Periconceptional folic acid and multivitamin supplementation for the prevention of neural tube defects and other congenital abnormalities

Czeizel, Andr̀ew E.

doi:10.1002/bdra.20563

Cited by 107 publications

(83 citation statements)

References 61 publications

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“…59 Malnourishment overall (poor diet quality) and vitamin deficiencies (such as folic acid) are associated with various congenital malformations, including neural tube defects, congenital heart defects, and orofacial clefts. 75,76 Depressed women are also more likely to smoke, 77 and not all studies controlled for smoking despite the known association of smoking with untoward effects. 78 Although our analysis was limited to what we deemed to be above quality threshold, and metaanalysis pools data so that conclusions can be reached with higher sample sizes, the original study limitations cannot be entirely ignored.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Antidepressant Exposure During Pregnancy and Congenital Malformations: Is There an Association?

Grigoriadis¹,

VonderPorten²,

Mamisashvili³

et al. 2013

J. Clin. Psychiatry

152

117

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Objective: Depression is often not optimally treated during pregnancy, partially because of conflicting data regarding antidepressant medication risk. This meta-analysis was conducted to determine whether antenatal antidepressant exposure is associated with congenital malformations and to assess the effect of known methodological limitations. Data Sources: EMBASE, CINAHL, PsycINFO, and MEDLINE were searched from their start dates to June 2010. Keywords of various combinations were used, including, but not limited to depressive/mood disorder, pregnancy, antidepressant drug/agent, congenital malformation, and cardiac malformation. Study Selection: English language studies reporting congenital malformations associated with antidepressants were included. Of 3,074 abstracts reviewed, 735 studies were retrieved and 27 studies were included. Data Extraction: Two reviewers working independently assessed article quality. Data on use of any antidepressant, including fluoxetine and paroxetine specifically, were extracted. Outcomes included congenital malformations, major congenital malformations, cardiovascular defects, septal heart defects (ventral septal defects and atrial septal defects), and ventral septal defects only. Results: Nineteen studies were above quality threshold and make up the primary meta-analyses. Pooled relative risks (RRs) were derived by using random-effects methods. Antidepressant exposure was not associated with congenital malformations (RR = 0.93; 95% CI, 0.85-1.02; P = .113) or major malformations (RR = 1.07; 95% CI, 0.99-1.17; P = .095). However, increased risk for cardiovascular malformations (RR = 1.36; 95% CI, 1.08-1.71; P = .008) and septal heart defects (RR = 1.40; 95% CI, 1.10-1.77; P = .005) were found; the RR for ventral septal defects was similar to septal defects, although not significant (RR = 1.54; 95% CI, 0.71-3.33; P = .274). Pooled effects were significant for paroxetine and cardiovascular malformations (RR = 1.43; 95% CI, 1.08-1.88; P = .012). These results are contrasted with those addressing methodological limitations but are typically consistent. Conclusions: Overall, antidepressants do not appear to be associated with an increased risk of congenital malformations, but statistical significance was found for cardiovascular malformations. Results were robust in several sensitivity analyses. Given that the RRs are marginal, they may be the result of uncontrolled confounders. Although the RRs were statistically significant, none reached clinically significant levels.

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Section: Strengths and Limitationsmentioning

confidence: 99%

Antidepressant Exposure During Pregnancy and Congenital Malformations: Is There an Association?

Grigoriadis¹,

VonderPorten²,

Mamisashvili³

et al. 2013

J. Clin. Psychiatry

152

117

View full text Add to dashboard Cite

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“…They found a decreased frequency of atrial septal defects, no change in the frequency of other cardiac anomalies, cleft lip/palate, cleft palate, or limb defects, and an increased frequency of obstructive renal anomalies, gastroschisis, and pyloric stenosis. Finally, Czeizel 25 reported that as part of the randomized controlled trial investigating the effect of multivitamin supplementation on NTD frequency, and a subsequent cohort-controlled trial comparing outcomes in supplemented versus nonsupplemented women, it was found that urinary tract anomalies and cardiovascular defects showed a statistically significant reduction in frequency (although confidence intervals included 1 for the odds ratio of urinary tract abnormalities). The frequency of cleft lip/palate did not show a reduction in either group.…”

mentioning

confidence: 99%

Policy statement on folic acid and neural tube defects

Toriello

2011

Genetics in Medicine

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Disclaimer: ACMG standards and guidelines are designed primarily as an educational resource for medical geneticists and other healthcare providers to help them provide quality medical genetic services. Adherence to these standards and guidelines does not necessarily ensure a successful medical outcome. These standards and guidelines should not be considered inclusive of all proper procedures and tests or exclusive of other procedures and tests that are reasonably directed to obtaining the same results. In determining the propriety of any specific procedure or test, the geneticists should apply their own professional judgment to the specific clinical circumstances presented by the individual patient or specimen. It may be prudent, however, to document in the patient's record the rationale for any significant deviation from these standards and guidelines.

