ppt jurnal reading anton
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By:dr. Anton
September 2013, American journal of obstetrics and
gynecology
The Impact of Folic Acid Intake on TheAssociation Among
Diabetes Mellitus, Obesity, and Spina
Bifida
Journal Reading
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BACKGROUND
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Folic acid intake in the periconceptuional period
reduce the risk of spina bifida in offspring
The US public Health Service, Intitute ofMedicine, and Preventive Service Task Force
reccomended that women of childbearing age
consume at least 400g of folic acid dailythrough supplements and fortified food
products .
Pre existing diabetes millitus and obesity havebeen indentified as 2 such risk factors for spina
bifida.
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Materials andMethods
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Case of birth defects are ascertained from birth
hospitals, tertiary care centers, and birth defects
registries in Massachusets (1976+); Philadelpia, PA
(1976+); San Diego CA (2001+); Toronto, ON,
Canada (1976-2005) selected countries in Iowa
(1983-1985); and parts of New York State (2004+).
The present study includes case of spina bifidaand control subjects that were ascertained in 1976-
2011.
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Information on preexisting and gestational
diabetes milllitus was collected throughout the
study. Data on body mass index were availablefrom 1993 onward,when information on
maternal height was incorporated into the
interview. Folic acid intake in the periconceptional period,
defined as the month before the last menstrual
period through the first lunar month ofpregnancy, was calculated by totalling aerage
daily folic acid in take from supplements and
fortified foods
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TABLE
Foloc acid , dia betes millitus, and risk of spina bifida,1976-2011
Preexixting diabetes
millitusFolic acid
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CLINICAL IMPLICATION :
Offspring of women with preexisting diabetes melitus
and of those whose are obese before pregnancy areincreased risk for spina bifida.
Folic acid intake
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RESULT
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The diabetes millitus analysis included
1154 cases of spina bifida and 9439
control subjects that were ascertainedfrom 1976-2011.
The join effect of low folic acid intake andpreexisting diabetes militus resulted in 4-
fold increasted risk of spina bifida relative
to mothers without diabetes milllitus and
with higher daily folic acid intake,which
was greater than expected given the
individual additive effects of low folic accid
intake and preexisting diabetes millitus
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Among case mothers , 19.0% were obese
compared with 10.0% of control mothers.
The aOR for spina bifida amongoverweight women was 1.24(95% Cl,0.93-
1.63) and for obese women was 1.97(95%
Cl,1.46-2.65).
There did not appear to be joint effect
between obesity and folic acid intake(relative excess risk due interaction, 0.14;
95% Cl,- 1.08 t0 1.35)
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DISCUSSION
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Failure of achieve the recomendded intake of folic
acid during the periconceptional period is suggestiveof a further increase in the risk of spina bifida among
mothers with preexisting diabetes millitus.
researcher observed a 2-fold increased risk for spina
bifida among women with preexisting diabetes millitus,but the estimate was unstable because of a small
number of diabetic cases.
Although other studies have considered the
relationship between preexisting diabetes millitus andthe combined group of all neural tube defect(including
spina bifida and annencephaly),few have quantified
the association between diabetes millitus and spina
bifida.
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The mechanism by which folic acid may reduce the
risk of spina bifida because of diabetic embryopathy is
not well understood.
It has been proposed that the antioxidant properties of
folic acid may mitigate the effect of reactive oxygen
species and abnormal apoptosis the result from
diabetes millitus.
A potential explanation of our findings involves the
ability of folic acid to reduce oxidative stress in theembryo that is caused by increased levels of glucose.
The risk of spina bifida among obese women was
comparable between those consuming vs not
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Strenghts of this study include its large sample size ,
more diabetes millitus cases than in previous studies,
and the short interval between delivery and interview.
Furthermore, dietary data were available from a
validate food frequence quetionare. The slone
Epidemiology Center has a comprehensive databaseof information on supplements in which the amount of
folic acid in specific supplement products is available.
Among limitations of the study is that data onpreexisting diabetes mellitus and obesity were
collected by maternal self-report, which may have
resulted in misclassification.
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In summary , the achievement of the daily
recomanded intake of 400g of folic acid
reduce the risk for spina bifida because ofdiabetes millitus than because of obesity.
An understanding of the mechanism bywhich diabetes millitus appears to increase
the risk of spina bifida and how folic acid
more reduce its teratogenic qualities would
provide more insight into wheth higher
levels of folic acid intake , might further
attenuate the risk for spina bifida because
of obesity.
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Conclusion
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General Description
1. Design : a retrospective cohort
2. Target Population: mothers with preexistingdiabetes mellitus (collected 1976-2011) andobesity (collected 1993-2011) with cases of
spina bifida3. Exclusion criteria were: maternal age, race,
education and study center
4. Sample : control partisipans (9439),spina bifida (1154)
5. Periode : Between 1976-2011
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What question did the study ask ?
P : mothers with preexisting diabetes mellitus (collected
1976-2011) and obesity (collected 1993-2011) with cases ofspina bifida
I : folic acid intake
C : The join effect of low folic acid intake and preexisting
diabetes militus with increasted risk of spina bifida relative to
mothers without diabetes milllitus and with higher daily folic
acid intake
O : giving folic acid further attenuates reduce the
possibility of spina bifida although does not elliminate the risk
of spina bifida
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Are the valid results of this prognosis studyimportant ?
Questions Answer
1. How precise are the prognostic
estimates ?
Yes
2. Were the study patients similar to your
own ?
Yes
3.Will this evidence make a clinicallyimportant impact on your conclusions about
what to offer or tell your patient ?
yes
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CONCLUSION
VALID, IMPORTANT,APPLICABLE
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hanks you
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