevent FAP SBA-associated disability and mortality, and to help achieve health-related Sustainable Development Goals. Birth Defects Research (Part A) 106:520–529, 2016. © 2016 Wiley Periodicals, Inc.
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preventable spina bifida and Anencephaly in europe
Birth Defects Research Part A-clinical and Molecular Teratology, 2015Co-Authors: Rima Obeid, Klaus Pietrzik, Godfrey P Oakley, Vijaya Kancherla, Wolfgang Holzgreve, Simon WieserAbstract:BACKGROUND Promotion of voluntary folic acid supplement use among women of reproductive age has been proven to be ineffective in lowering the risk of neural tube defects in Europe. METHODS Using surveillance data from all births covered by the full member countries of the European Surveillance of Congenital Anomalies (EUROCAT), we estimated the total prevalence of spina bifida and Anencephaly per 10,000 births between 2000 and 2010. We also estimated additional lifetime direct medical costs among individuals with spina bifida, compared with those without, in Germany for the year 2009. RESULTS During the study period, there were 7478 documented cases of spina bifida and Anencephaly among the 9,161,189 births, with an estimated average combined prevalence of 8.16 per 10,000 births (95% confidence interval, 7.98 – 8.35). For the 241 spina bifida-affected live births in 2009 in Germany, the estimated additional lifetime direct medical costs compared with non-spina bifida affected births were €65.5 million. Assuming a 50% reduction in the prevalence if folic acid has been provided to all women before pregnancy, 293 spina bifida cases could have been prevented in Germany in 2009. The estimated lifetime direct medical cost saving for the live births in 2009 was €32.9 million assuming a 50% reduction, or €26.1 million assuming a 40% risk reduction. CONCLUSION Europe has an epidemic of spina bifida and Anencephaly compared with countries with mandatory folic acid fortification policy. Primary prevention through mandatory folic acid fortification would considerably reduce the number of affected pregnancies, and associated additional costs. Birth Defects Research (Part A) 103:763–771, 2015. © 2015 Wiley Periodicals, Inc.
Vijaya Kancherla - One of the best experts on this subject based on the ideXlab platform.
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folic acid to prevent spina bifida and Anencephaly
2021Co-Authors: Vijaya KancherlaAbstract:Abstract Folate or folic acid, also known as vitamin-B9, is an essential micronutrient needed for the formation of neural tube early in pregnancy. Spina bifida and Anencephaly are two most common types of neural tube defects (NTDs) affecting births worldwide. Maternal folate insufficiency is a major risk factor for spina bifida and Anencephaly, and supplementing mother’s diet with adequate folic acid in the periconceptional period significantly reduces the risk. Blood folate concentrations in the women of reproductive age are useful biomarkers and can help predict the prevalence of NTDs in the population. Mandatory folic acid fortification of commonly consumed foods is deemed to be the best strategy for primary prevention of spina bifida and Anencephaly, and it is cost-effective and safe. Preventing spina bifida and Anencephaly will remarkably reduce neonatal, infant, and under-five mortality and assist countries in reaching their 2030 Sustainable Development Goals on child mortality reduction and other indicators.
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high potential for reducing folic acid preventable spina bifida and Anencephaly and related stillbirth and child mortality in ethiopia
Birth defects research, 2019Co-Authors: Meredith Dixon, Vijaya Kancherla, Tony Magana, Afework Mulugeta, Godfrey P OakleyAbstract:Background Recent surveillance studies in Ethiopia show an epidemic of spina bifida and Anencephaly, two major neural tube birth defects that are severe and life-threatening. Our objective was to estimate proportional reductions in current stillbirth and child mortality rates in Ethiopia through folic acid-based interventions to prevent spina bifida and Anencephaly. Methods Using secondary data from multiple sources, we estimated percent reductions in stillbirth, neonatal, infant, and under-five child mortality rates that would have occurred in Ethiopia in the year 2016 had all folic acid-preventable spina bifida and Anencephaly been prevented; and the contributions of these reductions toward Ethiopia's Year 2030 Every Newborn Action Plan (ENAP) goal on stillbirth, and sustainable development goal (SDG) on child mortality rates. The 2016 prevalence of spina bifida and Anencephaly in Ethiopia was assumed as 13 per 1,000 total births, with the prevention goal reaching 0.5 per 1,000 total births. Results Folic acid interventions in Ethiopia would have prevented about 41,610 cases of folic acid-preventable spina bifida and Anencephaly-affected pregnancies during the year 2016. We estimate that this prevention is associated with reduction of 31,830 stillbirths and 7,335 under-five child deaths annually. The proportional contribution of this prevention toward achieving Ethiopia's ENAP goal is 54% for stillbirth, and toward SDG is 4.5% for neonatal- and 6.8% for under-five mortality. Conclusions Spina bifida and Anencephaly contribute to substantial stillbirths and child death in Ethiopia. Large-scale fortification of foods like wheat flour and salt can help achieve Ethiopia's ENAP and SDG targets addressing preventable stillbirth, neonatal, and under-five mortality.
