Prevention = Pre-Conception Counselling

Wilson, R. Douglas

doi:10.1016/j.jogc.2018.05.025

Cited by 5 publications

(2 citation statements)

References 21 publications

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“…25 For every prospective pregnant woman, the health care provider should document an appropriate 3-generation pedigree for congenital anomalies (fetal or neonatal) and pregnancy outcome (live birth, stillbirth, pregnancy termination, and spontaneous loss) for both the mother's and father's families. Although pre-conception counselling is recommended for all pregnancies, it may have added value for those with a history of congenital anomalies in the mother's or father's families, adverse pregnancy outcomes, and maternal health conditions [26][27][28] (Box 2 11 ), and compliance should be emphasized. It is important to emphasize that, for recurrent NTD prevention, folic acid supplementation decreases risk from 3%e4% (the risk level in populations not receiving supplementation) to 1%.…”

Section: Pre-conception Counselling For Woman With Additional Specifi...mentioning

confidence: 99%

Guideline No. 427: Folic Acid and Multivitamin Supplementation for Prevention of Folic Acid–Sensitive Congenital Anomalies

Wilson

O’Connor²

2022

Journal of Obstetrics and Gynaecology Canada

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Section: Pre-conception Counselling For Woman With Additional Specifi...mentioning

confidence: 99%

Guideline No. 427: Folic Acid and Multivitamin Supplementation for Prevention of Folic Acid–Sensitive Congenital Anomalies

Wilson

O’Connor²

2022

Journal of Obstetrics and Gynaecology Canada

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“…Preconception counselling for pregnancy planning is recommended for all pregnancies but will have greater preventive value with a history of genetic morbidity (includes paternal), adverse pregnancy outcomes, and maternal co-morbidity conditions ( Wilson et al, 2021 , Bibbins-Domingo et al, 2017 , ACOG Practice Bulletin Neural Tube Defects, 2017 , Wilson, 2018 , ACOG Committee Opinion, 2019 , Broughton and Douek, 2019 ). A three-generation pedigree for congenital anomalies (personal, fetal or neonatal) and pregnancy outcomes (live birth, stillbirth, pregnancy termination, spontaneous loss) is required for the maternal and paternal families ( Table 3 ) World-wide NTD prevalence range is 0.3–200 per 10,000 births (Canada 5.66 per 10,000 births; USA range 3.0–6.3 per 10,000 births dependent on race and socioeconomic factors) where the identification of folate gene interactions, through transcriptome profiling studies, would allow enhanced genetic folate deficiency identification and management ( Public Health Infobase, 2021 , Au et al, 2017 ).…”

Section: Resultsmentioning

confidence: 99%

Maternal folic acid and multivitamin supplementation: International clinical evidence with considerations for the prevention of folate-sensitive birth defects

Wilson

O'Connor

2021

Preventive Medicine Reports

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More evidence is available for maternal intake, absorption, distribution, tissue specific concentrations, and pregnancy outcomes with folic acid (fortification/supplementation) during preconception – first trimester. This Quality Improvement prevention review used expert guidelines/opinions, systematic reviews, randomized control trials/controlled clinical trials, and observational case control/case series studies, published in English, from 1990 to August 2021. Optimization for an oral maternal folic acid supplementation is difficult because it relies on folic acid dose, type of folate supplement, bio-availability of the folate from foods, timing of supplementation initiation, maternal metabolism/genetic factors, and many other factors. There is continued use of high dose pre-food fortification ‘RCT evidenced-based’ folic acid supplementation for NTD recurrence pregnancy prevention. Innovation requires preconception and pregnancy use of ‘carbon one nutrient’ supplements (folic acid, vitamin B12, B6, choline), using the appropriate evidence, need to be considered. The consideration and adoption of directed personalized approaches for maternal complex risk could use serum folate testing for supplementation dosing choice. Routine daily folic acid dosing for low-risk women should consider a multivitamin with 0.4 mg of folic acid starting 3 months prior to conception until completion of breastfeeding. Routine folic acid dosing or preconception measurement of maternal serum folate (after 4–6 weeks of folate supplementation) could be considered for maternal complex risk group with genetic/medical/surgical co-morbidities. These new approaches for folic acid oral supplementation are required to optimize benefit (decreasing folate sensitive congenital anomalies; childhood morbidity) and minimizing potential maternal and childhood risk.

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Antenatal Fetal Assessment: 75 Years Later (1945-2019)

Wilson

2019

Journal of Obstetrics and Gynaecology Canada

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S eventy-five years ago, fetal assessment was limited to menstrual dating, estimating uterine size by pelvic examination or symphysis-fundal measurement, fetal heart auscultation, and rarely abdominal radiography or fluoroscopy. The real "fetal" assessment was neonatal, after birth.The use of maternal blood for screening initially focused on alpha-fetoprotein for detection of neural tube defects in the 1970s. The initial "B scan" ultrasound followed by real-time ultrasound imaging in the 1970s and 1980s offered the desired assessment "window" into the uterus with minimal fetal risk. KEY MESSAGES1. Fetal morbidity and mortality can be minimized with education and clear fetal assessment protocols. 2. Fetal assessment checklists should be added to the prenatal care pathway to assist in timely access and evaluation. 3. Pregnant patients need to understand that pregnancy is a "risk management" process with the goal to optimize the normal maternal and neonatal outcome.

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Prevention = Pre-Conception Counselling

Cited by 5 publications

References 21 publications

Guideline No. 427: Folic Acid and Multivitamin Supplementation for Prevention of Folic Acid–Sensitive Congenital Anomalies

Guideline No. 427: Folic Acid and Multivitamin Supplementation for Prevention of Folic Acid–Sensitive Congenital Anomalies

Maternal folic acid and multivitamin supplementation: International clinical evidence with considerations for the prevention of folate-sensitive birth defects

Antenatal Fetal Assessment: 75 Years Later (1945-2019)

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