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“…Our hypothesis regarding the unexpected association of maternal hypotension with lower risk for total CA is based on the combination of three factors: (i) a healthier lifestyle indicated by a lower prevalence of smoking during the study pregnancy, (ii) a higher incidence of severe nausea or vomiting in pregnancy associated with a lower risk of CAs and (iii) the CA-preventive effect of folic acid and multivitamins during early pregnancy [13][14][15][16][17][18][19] in about half of the hypotensive pregnant women.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, periconceptional folic acid and/or folic acid-containing multivitamin supplementation can prevent certain CAs such as neural-tube defects, [13][14][15] cardiovascular CA, urinary tract defects and congenital limb deficiencies. [16][17][18][19] Only one type of 3 mg folic acid tablet was available in Hungary during the study period. Folic acid-containing micronutrient combinations, (that is, multivitamins) had folic acid doses ranging from 0.1 to 1 mg per tablet.…”

Section: Diagnostic Criteria Of Hypotensionmentioning

confidence: 99%

Hypotension in pregnant women: a population-based case–control study of pregnancy complications and birth outcomes

et al. 2010

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Hypotension is frequent in pregnant women; nevertheless, its association with pregnancy complications and birth outcomes has not been investigated. Thus, the aim of this study was to analyze the possible association of hypotension in pregnant women with pregnancy complications and with the risk for preterm birth, low birthweight and different congenital abnormalities (CAs) in the children of these mothers in the population-based data set of the Hungarian Case-Control Surveillance of CAs, 1980CAs, -1996 Prospectively and medically recorded hypotension was evaluated in 537 pregnant women who later had offspring with CAs (case group) and 1268 pregnant women with hypotension who later delivered newborn infants without CAs (control group); controls were matched to sex and birth week of cases (in the year when cases were born), in addition to residence of mothers. Over half of the pregnant women who had chronic hypotension were treated with pholedrine or ephedrine. Maternal hypotension is protective against preeclampsia; however, hypotensive pregnant women were at higher risk for severe nausea or vomiting, threatened abortion (hemorrhage in early pregnancy) and for anemia. There was no clinically important difference in the rate of preterm births and low birthweight newborns in pregnant women with or without hypotension. The comparison of the rate of maternal hypotension in cases with 23 different CAs and their matched controls did not show a higher risk for CAs (adjusted OR with 95% confidence intervals: 0.66, 0.49-0.84). In conclusion, a higher risk for CAs and other adverse birth outcomes was not found in the offspring of pregnant women with hypotension, but maternal hypotension was associated with a higher risk of some pregnancy complications. Keywords: congenital abnormalities; hypotension; hypotension drugs; pregnancy; pregnancy complications INTRODUCTION Hypertension is a common medical condition that has multiple manifestations, including primary and secondary hypertension disease, preeclampsia and gestational hypertension in pregnant women. 1-3 However, the study of the other end of the blood pressure spectrum (that is, hypotension) has been neglected in pregnant women 4 even though hypotension occurs frequently during pregnancy. We were unable to find controlled epidemiological studies regarding the effect of hypotension and related drug treatments for pregnancy complications or adverse birth outcomes in the medical literature. 5 This medical attitude is partially understandable because hypotension is not a disease; rather, it is a symptom of low blood pressure in individuals and is generally not associated with serious complications.Hypotension occurs frequently in Hungarian pregnant women, and obstetricians, in general after consultation with specialists, prefer to treat the more severe and unpleasant symptomatic manifestations of hypotension during pregnancy. However, the potential teratogenic/

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Periconceptional folic acid and multivitamin supplementation for the prevention of neural tube defects and other congenital abnormalities

Cited by 107 publications

References 61 publications

Antidepressant Exposure During Pregnancy and Congenital Malformations: Is There an Association?

Antidepressant Exposure During Pregnancy and Congenital Malformations: Is There an Association?

Policy statement on folic acid and neural tube defects

Hypotension in pregnant women: a population-based case–control study of pregnancy complications and birth outcomes

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