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high potential for reducing folic acid preventable spina bifida and Anencephaly and related stillbirth and child mortality in ethiopia
Social Science Research Network, 2019Co-Authors: Meredith Dixon, Vijaya Kancherla, Tony Magana, Afework Mulugeta, Godfrey P OakleyAbstract:Background: Recent studies in Ethiopia show a profoundly large epidemic of spina bifida and Anencephaly: two common, severe, and life-threatening birth defects. Reductions can be achieved in stillbirth and child mortality rates in Ethiopia by preventing folic acid-preventable spina bifida and Anencephaly through effective interventions. Methods: We estimated percent reductions in stillbirth, neonatal, infant, and under-five child mortality rates that would have occurred in Ethiopia in year 2016 had all folic acid-preventable spina bifida and Anencephaly been prevented. We also estimated the contributions of these reductions toward Ethiopia's Year 2030 Every Newborn Action Plan goal on stillbirth, and Sustainable Development Goal on child mortality rates. Based on recent data from Ethiopia, we considered the current prevalence of spina bifida and Anencephaly in Ethiopia to be 13 per 1,000 total births, and the preventable rate to be 12·5 per 1,000 total births. Findings: Folic acid interventions would have prevented about 41,610 cases of folic acid-preventable spina bifida and Anencephaly-affected pregnancies and a related 31,830 stillbirths and 7,335 under-five child deaths. These reductions contribute to the reduction in stillbirths needed to achieve Ethiopia's Every Newborn Action Plan goal addressing stillbirth and reductions in neonatal and under-five mortality, needed to achieve the Sustainable Development Goals addressing preventable child mortality. Interpretation: Prevention of spina bifida and Anencephaly can immediately reduce stillbirth and child mortality rates in Ethiopia. Folic acid fortification of wheat, maize, and especially salt, can be highly effective in controlling the current epidemic of spina bifida and Anencephaly. Funding: None. Declaration of Interest: MD, VK, TM, AM, GPO have no financial relationships relevant to this article. Ethical Approval: Not needed.
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a 2017 global update on folic acid preventable spina bifida and Anencephaly
Birth defects research, 2018Co-Authors: Vijaya Kancherla, Quentin Johnson, Kaustubh Wagh, Godfrey P OakleyAbstract:BACKGROUND Spina bifida and Anencephaly are largely preventable birth defects through mandatory folic acid fortification. Our objective was to estimate the proportion of folic acid-preventable spina bifida and Anencephaly (FAP SBA) prevented worldwide through mandatory fortification of wheat and/or maize flour with folic acid during the year 2017. METHODS Using existing data, we identified countries with mandatory fortification policies that added at least 1.0 ppm folic acid to wheat and/or maize flour and had information on percentage of industrially milled flour that is fortified. We assumed mandatory folic acid fortification at 200 μg/day of folic acid fully protects against FAP SBA, reducing the prevalence of spina bifida and Anencephaly to 0.5 per 1,000 live births. RESULTS Overall, 59 countries met our criteria for implementing mandatory folic acid fortification of wheat and/or maize flour in 2017. These countries prevented about 50,270 out of 280,500 FAP SBA births in 2017. Thus, we have only achieved 18% prevention of FAP SBA worldwide. Several countries in Africa and Asia with a high number of FAP SBA-affected births do not have mandatory fortification. CONCLUSION About 230,000 children unnecessarily developed FAP SBA globally in 2017. There is an urgent need for all countries to implement mandatory folic acid fortification, a proven, safe public health intervention that saves money and prevents infant mortality and disability. Prevention of FAP SBA can play an important role in helping countries to achieve their Sustainable Development Goals for health.
