78 research outputs found
Evaluation of the prenatal diagnosis of neural tube defects by ultrasonographic examination in different centres across Europe.
No full textOBJECTIVE:
Evaluation of prenatal diagnosis of neural tube defects by ultrasound examination in unselected populations across Europe.
SETTING:
Prenatal ultrasound units in areas that report to contributing congenital malformation registers.
METHODS:
All cases with a suspected or confirmed neural tube defect and delivered within the 30 month study period were identified from 18 Congenital Malformation Registers from 11 European countries. Data on the pregnancy, prenatal scans, outcome of pregnancy, and information on different screening policies for each country were analysed.
RESULTS:
670766 deliveries occurred in the area covered by the registers during the study period. A neural tube defect was diagnosed at delivery in 542 cases. In 84% of these, the lesion was isolated (166 anencephaly, 252 spina bifida, 35 encephalocele). Of the 166 isolated cases with anencephaly, 96% were correctly identified prenatally; one was missed on scan, two were wrongly diagnosed, and four were not scanned (sensitivity 98%). 84% of the prenatal diagnoses were made before 24 weeks' gestation; 86% of isolated anencephalic pregnancies were terminated. Of the 252 cases of isolated spina bifida, 171 (68%) were correctly identified prenatally; 66% of these before 24 weeks' gestation. The diagnosis was missed on scan in 60 cases and 21 were not scanned (sensitivity 75%). The mean reduction in birth prevalence because of termination of pregnancy for spina bifida was 49% (range 6-100%). There was a wide variation between centres in prenatal detection rate (33-100%), termination of pregnancy of prenatally diagnosed cases (17-100%), and gestation both at diagnosis and termination of pregnancy.
CONCLUSION:
A high prenatal detection rate for anencephaly was reported by all registers. There is a large variation in prenatal detection and termination rates for spina bifida between centres, reflecting differences both in policy and culture
RCT to evaluate the efficacy of high dose of folic acid to prevent the occurrence of birth defects
No full textThe most common public health recommendation to prevent the occurrence of neural tube defects (NTDs), and possibly other congenital malformations (CMs), is to take a folic acid (FA) supplement containing 0.4 mg/day, however the question of the most appropriate dose of FA and the role of other B-vitamins is still open. To evaluate this issues we have planned a randomized, double-blind, controlled trial (RCT) to assess the effect of FA periconceptional supplementation of 4 mg/day compared to the 0.4 mg/day standard dose on reducing the occurrence of all CMs and to promote an international prospective meta-analysis (PMA). The RCT will start in 2009 in the Veneto Region, Italy. Similar studies that will be part of the PMA are already planned in The Netherlands (2010) and in Hungary
The promotion of preconception care and health: an update on the preconception counseling and recruitment of participants in rcts that evaluate the efficacy of high dose folic acid on the prevention of congenital malformations.
No full textBackgrounds: Periconceptional folic acid (FA) supplementation reduces the risk of neural tube defects (NTD). Observational studies suggest that,compared to the standard dose of 0.4 mg daily,a dose of 4.0 mg/day, could further reduce the risk of first NTD occurrence as well as the risk of other birth defects. We present an update on the RCTs that are conducted in Italy (I) and in the Netherlands (NL).
Methods: The study evaluates the overall rate of congenital malformations (CM) and that of selected CM, miscarriage, recurrent abortion, pre-eclampsia, abruptio placentae, small-for-gestational age, preterm birth and twinning in women intending to get pregnant. In Italy, all women in this study receive extensive preconception counselling and are then invited to participate. To date, 1000 women received this counselling . In NL the inclusion for the study started in April 2012 via community pharmacies (CPs), embedded in a broader preconception care project. All CPs in Northern NL are invited to participate. In both countries, women are randomly double-blind assigned to use FA-supplements of 4 mg or 0.4 mg daily.
Results: The characteristics of women who received preconception counselling in I and the results of the public information and recruitment campaign in NL will be described in detail.
