Working towards a risk prediction model for neural tube defects

Agopian, A. J.; Lupo, Philip J.; Tinker, Sarah C.; Canfield, Mark A.; Mitchell, Laura E.

doi:10.1002/bdra.22883

Cited by 12 publications

(15 citation statements)

References 41 publications

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“…Each participating mother completed a computer‐assisted telephone interview on exposures before and during pregnancy, including 10 known/highly suspected NTD risk factors: pre‐pregnancy obesity (body mass index ≥30.0), pre‐pregnancy (type I or II) diabetes, gestational diabetes, lack of any folic acid supplementation (folic acid, multivitamin, or prenatal supplement) during the month before pregnancy and the first month of pregnancy (B1–P1), low dietary folate intake (Agopian et al, 2012), anticonvulsant medication use during B1–P1, and any hot tub or sauna use during B1–P1. We also included established nonmodifiable risk factors (female infant sex, family history of NTDs in a first or second‐degree relative, and maternal Hispanic ethnicity) to fully estimate the proportion of NTD cases attributable to all established risk factors.…”

Section: Methodsmentioning

confidence: 99%

“…There are several factors that are known or highly suspected to increase the risk for neural tube defects (NTDs), including female infant sex and family history of NTDs, as well as maternal Hispanic ethnicity, obesity, folate status, pregestational diabetes, gestational diabetes, anticonvulsant use, and hot tub or sauna use (reviewed in Mitchell, 2005). Our previous work demonstrated that these factors poorly predict NTD risk at the population level (Agopian et al, 2012). However, the extent to which these factors account for the population burden of NTDs is unknown.…”

Section: Introductionmentioning

confidence: 99%

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Proportion of neural tube defects attributable to known risk factors

Agopian¹,

Tinker²,

Lupo³

et al. 2012

Birth Defects Research

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102

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BACKGROUND: Recognized risk factors for neural tube defects (NTDs) poorly predict population-level NTD risk. However, the proportion of NTDs that can be attributed to these risk factors is uncertain. METHODS: To determine the proportion of NTD cases that is attributable to known or suspected risk factors (i.e., female infant sex, family history of NTDs, and maternal Hispanic ethnicity, obesity, pregestational diabetes, gestational diabetes, low dietary folate intake, lack of folic acid supplementation, anticonvulsant use, and hot tub or sauna use), we estimated the adjusted population attributable fraction (aAF) for each factor, using the method of Eide and Geffler and data from the National Birth Defects Prevention Study. RESULTS: Our analyses of these data indicate that the proportion of cases of spina bifida and anencephaly that can be attributed to known risk factors is 28% and 44%, respectively. For spina bifida, the factor with the greatest attributable fraction was maternal obesity (aAF, 10%), whereas for anencephaly it was Hispanic ethnicity (aAF, 15%). CONCLUSION: Our analyses indicate that known risk factors account for <50% of NTD cases. Hence, the majority of NTD cases are attributable to, as yet, unidentified factors. These findings highlight the need for continued research to identify genetic and additional nongenetic risk factors for NTDs. Further, these findings suggest that strategies that aim to reduce the risk of NTDs associated with maternal Hispanic ethnicity and obesity may have the greatest impact on the population prevalence of these conditions. Birth Defects Research (Part A) 97:42À46,

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Proportion of neural tube defects attributable to known risk factors

Agopian¹,

Tinker²,

Lupo³

et al. 2012

Birth Defects Research

Self Cite

102

View full text Add to dashboard Cite

show abstract

“…Factors known to increase the risk of NTDs in subsequent pregnancies include birth of a previous child with a NTD, a family history of NTDs, maternal obesity and maternal Hispanic origin, and the use of some anticonvulsants. (48,49) Pregestational or gestational diabetes is of low predictive value,(48) perhaps because the risk may vary with the level of glycemic control. (50) Since the etiology appears to be multifactorial, each risk factor is of similarly low predictive value, with the highest risk being for women with a previous affected child (at 2% to 5% before fortification [24]).…”

Section: Folic Acid Fortification Of Foodsmentioning

confidence: 99%

Folate and neural tube defects: The role of supplements and food fortification

Ami¹,

Bernstein²,

Boucher³

et al. 2016

Paediatrics &Amp; Child Health

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Periconceptional folic acid significantly reduces the risk of neural tube defects. It is difficult to achieve optimal levels of folate by diet alone, even with fortification of flour, especially because flour consumption in Canada is slightly decreasing. Intermittent concerns have been raised concerning possible deleterious effects of folate supplementation, including the masking of symptoms of vitamin B12 deficiency and an association with cancer, especially colorectal cancer. Both concerns have been disproved. The Canadian Paediatric Society endorses the following steps to enhance folate intake in women of child-bearing age: encouraging the consumption of folate-rich foods such as leafy vegetables, increasing the level of folate food fortification, taking a supplement containing folate and B12, and providing free folate supplementation to disadvantaged women of child-bearing age. These recommendations are consistent with those of the Society of Obstetricians and Gynaecologists of Canada.

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“…Yet surveillance of brain malformations has only followed trends in anencephaly, microcephaly, and hydrocephalus (Correa et al, ) – all abnormalities that can be diagnosed at birth with 1960's technology. Although surveillance of neural tube defects (NTDs), including anencephaly, has played an important role in the reduction of folic acid responsive NTDs (Agopian et al, ), the overall impact of public health surveillance of congenital brain malformations has been quite modest. Simply stated, surveillance of the frequency of major types of congenital brain malformations based upon modern classifications of brain malformations and routine diagnostic technology is nonexistent in the United States and around the world.…”

Section: Current State Of Congenital Brain Malformation Surveillancementioning

confidence: 99%

Editorial brain malformation surveillance in the Zika era

Trevathan

2016

Birth Defects Research

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The current surveillance systems for congenital microcephaly are necessary to monitor the impact of Zika virus (ZIKV) on the developing human brain, as well as the ZIKV prevention efforts. However, these congenital microcephaly surveillance systems are insufficient. Abnormalities of neuronal differentiation, development and migration may occur among infants with normal head circumference who have intrauterine exposure to ZIKV. Therefore, surveillance for congenital microcephaly does not ascertain many of the infants seriously impacted by congenital ZIKV infection. Furthermore, many infants with normal head circumference and with malformations of the brain cortex do not have clinical manifestations of their congenital malformations until several months to many years after birth, when they present with clinical manifestations such as seizures/epilepsy, developmental delays with or without developmental regression, and/or motor impairment.In response to the ZIKV threat, public health surveillance systems must be enhanced to ascertain a wide variety of congenital brain malformations, as well as their clinical manifestations that lead to diagnostic brain imaging. Birth Defects Research (Part A) 106:869–874, 2016. © 2016 The Authors Birth Defects Research Part A: Clinical and Molecular Teratology Published by Wiley Periodicals, Inc.

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Working towards a risk prediction model for neural tube defects

Abstract: BACKGROUND-Several risk factors have been consistently associated with neural tube defects (NTDs). However, the predictive ability of these risk factors in combination has not been evaluated.

Cited by 12 publications

References 41 publications

Proportion of neural tube defects attributable to known risk factors

Proportion of neural tube defects attributable to known risk factors

Folate and neural tube defects: The role of supplements and food fortification

Editorial brain malformation surveillance in the Zika era

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