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countries with an immediate potential for primary prevention of spina bifida and Anencephaly mandatory fortification of wheat flour with folic acid
Birth defects research, 2018Co-Authors: Vijaya KancherlaAbstract:Objectives Mandatory fortification of flour with folic acid has been proven to be a highly effective way to prevent spina bifida and Anencephaly. Yet, over 100 countries worldwide do not implement this intervention. Our objectives were to identify countries with an immediate potential for mandatory fortification of wheat flour with folic acid and to estimate the number of preventable cases of spina bifida and Anencephaly that would be averted each year through the intervention. Methods We examined folic acid fortification characteristics in countries as of September 2017. Country selection criteria included current fortification status, existing industrial capacity for flour production, fortification coverage, and daily grams of per capita wheat flour available for human consumption. We estimated the country-specific number of preventable cases of spina bifida and Anencephaly by calculating the difference between the observed prevalence (prefortification) and expected prevalence that can be achieved postfortification (0.5 per 1,000 live births). Results We identified 71 countries with an immediate potential for mandatory fortification of 145 million metric tons of wheat flour with folic acid. Fortification in identified countries would avert approximately 57,000 live births associated with folic acid-preventable spina bifida and Anencephaly annually and increase global prevention from the current rate of 13% to a new rate of 34%. Conclusions Fortification can be achieved immediately in many countries with existing industrial milling infrastructure. Effective fortification interventions can accelerate global primary prevention efforts of folic acid-preventable spina bifida and Anencephaly, especially in developing countries with a high prevalence of neural tube defects and associated morbidity and mortality.
Gary M Shaw - One of the best experts on this subject based on the ideXlab platform.
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quantification of selection bias in studies of risk factors for birth defects among livebirths
Paediatric and Perinatal Epidemiology, 2020Co-Authors: Dominique Heinke, Janet W Richedwards, Paige L Williams, Sonia Hernandezdiaz, Marlene Anderka, Sarah C Fisher, Tania A Desrosiers, Gary M ShawAbstract:Background Risk factors for birth defects are frequently investigated using data limited to liveborn infants. By conditioning on survival, results of such studies may be distorted by selection bias, also described as "livebirth bias." However, the implications of livebirth bias on risk estimation remain poorly understood. Objectives We sought to quantify livebirth bias and to investigate the conditions under which it arose. Methods We used data on 3994 birth defects cases and 11 829 controls enrolled in the National Birth Defects Prevention Study to compare odds ratio (OR) estimates of the relationship between three established risk factors (antiepileptic drug use, smoking, and multifetal pregnancy) and four birth defects (Anencephaly, spina bifida, omphalocele, and cleft palate) when restricted to livebirths as compared to among livebirths, stillbirths, and elective terminations. Exposures and birth defects represented varying strengths of association with livebirth; all controls were liveborn. We performed a quantitative bias analysis to evaluate the sensitivity of our results to excluding terminated and stillborn controls. Results Cases ranged from 33% liveborn (Anencephaly) to 99% (cleft palate). Smoking and multifetal pregnancy were associated with livebirth among Anencephaly (crude OR [cOR] 0.61 and cOR 3.15, respectively) and omphalocele cases (cOR 2.22 and cOR 5.22, respectively). For analyses of the association between exposures and birth defects, restricting to livebirths produced negligible differences in estimates except for Anencephaly and multifetal pregnancy, which was twofold higher among livebirths (adjusted OR [aOR] 4.93) as among all pregnancy outcomes (aOR 2.44). Within tested scenarios, bias analyses suggested that results were not sensitive to the restriction to liveborn controls. Conclusions Selection bias was generally limited except for high mortality defects in the context of exposures strongly associated with livebirth. Findings indicate that substantial livebirth bias is unlikely to affect studies of risk factors for most birth defects.