Acknowledgement: these studies are supported by the Italian Medicines Agency (AIFA) under contract no. FARM6KWTC and The Netherlands Organisation for Health Research and Development resepectively
Maternal smoking and deformities of the foot: Results of the EUROCAT study
No full textBackground While monitoring birth defects in a registry, statistically significant increases in prevalence occasionally occur. In the European Registration Of Congenital Anomalies (EUROCAT) in the Northern Netherlands 20 000 births are monitored every year. For omphaloceles, a steady increase in the prevalence from 0.86 per 10 000 live- and stillbirths in 1981-1983 to 3.11 per 10 000 live- and stillbirths in 1994 was seen in the three northern provinces of The Netherlands.Methods A stepwise enquiry into this increase, which included checking for misclassification and change in coding and ascertainment when necessary, was done. All cases of omphalocele and associated or similar birth defects registered at the EUROCAT registry were retrieved and if necessary recoded.Results This study showed that the increase reported previously was not a true time trend. A few cases of e.g. diastasis recti and trisomy 18 were misclassified. The prevalence in more recent years is comparable with that in the rest of Europe, whereas it used to be lower. There was an increase in isolated omphalocele, but the numbers are small.Conclusions The stepwise enquiry described should be a standard procedure after noticing an increasing prevalence in a registry. A better subdivision, e.g. in isolated cases versus children with multiple congenital anomalies, before monitoring can contribute to a lower number of false positive signals.</p
Folic acid prevents more than neural tube defects:A registry-based study in the northern Netherlands
No full textInsufficient folic acid intake in the Netherlands: What about the future?
No full textBackground: in 1993 all women of childbearing age in the Netherlands were advised to take a daily 0.5 mg folic acid pill to reduce the risk for neural tube defects. This study describes both recent and past awareness and use of folic acid supplements in relation to socioeconomic status in the Northern Netherlands. The consequences of a recent report of the Dutch Health Council report will be discussed as well. Methods: In the most recent cross-sectional study (November 2000), pregnant women filled out a questionnaire. Out of 473 women, 461 were willing to cooperate. The highest fulfilled level of education was taken as an indicator for socio-economic status. Results: Seventy-seven percent (n = 357) of the respondents had heard about folic acid before being pregnant. Sixty-three percent (n = 289) knew about the protective effect for NTDs and 33% (n = 151) knew the entire advised period. Sixty-one percent (n = 265) of the respondents used folic acid in some part of the advised period and 36% (n = 164) used it in the entire advised period. Higher educated women knew more about folic acid and used it significantly more often in the periconceptional period than lower educated women. Conclusions: Because compliance to proper use of folic acid was poor, food fortification in the Netherlands must be seriously considered. The Dutch Health Council wants to limit the fortification of food products to those products that are especially aimed for women who wish to become pregnant. The fortification of specific products instead of staple foods is a missed chance to reduce NTDs and possibly other birth defects and cardiovascular defects as well
Folic acid prevents more than neural tube defects: A registry-based study in the northern Netherlands
No full textAssociation between Antibiotic Prescribing in Pregnancy and Cerebral Palsy or Epilepsy in Children Born at Term: A Cohort Study Using The Health Improvement Network.
No full textBetween 19%-44% pregnant women are prescribed antibiotics during pregnancy. A single, large randomised-controlled-trial (ORACLE Childhood Study II) found an increased risk of childhood cerebral palsy and possibly epilepsy following prophylactic antibiotic use in pregnant women with spontaneous preterm labour. We ascertained whether this outcome could be reproduced across the population of babies delivered at term and prospectively followed in primary-care using data from The Health Improvement Network
Additional information from parental questionnaires and pharmacy records for registration of birth defects
No full textEUROCAT Northern Netherlands registers children born with a birth defect in the Northern Netherlands. Data used to be collected via a notification form, which is filled out by the notifier and, if necessary, completed by the general practitioner. To increase the amount of information, EUROCAT started using new methodology in July 1997. The new procedure consists of three additional steps. Firstly, a parental questionnaire with 43 questions concerning pregnancy and medical history is sent to the parents. Also, the pharmacist is approached to provide information on the drugs that were dispensed to the mother in the period from three months before until the end of the pregnancy. The last step is a telephone interview with the mother. In this study the old and new method are compared with respect to response, quality and quantity of the data. Of the 198 parental questionnaires included in this study, 179 (90.4%) were returned. The pharmacists returned 173 out of 179 requests for information (96.6%). The parental information is more complete for ethnicity and serum screening. The quality of the drug exposure data is much better using the new methodology. The general practitioner's input is still necessary for specification and verification of the diagnosis
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