Prepregnant Weight in Relation to Risk of Neural Tube Defects

Werler, Martha M.; Louik, Carol; Shapiro, Samuel; Mitchell, Allen A.

doi:10.1001/jama.1996.03530380031027

Cited by 269 publications

(149 citation statements)

References 12 publications

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“…Furthermore, after supplementation with the same amount of folic acid obese women have a lower concentration in their serum compared to women with a normal BMI (40). This might explain why the risk reduction for neural tube defects was observed in normal weight women, only (41). In conclusion, this retrospective matched case control study conducted in a single center was able to confirm the association between maternal BMI and the increased risk of fetal anomalies published by several groups.…”

Section: Discussionsupporting

confidence: 67%

Increasing Maternal Body Mass Index Is Associated With Fetal Defects

Mackelenbergh¹,

Marotte²,

Alkatout³

et al. 2016

IJWHR

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IntroductionThe incidence of obesity is constantly rising and is developing into a relevant economic and public health concern. According to the World Health Organization (WHO) 1.4 billion people in the world suffered from obesity in 2008. Of these 0.3 billion were women including those of childbearing age. In pregnancy, obesity increases the risks both for the mother and fetus. Maternal risks are thromboembolism, gestational diabetes, preeclampsia, hypertension and urogenital infections (1-3). Moreover, an increased maternal body mass index (BMI) has been shown to be a risk factor for spontaneous abortion and intrauterine fetal death (2,4). A recent study demonstrated that obese women who suffered two or more abortions tended to have a higher incidence of euploid abortions (5). Regarding delivery, a higher rate of cesarean sections has been described in obese women with an increase in surgical and postoperative complications (3,6). Children of women with a high BMI are more likely to be delivered preterm with a subsequent need for neonatal intensive care treatment (7,8). In addition, maternal obesity is linked to high infant birth weight, subsequent complications during delivery and an increased incidence of children suffering from a metabolic syndrome in their later lives (9,10). However, the occurrence of congenital fetal anomalies has also been associated with obesity in pregnant women. A meta-analysis of 12 studies could confirm an association between maternal obesity and an increased risk of neural tube defects (11), whereas another meta-analysis of 18 studies showed an association between the incidence of fetal hydrocephaly, cardiovascular anomalies, cleft palate, anorectal atresia and limb reduction anomalies (12). Interestingly, the risk of gastroschisis was significantly reduced in obese mothers. On the other hand, congenital anomalies are a major risk factor for perinatal and infant death (13). Prenatal ultrasound scans are utilized to detect congenital malformations in pregnancy. The effect of maternal overweight and obesity on the sensitivity of ultrasound diagnostics has been reported previously. Aagaard-Tillery et al described that maternal obesity significantly decreased the likelihood of sonographic detection of common anomalies in 8555 pregnancies with available BMI (14). This would lead to the assumption that obese women not only tend to have a higher risk of having children with congenital anomalies but also suffer from lower detection rates which has implications on antenatal counseling in this group (15). The aim of this retrospective case-control study was to investigate the association between maternal BMI and con- AbstractObjectives: To test the hypothesis, that increasing maternal weight is directly related to the incidence of fetal anomalies, to rank anomalies according to their frequency and to establish detection rates for the various anomalies with increasing body mass index (BMI). Materials and Methods: Retrospective single center matched case control study, analysis of the associa...

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Section: Discussionsupporting

confidence: 67%

Increasing Maternal Body Mass Index Is Associated With Fetal Defects

Mackelenbergh¹,

Marotte²,

Alkatout³

et al. 2016

IJWHR

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“…Myelomeningocele has been linked with reduced glutathione peroxidase activity apparently resulting from a genetic polymorphism [60]. Finally, maternal obesity, which could increase embryo oxidant exposure due to maternal glucose intolerance, has been found to increase the relative risk for NTD [61,62].…”