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Anencephaly and spina bifida among hispanics maternal sociodemographic and acculturation factors in the national birth defects prevention study
Birth Defects Research Part A-clinical and Molecular Teratology, 2009Co-Authors: Mark A Canfield, Kim D Waller, Gary M Shaw, Tunu Ramadhani, Suzan L Carmichael, Bridget S Mosley, Marjorie H Royle, Richard S OlneyAbstract:BACKGROUND: We used data from the multisite National Birth Defects Prevention Study for expected delivery dates from October 1997 through 2003, to determine whether the increased risk in Anencephaly and spina bifida (neural tube defects (NTDs)) in Hispanics was explained by selected sociodemographic, acculturation, and other maternal characteristics. METHODS: For each type of defect, we examined the association with selected maternal characteristics stratified by race/ethnicity and the association with Hispanic parents' acculturation level, relative to non-Hispanic whites. We used logistic regression and calculated crude odds ratios (ORs) and their 95% confidence intervals (CIs). RESULTS: Hispanic mothers who reported the highest level of income were 80% less likely to deliver babies with spina bifida. In addition, highly educated Hispanic and white mothers had 76 and 35% lower risk, respectively. Other factors showing differing effects for spina bifida in Hispanics included maternal age, parity, and gestational diabetes. For spina bifida there was no significant elevated risk for U.S.–born Hispanics, relative to whites, but for Anencephaly, corresponding ORs ranged from 1.9 to 2.3. The highest risk for spina bifida was observed for recent Hispanic immigrant parents from Mexico or Central America residing in the United States <5 years (OR = 3.28, 95% CI = 1.46–7.37). CONCLUSIONS: Less acculturated Hispanic parents seemed to be at highest risk of NTDs. For Anencephaly, U.S.–born and English-speaking Hispanic parents were also at increased risk. Finally, from an etiologic standpoint, spina bifida and Anencephaly appeared to be etiologically heterogeneous from these analyses. Birth Defects Research (Part A), 2009. © 2009 Wiley-Liss, Inc.
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maternal obesity gestational diabetes and central nervous system birth defects
Obstetrical & Gynecological Survey, 2005Co-Authors: James L Anderson, Kim D Waller, Mark A Canfield, Gary M Shaw, Margaret L Watkins, Martha M WerlerAbstract:ABSTRACT Several large-scale cohort studies suggest that obese mothers are at increased risk of having infants with neural tube defects and, possibly, other central nervous system (CNS) birth defects. Because obesity and diabetes share similar metabolic abnormalities, a study was planned to determine whether gestational diabetes influences the association between maternal obesity and CNS birth defects. In this population-based case–control study, covering the years 1997 to mid-2000, structured telephone interviews were conducted with mothers of offspring having Anencephaly (n = 120), spina bifida (n = 184), holoprosencephaly (n = 49), or isolated hydrocephaly (n = 124). Control women whose infants were neurologically normal were randomly chosen from the same hospitals. Approximately 60% of both cases and control subjects responded. Maternal obesity was defined as a body mass index of 30 kg/m2 or higher. Pregestational diabetes, both type 1 and type 2, correlated closely with holoprosencephaly (adjusted odds ratio [OR], 47; 95% confidence interval [CI], 9.5–230), and isolated hydrocephaly (OR, 12; 95% CI, 2.9–47). There was no increase in the risk of Anencephaly or spina bifida. Gestational diabetes increased only the risk of holoprosencephaly (OR, 2.9; 95% CI, 1.0–8.4). Mothers of infants with Anencephaly were less likely than control mothers to have gestational diabetes. Obese mothers were likelier than control subjects to have infants with any of the 4 CNS birth defects. Underweight women were less likely to have an infant with spina bifida. The association between maternal obesity and an increased risk of neural tube defects and isolated hydrocephaly held for all ethnic groups. Associations between maternal obesity and Anencephaly (OR, 2.3; 95% CI, 1.2–4.3), spina bifida (OR, 2.8; 95% CI, 1.7–4.5), and isolated hydrocephaly (OR, 2.7; 95% CI, 1.5–5.0) persisted after adjusting for maternal age, ethnicity, education, smoking, alcohol use, and periconceptional vitamin use. For both spina bifida and holoprosencephaly, the joint effects of maternal obesity and gestational diabetes appeared to be interactive. These findings suggest that gestational diabetes and maternal obesity may increase the risk of CNS birth defects through common mechanisms, and they strongly support the need for ways of preventing these conditions.
