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Friday, 20 December 2013

Women' health: Obesity and Neural Tube Birth Defects

A. Obesity is defined as a medical condition of excess body fat has accumulated overtime, while overweight is a condition of excess body weight relatively to the height. According to the Body Mass Index(BMI), a BMI between 25 to 29.9 is considered over weight, while a BMI of over 30 is an indication of obesity. According to the statistic, 68% of American population are either overweight or obese.

B. How do calculate your BMI index
BMI= weight (kg)/ height (m2)

C. Neural Tube Birth Defects
is a type of birth defect and defined as a medical condition of the spinal cord or brain that occurs very early in the development stage of the fetus, including spina bifida (the spinal cord and spine does not close properly) and anencephaly (much of the brain does not develop). Approximately, according to the statistic of the Public Health Agency of Canada, the birth prevalence of NTDs in Canada has been declining gradually. In 1989, the rate was 1.1 per 1,000 total births compared with 0.77 per 1,000 total births in 1996.

D. How Obesity associates with Neural Tube Birth Defects
1. In a study of 64 SNPs in 34 genes for association with spina bifida in up to 558 case families (520 cases, 507 mothers, 457 fathers) and 994 controls in Ireland of " Evaluation of 64 candidate single nucleotide polymorphisms as risk factors for neural tube defects in a large Irish study population" by Carter TC, Pangilinan F, Troendle JF, Molloy AM, VanderMeer J, Mitchell A, Kirke PN, Conley MR, Shane B, Scott JM, Brody LC, Mills JL., conducted by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, posted in PubMed, researchers found that The associations between LEPR SNPs and spina bifida suggest a possible mechanism for the finding that obesity is a NTD risk factor. The association between a variant in COMT and spina bifida implicates methylation and epigenetics in NTDs.

2. According to the study of "Prepregnancy obesity: a complex risk factor for selected birth defects" by Carmichael SL, Rasmussen SA, Shaw GM, posted in PubMed, researchers indicated that This article briefly reviews existing literature on the association between maternal obesity and birth defects, discusses potential underlying mechanisms, and suggests research needed to improve our understanding of this important association.

3. In a study conducted by the National Birth Defects Prevention Study who had index pregnancies between October 1, 1997, and December 31, 2002 with an aim to To describe the relation between maternal obesity, overweight and underweight status, and 16 categories of structural birth defects, Posted in PubMed, researchers filed the result that Mothers of offspring with spina bifida, heart defects, anorectal atresia, hypospadias, limb reduction defects, diaphragmatic hernia, and omphalocele were significantly more likely to be obese than mothers of controls, with odds ratios ranging between 1.33 and 2.10. Mothers of offspring with gastroschisis were significantly less likely to be obese than mothers of controls.

4. According to the abstract of the study of "Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis" by Stothard KJ, Tennant PW, Bell R, Rankin J., posted in PubMed, researchers filed the result that Pooled ORs for overweight and obesity were calculated for 16 and 15 anomaly groups or subtypes, respectively. Compared with mothers of recommended BMI, obese mothers were at increased odds of pregnancies affected by neural tube defects (OR, 1.87; 95% confidence interval [CI], 1.62-2.15), spina bifida (OR, 2.24; 95% CI, 1.86-2.69), cardiovascular anomalies (OR, 1.30; 95% CI, 1.12-1.51), septal anomalies (OR, 1.20; 95% CI, 1.09-1.31), cleft palate (OR, 1.23; 95% CI, 1.03-1.47), cleft lip and palate (OR, 1.20; 95% CI, 1.03-1.40), anorectal atresia (OR, 1.48; 95% CI, 1.12-1.97), hydrocephaly (OR, 1.68; 95% CI, 1.19-2.36), and limb reduction anomalies (OR, 1.34; 95% CI, 1.03-1.73). The risk of gastroschisis among obese mothers was significantly reduced (OR, 0.17; 95% CI, 0.10-0.30).

5. In a case-control study of fetuses and liveborn infants among California births, July 1999 and June 2004. Of those eligible, 80% of case mothers (n = 659) and 77% of control mothers (n = 700) were interviewed. Cases were 147 infants with anencephaly, 191 with spina bifida, 142 with d-transposition of great arteries, and 181 with tetralogy of Fallot. Maternal body mass index (BMI) was based on prepregnant weight and height, conducted by the Children's Hospital Oakland Research Institute, posted in PubMed, researchers indicated in the result that the odds ratios of birth defects with obesity (BMI > or =30 relative to normal BMI) were 1.6 for anencephaly (95% confidence intervals = 1.0-2.6); 1.4 for spina bifida (0.8-2.2); 0.7 for d-transposition of great arteries (0.4-1.4); and 0.8 for tetralogy of Fallot (0.4-1.4). Modestly elevated odds ratios were observed with obesity among women who reported weight gain in their waist before pregnancy-for anencephaly, 2.4 (1.2-5.1) and for spina bifida, 1.8 (0.9-3.6)

6. In a study of 499 mothers of offspring with neural tube defects, 337 mothers of offspring with other major birth defects, and 534 mothers of offspring without birth defects, conducted by California Department of Health Services, posted in PubMed, researchers concluded that our data suggest that offspring of obese women (but not underweight women) are at an increased risk of neural tube defects and several other malformations.

7. Etc.

E. Treatment of Obesity and Neural Tube Birth Defects
1. According to the study of "Risks and management of obesity in pregnancy: current controversies" by Wax JR., posted in PubMed, researchers found that Limiting maternal weight gain in obese women to less than 15 lb may favorably attenuate perinatal risk (macrosomia, cesarean delivery, preeclampsia) but increase risk for small-for-gestational-age newborns. Obese women are at significantly increased risk for offspring to develop open neural tube defects and congenital heart disease as well as other anomalies and concluded that obesity and its surgical treatment are associated with lifelong health implications for the mother as well as her offspring. An appreciation of these obesity-related reproductive issues is critical for optimal care of this growing segment of the female population.

2. In a study of "Maternal obesity and risk of neural tube defects" by Koren G., posted in PubMed, researchers found that Experience with olanzapine is relatively slight, but available prospective data do not show increased teratogenic risk. Adiposity, on the other hand, is associated with increased risk of neural tube defects. Only some of this risk can be reduced by folate supplementation.

3. Etc.

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