Periconceptional use of multivitamins and the occurrence of neural tube defects

Mulinare, Joseph

doi:10.1001/jama.260.21.3141

Cited by 153 publications

(82 citation statements)

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“…7 The risk of NTDs is significantly decreased when a healthy diet is supplemented with multivitamins, principally folic acid. 8,9 Indeed, studies in the United States have suggested a significant decrease in the prevalence of spina bifida and anencephaly as the Food and Drug Administration (FDA) mandated the addition of folic acid to all enriched cereal grain products by January 1998. [10][11][12] Cancer Low-plasma folate levels have been associated with an increased incidence of a number of types of cancer.…”

Section: Neural Tubule Defectsmentioning

confidence: 99%

Investigation of inter-individual variability of the one-carbon folate pathway: a bioinformatic and genetic review

2009

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Section: Neural Tubule Defectsmentioning

confidence: 99%

Investigation of inter-individual variability of the one-carbon folate pathway: a bioinformatic and genetic review

2009

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“…There is also substantial evidence that folate supplementation reduces not only the recurrence but also the occurrence of NTDs. For example, several epide-miological studies have reported reductions in NTD risks associated with maternal intake of folic acid supplements or folaterich diets [14][15][16][17][18][19][20] . Additional support for the importance of folate in NTD risk reduction was provided by Hernandez-Diaz et al 21 Their study showed that periconceptional intake of medications that act as folic acid antagonists, such as carbamazepine or tri-methoprim, could double the risk of NTD-affected pregnancies.…”

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Neural tube defects and folate: case far from closed

Shaw²,

et al. 2006

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Neural tube closure takes place during early embryogenesis and requires interactions between genetic and environmental factors. Failure of neural tube closure is a common congenital malformation that results in morbidity and mortality. A major clinical achievement has been the use of periconceptional folic acid supplements, which prevents ~50-75% of cases of neural tube defects. However, the mechanism underlying the beneficial effects of folic acid is far from clear. Biochemical, genetic and epidemiological observations have led to the development of the methylation hypothesis, which suggests that folic acid prevents neural tube defects by stimulating cellular methylation reactions. Exploring the methylation hypothesis could direct us towards additional strategies to prevent neural tube defects.Neural tube defects (NTDs) are complex congenital malformations of the CNS. Anencephaly and spina bifida are the most common and severe forms of NTD, with a prevalence of about 1 in 1,000 births, although this varies throughout the world 1 . Infants with anencephaly are stillborn or die shortly after birth, whereas infants with spina bifida can survive but are likely to have severe lifelong disabilities and are at risk of psychosocial maladjustment. The estimated lifetime medical costs are high; for example, in California, USA, the costs for children born with spina bifida exceed US$81 million per year 2 .It has been known for more than 20 years that women can reduce their risk of having an NTDaffected pregnancy by taking folic acid supplements. However, the underlying mechanisms byCorrespondence to H.J.B. H.Blom@cukz.umcn.nl. Competing interests statementThe authors declare no competing financial interests. DATABASES NIH Public Access Author ManuscriptNat Rev Neurosci. Author manuscript; available in PMC 2010 November 2. Neurulation and neural tube defectsNeurulation has long fascinated scientists, as evidenced by a devoted literature that extends back hundreds of years. The process of neurulation occurs during early embryogenesis, starting with the formation of the neural plate from specialized ectodermal cells and culminating in the closure of the neural tube (FIG. 1), the precursor of both the CNS and most of the PNS. Considered most simply, the neural plate develops bilateral neural folds, which elevate and fuse at the midline to create the neural tube. Subsequent development, together with vesiculation within the tube, gives rise to the brain and spinal cord. Further details of this complex process are beyond the scope of this review (for reviews, see REFS 4,5 ).Neurulation seems to be highly complex and tightly regulated. The development and closure of the neural tube is usually completed by 28 days post-conception. This means that by the time a woman finds out that she is pregnant, the neural tube is almost completely closed. For the neural tube to close properly, genes that regulate various morphogenetic activities must function cooperatively. These activities include programmed cell death, neural crest...

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“…Most of these were case-control studies, one was a cohort study, and one was a randomized controlled trial. Most of the case-control studies found a correlation between low folate levels and occurrence of NTDs, [5][6][7][8] with odds ratios between 0.4 and 0.65. One of the studies 6 stratified odds ratios by amount of folate ingested and showed decreasing risk with increasing folate, with odds ratios ranging between 0.94 and 0.38 (although all of the confidence intervals included 1).…”

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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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Periconceptional use of multivitamins and the occurrence of neural tube defects

Cited by 153 publications

References 0 publications

Investigation of inter-individual variability of the one-carbon folate pathway: a bioinformatic and genetic review

Investigation of inter-individual variability of the one-carbon folate pathway: a bioinformatic and genetic review

Neural tube defects and folate: case far from closed

Policy statement on folic acid and neural tube defects

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