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prevalence of spina bifida and Anencephaly during the transition to mandatory folic acid fortification in the united states
Obstetrical & Gynecological Survey, 2003Co-Authors: Laura J Williams, Gary M Shaw, Russell S Kirby, Larry D Edmonds, Cara T Mai, Charlotte A Hobbs, Lowell E Sever, Lisa Miller, John F Meaney, Miriam LevittAbstract:A decade ago, in 1992, the US Public Health Service recommended 400 μg of folic acid daily for all women of childbearing age. Four years later the Food and Drug Administration approved adding synthetic folic acid to grainproducts, and early in 1998 this became mandatory. The investigators sought to learn whether neural tube defects, that is, spina bifida and Anencephaly, have declined in prevalence as a result. A survey of 24 population-based surveillance systems identified 5630 study cases in the years 1995 to 1999 spanning the periods before and during optional folic acid fortification and after fortification became mandatory. Spina bifida declined 31% from the pre-fortification period to the mandatory fortification period. Anencephaly declined 16% in the same time, but not significantly from the optional to the mandatory fortification period. In nine programs with prenatal ascertainment (ascertainment of cases from sources other than birth certificates), the prevalence of spina bifida decreased 40% from the pre-fortification period to the mandatory fortification period. A decline in Anencephaly was significant only in programs with prenatal ascertainment. The authors conclude that spina bifida has become less prevalent in connection with folic acid fortification of grain supplies in the United States. A similar connection with Anencephaly remains less clear.
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prevalence of spina bifida and Anencephaly during the transition to mandatory folic acid fortification in the united states
Teratology, 2002Co-Authors: Laura J Williams, Gary M Shaw, Russell S Kirby, Larry D Edmonds, Cara T Mai, Charlotte A Hobbs, Lowell E Sever, Lisa Miller, John F Meaney, Miriam LevittAbstract:Background In 1992, the United States Public Health Service recommended that all women of childbearing age consume 400 μg of folic acid daily. The Food and Drug Administration authorized the addition of synthetic folic acid to grain products in March 1996 with mandatory compliance by January 1998. The impact of these public health policies on the prevalence of neural tube defects needs to be evaluated. We sought to determine the prevalences of spina bifida and Anencephaly during the transition to mandatory folic acid fortification. Methods Twenty-four population-based surveillance systems were used to identify 5,630 cases of spina bifida and Anencephaly from 1995–99. Cases were divided into three temporal categories depending on whether neural tube development occurred before folic acid fortification (January 1995 to December 1996), during optional fortification (January 1997 to September 1998), or during mandatory fortification (October 1998 to December 1999). Prevalences for each defect were calculated for each time period. Data were also stratified by programs that did and did not ascertain prenatally diagnosed cases. Results The prevalence of spina bifida decreased 31% (prevalence ratio [PR] = 0.69, 95% confidence interval [CI] = 0.63–0.74) from the pre- to the mandatory fortification period and the prevalence of Anencephaly decreased 16% (PR = 0.84, 95% CI = 0.75–0.95). Stratification by prenatal ascertainment did not alter results for spina bifida but did impact Anencephaly trends. Conclusions The decline in the prevalence of spina bifida was temporally associated with folic acid fortification of US grain supplies. The temporal association between fortification and the prevalence of Anencephaly is unclear. Teratology 66:33–39, 2002. Published 2002 Wiley-Liss, Inc.
Aiguo Ren - One of the best experts on this subject based on the ideXlab platform.
