Objective To systematically summarise the available evidence concerning the rate of folic acid supplement use pre-and periconceptionally, to identify those characteristics associated with low rates of use and to assess whether folic acid public awareness campaigns are associated with higher folic acid use. Design Systematic overview.Setting Survey studies.Population Women of reproductive age, most of whom were currently or recently pregnant.Methods Two investigators searched MEDLINE, Embase and Nutriotiongate databases between 1990 and 2003. Bibliographies of retrieved references were scanned for other relevant publications, and authors were contacted if necessary. Studies were included that evaluated the rate of folic acid supplement use either before conception or in early pregnancy. Main outcome measures Rate of preconceptional and/or periconceptional folic acid use, rate of planned pregnancy in each study, as well as significant characteristics differentiating non-users from users of folic acid, including the effect of folic acid awareness campaigns. Results A total of 52 studies were included. In 34 studies, reported preconceptional folic acid use varied from 0.9% to 50%. In 49 studies, the reported rate of periconceptional supplement use ranged from 0.5% to 52%. Significant predictors of reduced periconceptional folic acid use were a low level of formal education, immigrant status, young maternal age, lack of a partner and an unplanned pregnancy. Four studies examined the effect of mass media campaigns on periconceptional folic acid use; the reported rates increased significantly, by a factor of 1.7 to 7.2, but in no study was the post-campaign rate above 50%. Conclusions In many countries, fewer than 50% of women take periconceptional folic acid supplements.Consideration should be given to the practical advantages of folic acid fortification of centrally processed foods, such as wheat, corn and rice flour, while further promoting vitamin tablet supplement use and planned pregnancy.

Background Features of the metabolic syndrome-maternal obesity, diabetes mellitus and chronic hypertension-are risk factors for pre-eclampsia.Objectives To determine the risk of pre-eclampsia in the presence of maternal hypertriglyceridemia, another major element of the metabolic syndrome.Search strategy Two investigators independently searched PubMed and Embase databases from 1980 to December 2004 for relevant studies. The terms preeclampsia, eclampsia, pregnancyinduced hypertension or toxemia were combined with dyslipidemia, hyperlipidemia, hypertriglyceridemia, lipids, cholesterol, triglycerides (TG) or lipoprotein.Selection criteria We included case-control and cohort studies published in English that included at least 20 women with preeclampsia and that sampled serum or plasma TG at any time before, during or after pregnancy.Data collection and analysis Mean maternal TG concentrations were compared between cases and controls within each study. The odds ratio of pre-eclampsia was calculated by comparing the risk of pre-eclampsia among women in each higher TG concentration category with that in the lowest reference category.Main results A total of 19 case-control and 3 prospective cohort studies were included. In 14 studies, the mean TG concentration was significantly higher among pre-eclamptic cases than among unaffected controls; in seven other studies, there was a nonsignificant trend in the same direction. The risk of preeclampsia typically doubled with each increasing TG category. In the four studies that adjusted for potential confounders, such as maternal age, parity and body mass index, there was about a fourfold higher risk of pre-eclampsia in the highest relative to the lowest TG category.Author's conclusions There exists a consistent positive association between elevated maternal TG and the risk of pre-eclampsia. Given that maternal hypertriglyceridemia is a common feature of the metabolic syndrome, interventional studies are needed to determine whether pre-pregnancy weight reduction and dietary modification can lower the risk of pre-eclampsia.

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Background:People who immigrate to Western nations may experience fewer chronic health problems than original residents of those countries, which raises concerns about long-term environmental or lifestyle factors in those countries. We tested whether the "healthy immigrant effect" extends to the risk of placental dysfunction during the short interval of pregnancy. Methods:We conducted a population-based retrospective cohort study of data for 796 105 women who had a first documented obstetric delivery in Ontario between 1995 and 2005. Recency of immigration was determined for each woman as the time from her enrolment in universal health insurance to her date of delivery, classified as less than 3 months, 3-5 months, 6-11 months, 12-23 months, 24-35 months, 36-47 months, 48-59 months and 5 years or more (the referent). The primary composite outcome was maternal placental syndrome (defined as a diagnosis of pre-eclampsia or eclampsia, placental abruption or placental infarction). Results:The mean age of the women was 28.8 years. Maternal placental syndrome occurred in 45 216 women (5.7%). The risk of this outcome was lowest among the women who had immigrated less than 3 months before delivery (3.8%) and highest among those living in Ontario at least 5 years (6.0%), for a crude odds ratio (OR) of 0.62 (95% confidence interval [CI] 0.54-0.71). After adjustment for maternal age, income status, pre-existing hypertension, diabetes mellitus, multiple gestation and receipt of prenatal ultrasonography, the risk of maternal placental syndrome was correlated with the number of months since immigration in a gradient manner (OR, 95% CI): less than 3 months (0.53, 0.47-0.61), 3-5 months (0.68, 0.61-0.76), 6-11 months (0.67, 0.63-0.71), 12-23 months (0.69, 0.66-0.73), 24-35 months (0.75, 0.70-0.79), 36-47 months (0.75, 0.70-0.80) and 48-59 months (0.82, 0.77-0.87).Interpretation: There was a progressively lower risk of maternal placental syndromes associated with recency of immigration. The "healthy immigrant effect" may extend to common placental disorders, diminishes with the duration of residency and underscores the importance of nongenetic determinants of maternal health accrued over a brief period. CMAJ 2007;176(10) Abstract

In the present work, we describe a simple, cheap, and unexplored method for "green" synthesis of silver nanoparticles using cell extracts of the cyanobacterium Anabaena doliolum. An attempt was also made to test the antimicrobial and antitumor activities of the synthesized nanoparticles. Analytical techniques, namely UV-vis spectroscopy, X-ray diffraction, Fourier transform infrared (FTIR) spectroscopy, transmission electron microscopy (TEM), and TEMselected area electron diffraction, were used to elucidate the formation and characterization of silver-cyanobacterial nanoparticles (Ag-CNPs). Results showed that the original color of the cell extract changed from reddish blue to dark brown after addition of silver nitrate solution (1 mM) within 1 h, suggesting the synthesis of Ag-CNPs. That the formation Ag-CNPs indeed occurred was also evident from the spectroscopic analysis of the reaction mixture, wherein a prominent peak at 420 nm was noted. TEM images revealed well-dispersed, spherical Ag- CNPs with a particle size in the range of 10-50 nm. The X-ray diffraction spectrum suggested a crystalline nature of the Ag-CNPs. FTIR analysis indicated the utilization of a hydroxyl (-OH) group in the formation of Ag-CNPs. Ag-CNPs exhibited strong antibacterial activity against three multidrug-resistant bacteria. Additionally, Ag-CNPs strongly affected the survival of Dalton's lymphoma and human carcinoma colo205 cells at a very low concentration. The Ag-CNPs-induced loss of survival of both cell types may be due to the induction of reactive oxygen species generation and DNA fragmentation, resulting in apoptosis. Properties exhibited by the Ag-CNP suggest that it may be used as a potential antibacterial and antitumor agent.