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8/13/2019 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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