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periconceptional folic acid supplementation and sex difference in prevention of neural tube defects and their subtypes in china results from a large prospective cohort study
Nutrition Journal, 2018Co-Authors: Jufen Liu, Jianmeng Liu, Aiguo RenAbstract:Folic acid (FA) supplementation is known to prevent neural tube defects (NTDs). We examined whether this preventive effect differs by the sex of the infant. Data were gathered from a large population-based cohort study in China that evaluated the effects of FA supplementation on NTDs. All births at 20 complete gestational weeks, including live births, stillbirths, and pregnancy terminations, and all NTDs, regardless of gestational age, were recorded. In a northern China province, a total of 30,801 singleton live births to women whose use of FA supplements during the first trimester was known at the time were included in the study. The birth prevalence of NTDs was classified by sex, subtype, and maternal FA supplementation. Male to female rate ratios [RR] and their 95% confidence intervals [CI] were calculated. A total of 106 NTDs cases were recorded. The overall prevalence of NTDs was 2.5‰ among males and 4.4‰ among females; NTDs were less prevalent among males than among females (RR, 0.58; 95% CI, 0.54–0.63). There was a higher prevalence of Anencephaly (RR, 0.34; 95% CI, 0.27–0.43) and spina bifida (RR, 0.73; 95% CI, 0.63–0.84) among females. However, FA supplementation led to significantly greater decreases in the rates of Anencephaly (4.8‰) and total NTDs (7.6‰) in females than in males (1.6‰ and 2.8‰, respectively). FA supplementation successfully reduces the prevalence of NTDs in both male and female infants, although we found a significantly greater decrease in Anencephaly and total NTDs in females than in males. How the protective effects of FA supplementation affect the sexes differently needs to be studied further.
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Periconceptional folic acid supplementation and sex difference in prevention of neural tube defects and their subtypes in China: results from a large prospective cohort study
'Springer Science and Business Media LLC', 2018Co-Authors: Jufen Liu, Jianmeng Liu, Aiguo RenAbstract:Abstract Background Folic acid (FA) supplementation is known to prevent neural tube defects (NTDs). We examined whether this preventive effect differs by the sex of the infant. Methods Data were gathered from a large population-based cohort study in China that evaluated the effects of FA supplementation on NTDs. All births at 20 complete gestational weeks, including live births, stillbirths, and pregnancy terminations, and all NTDs, regardless of gestational age, were recorded. In a northern China province, a total of 30,801 singleton live births to women whose use of FA supplements during the first trimester was known at the time were included in the study. The birth prevalence of NTDs was classified by sex, subtype, and maternal FA supplementation. Male to female rate ratios [RR] and their 95% confidence intervals [CI] were calculated. Results A total of 106 NTDs cases were recorded. The overall prevalence of NTDs was 2.5‰ among males and 4.4‰ among females; NTDs were less prevalent among males than among females (RR, 0.58; 95% CI, 0.54–0.63). There was a higher prevalence of Anencephaly (RR, 0.34; 95% CI, 0.27–0.43) and spina bifida (RR, 0.73; 95% CI, 0.63–0.84) among females. However, FA supplementation led to significantly greater decreases in the rates of Anencephaly (4.8‰) and total NTDs (7.6‰) in females than in males (1.6‰ and 2.8‰, respectively). Conclusions FA supplementation successfully reduces the prevalence of NTDs in both male and female infants, although we found a significantly greater decrease in Anencephaly and total NTDs in females than in males. How the protective effects of FA supplementation affect the sexes differently needs to be studied further
Mark A Canfield - One of the best experts on this subject based on the ideXlab platform.
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polytomous logistic regression as a tool for exploring heterogeneity across birth defect subtypes an example using Anencephaly and spina bifida
Birth Defects Research Part A-clinical and Molecular Teratology, 2010Co-Authors: Philip J Lupo, Kim D Waller, Mark A Canfield, Elaine Symanski, Wenyaw Chan, Peter H Langlois, Laura E MitchellAbstract:BACKGROUND In birth defect epidemiology, phenotypic subgroups are often combined into a composite phenotype in an effort to increase statistical power. Although the validity of using composite phenotypes has been questioned, formal evaluations of the underlying assumption of effect homogeneity across component phenotypes have not been conducted. METHODS Polytomous logistic regression was used to assess effect heterogeneity of several generally accepted neural tube defect (NTD) risk factors across the component phenotypes of Anencephaly and spina bifida. Data for these analyses were obtained from the National Birth Defects Prevention Study. RESULTS The use of a composite phenotype has the potential to mask associations specific to a component phenotype and in some cases the effect of a variable may be misattributed to the composite phenotype. For example, an association between infant sex and Anencephaly (adjusted odds ratio [AOR], 1.5; 95% CI, 1.1–1.9) was masked when data from all NTDs were analyzed (AOR, 1.1; 95% CI, 0.9–1.3), whereas an association with maternal body mass index that was specific to spina bifida (AOR, 1.9; 95% CI, 1.6–2.4) was attributed to all NTDs (AOR, 1.6; 95% CI, 1.4–2.0). Furthermore, conclusions regarding effect heterogeneity based on ad hoc comparisons, rather than some formal assessment, may be vulnerable to considerable subjectivity, as was the case for the association of maternal Hispanic ethnicity with spina bifida (AOR, 1.4; 95% CI, 1.2–1.8) and Anencephaly (AOR, 2.0; 95% CI, 1.5–2.8). CONCLUSIONS Polytomous logistic regression provides a useful tool for evaluating putative risk factors for which there is no a priori basis for assuming effect homogeneity across component phenotypes. Birth Defects Research (Part A), 2010. © 2010 Wiley-Liss, Inc.
