The role of Vitamin B12 and genetic risk factors in the etiology of neural tube defects: A systematic review

Wahbeh, Farah; Manyama, Mange

doi:10.1002/jdn.10113

Cited by 9 publications

(5 citation statements)

References 59 publications

(149 reference statements)

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“…18 The anatomical position of myelomeningocele varies in literature however it has often present at 22.3% to 55.7% lumbosacral, cervical 1.8% to 5.6%, cervicothoracic 0.9%, thoracic 4.2%, lumbar 16.8% to 55.7%, sacral 16% to 34.5% and in 0.9% cervical, 5.6% thoracolumbar, and 16% sacral injuries were reported. [19][20] Age of pediatric patients was not statistically significant in our study which was found to be similar to the Lillegard J.B. et al, study results i.e., with two groups of OMFS (open maternal-fetal surgery) for fMMC (fetal myelomeningocele) closure compared with fetal and maternal outcomes (anterior and posterior placental locations) and found insignificance in gestational age at the time of delivery (p = 0.583). 21 In the Management of Myelomeningocele Study (MOMS) on 161 cohort patients, the children's average age at the time of the study visit was 7.8 years (range 5.9 -10.3).…”

Section: Discussionsupporting

confidence: 86%

Assessment of Outcomes of Myelomeningocele Repair and Early Post-Operative Complications

Aftab¹,

Akbar²,

Rehman³

et al. 2022

Pak J Neurol Surg

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Objective: To explore the result and frequency of different problems that occur in the early post-operative period and the incidence of these complications in our community. It will give insight and drive further development in the care of myelomeningoceles as well as the unique problems that emerge in these patients post-operatively. Materials and Methods: At the Jinnah Postgraduate Medical Center in Karachi, the Department of Neurosurgery, this prospective, observational study was carried out over 12 months. Patients of both genders from 1 month to 2 years of age, diagnosed with myelomeningocele, and admitted to the ward for surgical repair were included in the study. Results: Out of 94, there were 58.5% female patients, with the highest percentage of age group i.e. 48.9% in > 3 months to 9 months. Medium size of MMC (71.3%) at the lumbar side location (46.8%) was observed in the highest frequency among the study sample. The overall postoperative complication rate was 19.1%, with CSF leak being the most common (9.6%) followed by wound infection (5.3%). There was no association of the complications with the age, size, and location of MMC. Conclusion: Myelomeningocele treatment may be delayed as a result of distant homebirths. Neurosurgeons who are trying to give prompt access to medical care for individuals born with MMC face various hurdles, including the family's desire to seek medical attention, their capacity to do so, and the availability of proper medical treatment.

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Section: Discussionsupporting

confidence: 86%

Assessment of Outcomes of Myelomeningocele Repair and Early Post-Operative Complications

Aftab¹,

Akbar²,

Rehman³

et al. 2022

Pak J Neurol Surg

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“…Genetics, maternal diminished folate status, maternal obesity, ambient air pollution, smoking, and maternal alcohol use are among the most important risk factor for NTDs 3,4,9,15,21,27,28 .…”

Section: Discussionmentioning

confidence: 99%

Surgical Outcomes of Myelomeningocele Repair: a 20-Year Experience from a Single Center in a Middle-Income Country

Zoghi

Feili

Mosayebi

et al. 2021

Preprint

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ObjectiveSpina bifida primarily affects people of low and middle socioeconomic status. Herein, we describe the outcome of myelomeningocele surgical management in Iran and predictors of its postoperative complications and mortality.MethodsThis retrospective chart review studies the children who underwent surgical management for myelomeningocele in Shiraz, Fars province, Iran, from May 2001 to September 2020. To this end, we investigated mortality and 30-day complications and the factors that determined the operation’s outcome.Results256 patients were enrolled. The median age at the operation was roughly eight days (IQR: 7). The most common site of involvement of Myelomeningocele (MMC) was Lumbosacral (86%, n = 204). At the evaluation conducted prior to operation, CSF leaking was observed in 7% (n=16) of the patients. Postoperatively, 5.7% of the patients were expired in the 30 days following the operation (n = 14), while 24% needed readmission (n = 47). The most common complications leading to readmission included wound dehiscence (n = 10, 42%) and wound purulence (n = 6, 25%). No variable was significantly associated with postoperative complication except for the site of the lesion (p-value = 0.035) and the presence of the lipid content in the defect (p-value = 0.044).ConclusionsMost patients born with MMC are referred for the neurosurgical evaluation following their birth; however, as results show there is much left to be desired compared with the 48h recommended by The Congress of Neurological Surgeons. Here, we concluded that presence of lipid compartment in the lesion and the site of the lesion are the two factor that were associated with the rate of mortality. However, further investigation into preoperative interventions and risk factors to mitigate risk of postoperational complications and mortality is highly encouraged. We highly advocate for the investigation and dissemination of the outcome of the conventional surgical management of MMC in financially restrained areas; because they can show the limitation these settings are confronted with (that are in a way unique to them and different from the resourceful settings) and provide a model for other similar areas with limited suitable care.