Section: Discussionmentioning

confidence: 99%

Oxidant regulation of gene expression and neural tube development: Insights gained from diabetic pregnancy on molecular causes of neural tube defects

et al. 2003

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Aims/hypothesis. Maternal diabetes increases oxidative stress in embryos. Maternal diabetes also inhibits expression of embryonic genes, most notably, Pax-3, which is required for neural tube closure. Here we tested the hypothesis that oxidative stress inhibits expression of Pax-3, thereby providing a molecular basis for neural tube defects induced by diabetic pregnancy. Methods. Maternal diabetes-induced oxidative stress was blocked with α-tocopherol (vitamin E), and oxidative stress was induced with the complex III electron transport inhibitor, antimycin A, using pregnant diabetic or non-diabetic mice, primary cultures of neurulating mouse embryo tissues, or differentiating P19 embryonal carcinoma cells. Pax-3 expression was assayed by quantitative RT-PCR, and neural tube defects were scored by visual inspection. Oxidation-induced DNA fragmentation in P19 cells was assayed by electrophoretic analysis.Results. Maternal diabetes inhibited Pax-3 expression and increased neural tube defects, and α-tocopherol blocked these effects. In addition, induction of oxidative stress with antimycin A inhibited Pax-3 expression and increased neural tube defects. In cultured embryo tissues, high glucose-inhibited Pax-3 expression, and this effect was blocked by α-tocopherol and GSHethyl ester, and Pax-3 expression was inhibited by culture with antimycin A. In differentiating P19 cells, antimycin A inhibited Pax-3 induction but did not induce DNA strand breaks. Conclusion/interpretation. Oxidative stress inhibits expression of Pax-3, a gene that is essential for neural tube closure. Impaired expression of essential developmental control genes could be the central mechanism by which neural tube defects occur during diabetic pregnancy, as well as other sources of oxidative stress. [Diabetologia (2003) 46:538-545]

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“…Pregravid overweight and obesity have been associated not only with excessive weight gain 9 , but also with pregnancy complications such as Caesarean section 10 , gestational diabetes 11 , pre-eclampsia 12 , pregnancyinduced hypertension 13 and postpartum anaemia 14 . With regards to infant outcomes, pregravid overweight and obesity status has been independently associated with macrosomia 10,15 , neural tube defects 16 and infant mortality 10,17 . Most of these maternal and infant outcomes are influenced by diet as well, but the impact of diet may be overshadowed by the strong association of current weight status.…”

mentioning

confidence: 99%

Pregravid body mass index is negatively associated with diet quality during pregnancy

Laraia

Bodnar

Siega‐Riz

2007

Public Health Nutr.

139

127

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Objective: To investigate the association between pregravid weight status and diet quality. Design: Institute of Medicine body mass index (BMI) cut-off points of ,19.8 kg m 22 for underweight, 19.8-26.0 kg m 22 for normal weight, . 26.0 -29.0 kg m 22 for overweight and . 29 kg m 22 for obese were used to categorise women's weight status. Dietary information was obtained by self-report at 26-28 weeks' gestation using a modified Block food-frequency questionnaire. The Diet Quality Index for Pregnancy (DQI-P) included: servings of grains, vegetables and fruits, folate, iron and calcium intake, percentage calories from fat, and meal pattern score. Multinomial logistic regression models were used to estimate the association between weight status and tertiles of DQI-P controlling for potential individual confounders. Setting: A clinical-based population recruited through four prenatal clinics in central North Carolina. Subjects: A total of 2394 women from the Pregnancy, Infection and Nutrition study were included in this analysis. Results: Evidence of a dose -response relationship was found between BMI and inadequate servings of grains and vegetables, and iron and folate intake. Pregravid obesity was associated with 76% increased odds of falling into the lowest diet quality tertile compared with underweight women after controlling for potential confounders. Conclusion: A modest association was found between pregravid weight status and diet quality. If corroborated, these findings suggest that overweight pregnant women should be targeted for nutrition counselling interventions aimed to improve diet quality.

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Prepregnant Weight in Relation to Risk of Neural Tube Defects

Cited by 269 publications

References 12 publications

Increasing Maternal Body Mass Index Is Associated With Fetal Defects

Increasing Maternal Body Mass Index Is Associated With Fetal Defects

Oxidant regulation of gene expression and neural tube development: Insights gained from diabetic pregnancy on molecular causes of neural tube defects

Pregravid body mass index is negatively associated with diet quality during pregnancy

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