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Anencephaly and spina bifida among hispanics maternal sociodemographic and acculturation factors in the national birth defects prevention study
Birth Defects Research Part A-clinical and Molecular Teratology, 2009Co-Authors: Mark A Canfield, Kim D Waller, Gary M Shaw, Tunu Ramadhani, Suzan L Carmichael, Bridget S Mosley, Marjorie H Royle, Richard S OlneyAbstract:BACKGROUND: We used data from the multisite National Birth Defects Prevention Study for expected delivery dates from October 1997 through 2003, to determine whether the increased risk in Anencephaly and spina bifida (neural tube defects (NTDs)) in Hispanics was explained by selected sociodemographic, acculturation, and other maternal characteristics. METHODS: For each type of defect, we examined the association with selected maternal characteristics stratified by race/ethnicity and the association with Hispanic parents' acculturation level, relative to non-Hispanic whites. We used logistic regression and calculated crude odds ratios (ORs) and their 95% confidence intervals (CIs). RESULTS: Hispanic mothers who reported the highest level of income were 80% less likely to deliver babies with spina bifida. In addition, highly educated Hispanic and white mothers had 76 and 35% lower risk, respectively. Other factors showing differing effects for spina bifida in Hispanics included maternal age, parity, and gestational diabetes. For spina bifida there was no significant elevated risk for U.S.–born Hispanics, relative to whites, but for Anencephaly, corresponding ORs ranged from 1.9 to 2.3. The highest risk for spina bifida was observed for recent Hispanic immigrant parents from Mexico or Central America residing in the United States <5 years (OR = 3.28, 95% CI = 1.46–7.37). CONCLUSIONS: Less acculturated Hispanic parents seemed to be at highest risk of NTDs. For Anencephaly, U.S.–born and English-speaking Hispanic parents were also at increased risk. Finally, from an etiologic standpoint, spina bifida and Anencephaly appeared to be etiologically heterogeneous from these analyses. Birth Defects Research (Part A), 2009. © 2009 Wiley-Liss, Inc.
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the prevalence and predictors of Anencephaly and spina bifida in texas
Paediatric and Perinatal Epidemiology, 2009Co-Authors: Mark A Canfield, Jean D Brender, Lucina Suarez, Lisa Marengo, Tunu A Ramadhani, Angela E ScheuerleAbstract:Texas shares a 1255-mile border with Mexico and encompasses a variety of ecosystems, industries and other potential environmental exposures. The Texas Birth Defects Registry is an active surveillance system which covers all pregnancy outcomes (livebirths, fetal deaths and elective pregnancy terminations). This study describes the occurrence and the predictors of neural tube defects (Anencephaly and spina bifida) in Texas between 1999 and 2003. Birth prevalence, crude and adjusted prevalence ratios and 95% confidence intervals were calculated using Poisson regression, for each defect, by fetal/infant sex, delivery year and maternal sociodemographic characteristics. Among approximately 1.8 million livebirths, a total of 1157 neural tube defects cases were ascertained by the Registry, resulting in an overall prevalence of 6.33 cases per 10 000 livebirths. The prevalences of Anencephaly and spina bifida were 2.81 and 3.52 per 10 000 livebirths respectively. Prevalences of both defects were highest in Hispanics, among mothers living along the border with Mexico, among women of higher parity and among mothers who were 40+ years of age. In addition, the prevalence of each defect was higher among women with no record of prenatal care and among women with less than 7 years of education. Hispanic ethnicity was an important predictor for Anencephaly, along with sex, maternal age, parity and border residence. However, only border residence and delivery year were significant predictors for spina bifida.