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“…Indeed, the early phase of pregnancy represents a period of high embryonic developmental vulnerability that is critically dependent on the adequate provision of interacting nutrients involved in one-carbon metabolism, as most clearly exemplified in the case of NTDs, a group of congenital malformations of the central nervous system that arise from a failure of neural tube closure during embryogenesis. Sensitivity of neural tube closure to one-carbon metabolism is signified by the lowering of NTD risk associated with higher maternal folate ( MRC Vitamin Study Research Group, 1991 ; Czeizel et al, 2011 ; De-Regil et al, 2015 ; Yadav et al, 2021 ), vitamin B 12 ( Ray et al, 2007 ; Gu et al, 2012 ; Molloy, 2018 ; Wahbeh and Manyama 2021 ; Yadav et al, 2021 ), vitamin B 6 ( Candito et al, 2008 ), choline ( Shaw et al, 2004 ; Shaw et al, 2009 ), betaine ( Shaw et al, 2004 ), and methionine ( Shaw et al, 1997 ; Shaw et al, 2004 ) status.…”

Section: Introductionmentioning

confidence: 99%

Homocysteine Metabolism in Pregnancy and Developmental Impacts

D'Souza

Glazier

2022

Front. Cell Dev. Biol.

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Homocysteine is a metabolite generated by methionine cycle metabolism, comprising the demethylated derivative of methionine. Homocysteine can be metabolised by the transsulphuration pathway to cystathionine, which requires vitamin B6, or can undergo remethylation to methionine. Homocysteine remethylation to methionine is catalysed by methionine synthase activity which requires vitamin B12, regenerating methionine to allow synthesis of the universal methyl donor S-adenosylmethionine required for methylation and gene transcription regulation. The methyl-group donated for homocysteine remethylation comes from 5-methyltetrahydrofolate generated by the folate cycle, which allows tetrahydrofolate to be returned to the active folate pool for nucleotide biosynthesis. Therefore the integrated actions of the methionine and folate cycles, required to metabolise homocysteine, also perpetuate methylation and nucleotide synthesis, vitally important to support embryonic growth, proliferation and development. Dysregulated activities of these two interdependent metabolic cycles, arising from maternal suboptimal intake of nutrient co-factors such as folate and vitamin B12 or gene polymorphisms resulting in reduced enzymatic activity, leads to inefficient homocysteine metabolic conversion causing elevated concentrations, known as hyperhomocysteinemia. This condition is associated with multiple adverse pregnancy outcomes including neural tube defects (NTDs). Raised homocysteine is damaging to cellular function, binding to proteins thereby impairing their function, with perturbed homocysteine metabolism impacting negatively on embryonic development. This review discusses the “cross-talk” of maternal-fetal homocysteine interrelationships, describes the placental transport of homocysteine, homocysteine impacts on pregnancy outcomes, homocysteine and methylation effects linking to NTD risk and proposes a putative pathway for embryonic provision of folate and vitamin B12, homocysteine-modulating nutrients that ameliorate NTD risk.

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The role of Vitamin B12 and genetic risk factors in the etiology of neural tube defects: A systematic review

Cited by 9 publications

References 59 publications

Assessment of Outcomes of Myelomeningocele Repair and Early Post-Operative Complications

Assessment of Outcomes of Myelomeningocele Repair and Early Post-Operative Complications

Surgical Outcomes of Myelomeningocele Repair: a 20-Year Experience from a Single Center in a Middle-Income Country

Homocysteine Metabolism in Pregnancy and Developmental Impacts

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