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trends in the postfortification prevalence of spina bifida and Anencephaly in the united states
Birth Defects Research Part A-clinical and Molecular Teratology, 2008Co-Authors: Sheree L Boulet, Mark A Canfield, Russell S Kirby, Quanhe Yang, Julianne S Collins, James M Robbins, Robert E Meyer, Joseph MulinareAbstract:BACKGROUND: The prevalence of NTDs in the US declined significantly after mandatory folic acid fortification; however, it is not known if the prevalence of NTDs has continued to decrease in recent years relative to the period immediately following the fortification mandate. METHODS: Population-based data from 21 birth defects surveillance systems were used to examine trends in the birth prevalence of spina bifida and Anencephaly during 1999–2000, 2001–2002, and 2003–2004. Prevalence data were stratified by non-Hispanic White, non-Hispanic Black, and Hispanic race or ethnicity. Prevalence ratios were calculated by dividing the birth prevalences during the later time periods (2001–2002 and 2003–2004) by the birth prevalences during 1999–2000. RESULTS: During 1999–2004, 3,311 cases of spina bifida and 2,116 cases of Anencephaly were reported. Hispanic infants had the highest prevalences of NTDs for all years. For all infants, the combined birth prevalences of spina bifida and Anencephaly decreased 10% from the 1999–2000 period to the 2003–2004 period. The decline in spina bifida (3%) was not significant; however the decline in Anencephaly (20%) was statistically significant. CONCLUSIONS: While the prevalences of spina bifida and Anencephaly in the United States have declined since folic acid fortification in the food supply began, these data suggest that reductions in the prevalence of Anencephaly continued during 2001–2004 and that racial and ethnic and other disparities remain. Birth Defects Research (Part A), 2008. © 2008 Wiley-Liss, Inc.
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maternal obesity gestational diabetes and central nervous system birth defects
Obstetrical & Gynecological Survey, 2005Co-Authors: James L Anderson, Kim D Waller, Mark A Canfield, Gary M Shaw, Margaret L Watkins, Martha M WerlerAbstract:ABSTRACT Several large-scale cohort studies suggest that obese mothers are at increased risk of having infants with neural tube defects and, possibly, other central nervous system (CNS) birth defects. Because obesity and diabetes share similar metabolic abnormalities, a study was planned to determine whether gestational diabetes influences the association between maternal obesity and CNS birth defects. In this population-based case–control study, covering the years 1997 to mid-2000, structured telephone interviews were conducted with mothers of offspring having Anencephaly (n = 120), spina bifida (n = 184), holoprosencephaly (n = 49), or isolated hydrocephaly (n = 124). Control women whose infants were neurologically normal were randomly chosen from the same hospitals. Approximately 60% of both cases and control subjects responded. Maternal obesity was defined as a body mass index of 30 kg/m2 or higher. Pregestational diabetes, both type 1 and type 2, correlated closely with holoprosencephaly (adjusted odds ratio [OR], 47; 95% confidence interval [CI], 9.5–230), and isolated hydrocephaly (OR, 12; 95% CI, 2.9–47). There was no increase in the risk of Anencephaly or spina bifida. Gestational diabetes increased only the risk of holoprosencephaly (OR, 2.9; 95% CI, 1.0–8.4). Mothers of infants with Anencephaly were less likely than control mothers to have gestational diabetes. Obese mothers were likelier than control subjects to have infants with any of the 4 CNS birth defects. Underweight women were less likely to have an infant with spina bifida. The association between maternal obesity and an increased risk of neural tube defects and isolated hydrocephaly held for all ethnic groups. Associations between maternal obesity and Anencephaly (OR, 2.3; 95% CI, 1.2–4.3), spina bifida (OR, 2.8; 95% CI, 1.7–4.5), and isolated hydrocephaly (OR, 2.7; 95% CI, 1.5–5.0) persisted after adjusting for maternal age, ethnicity, education, smoking, alcohol use, and periconceptional vitamin use. For both spina bifida and holoprosencephaly, the joint effects of maternal obesity and gestational diabetes appeared to be interactive. These findings suggest that gestational diabetes and maternal obesity may increase the risk of CNS birth defects through common mechanisms, and they strongly support the need for ways of preventing these conditions.