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Zappacosta B.,Catholic University of the Sacred Heart | Mastroiacovo P.,Alessandra Lisi International Center on Birth Defects and Prematurity | Persichilli S.,Catholic University of the Sacred Heart | Pounis G.,Catholic University of the Sacred Heart | And 11 more authors.
Nutrients | Year: 2013

Background/Objectives: To compare the efficacy of a diet rich in natural folate and of two different folic acid supplementation protocols in subjects with "moderate" hyperhomocysteinemia, also taking into account C677T polymorphism of 5,10-methylenetetrahydrofolate reductase (MTHFR) gene. Subjects/Methods: We performed a 13 week open, randomized, double blind clinical trial on 149 free living persons with mild hyperhomocyteinemia, with daily 200 μg from a natural folate-rich diet, 200 μg [6S]5-methyltetrahydrofolate (5-MTHF), 200 μg folic acid or placebo. Participants were stratified according to their MTHFR genotype. Results: Homocysteine (Hcy) levels were reduced after folate enriched diet, 5-MTHF or folic acid supplementation respectively by 20.1% (p < 0.002), 19.4% (p < 0.001) and 21.9% (p < 0.001), as compared to baseline levels and significantly as compared to placebo (p < 0.001, p < 0.002 and p < 0.001, respectively for enriched diet, 5-MTHF and folic acid). After this enriched diet and the folic acid supplementation, Hcy in both genotype groups decreased approximately to the same level, with higher percentage decreases observed for the TT group because of their higher pre-treatment value. Similar results were not seen by genotype for 5-MTHF. A significant increase in RBC folate concentration was observed after folic acid and natural folate-rich food supplementations, as compared to placebo. Conclusions: Supplementation with natural folate-rich foods, folic acid and 5-MTHF reached a similar reduction in Hcy concentrations. © 2013 by the authors; licensee MDPI, Basel, Switzerland.

Aim of the study is to investigate long term outcomes of diseases associated with birth at less than 39 weeks gestation. Data comes from the Millennium Cohort Study, a longitudinal study on infants born in the United Kingdom between 2000 and 2002. The main outcome measures were: growth, hospital admissions, longstanding illness/disability, wheezing/asthma, drug usage, and parental rating of their children's health. A dose-response effect of prematurity has been found, with increasing risks of outcomes with a decrease of GA. However, the contribution to the global burden of disease at 3 and 5 years, calculated by the population attributable fraction (PAF), has been found higher for late preterms, for moderately preterm children and for early term babies (37-38 weeks gestation) in respect to those born before 32 weeks. Nevertheless the contribution to the global burden of disease in the population as a whole is greater with the increase of GA.

Shawe J.,University of Surrey | Delbaere I.,The College of Nursing and Midwifery | Ekstrand M.,Malmo University | Ekstrand M.,Uppsala University | And 7 more authors.
European Journal of Contraception and Reproductive Health Care | Year: 2015

Objectives: Preconception care is important for the screening, prevention and management of risk factors that affect pregnancy outcomes. We aimed to investigate pre-pregnancy care policies, guidelines, recommendations and services in six European countries. Methods: In 2013, an electronic search and investigation was undertaken of preconception policy, guidelines, recommendations and services available to healthcare professionals and the general public in six European countries: Belgium (Flanders), Denmark, Italy, the Netherlands, Sweden and the United Kingdom. Findings were compared within five categories: Governmental policy and legislation; Professional bodies and organisations; Healthcare providers; Charitable organisations; Web-based public information and internet sites. Results: All countries had preconception recommendations for women with chronic diseases, such as diabetes and epilepsy. Recommendations for healthy women and men were fragmented and inconsistent. Preconception guidance was often included in antenatal and pregnancy guidelines. Differences between countries were seen with regard to nutritional and lifestyle advice particularly in relation to fish, caffeine and alcohol consumption, and vitamin supplementation. Conclusions: Current guidelines are heterogeneous. Collaborative research across Europe is required in order to develop evidence-based guidelines for preconception health and care. There is a need to establish a clear strategy for promoting advice and guidance within the European childbearing population. © 2014 The European Society of Contraception and Reproductive Health.

Pandolfi E.,Epidemiology Unit | Agricola E.,Epidemiology Unit | Gonfiantini M.V.,Epidemiology Unit | Gesualdo F.,Epidemiology Unit | And 4 more authors.
BMC Pregnancy and Childbirth | Year: 2014

Background: Adverse pregnancy outcomes (APOs) can be increased by preconception risk factors and lifestyles.We measured the prevalence of preconception risk factors for APOs in a population of Italian women of childbearing age enrolled in a web-based study.Methods: Participants were enrolled through a web platform (http://www.mammainforma.it). After enrollment, participants filled in a questionnaire regarding socio-demographic characteristics, clinical data and preconception risk factors for adverse pregnancy outcomes. Through logistic regression, we explored how the prevalence of risk factors was affected by age, education level, employment, parity, physician's recommendation and knowledge of the specific risk factor.Results: We enrolled a total of 728 women. Sixty-two percent had a University degree, 84% were employed and 77% were planning their first pregnancy.Nearly 70% drank alcohol in any quantity; 16% were smokers; 6% was underweight; 21.4% was overweight; 51.6% did not assume folic acid; 22% was susceptible to rubella, 44.5% to hepatitis b and 13.2% to varicella.According to the multivariate analysis, compared to women who already had at least one pregnancy, nulliparous women had a higher BMI [OR 1.60 (CI 1.02;2.48)] and were less likely to be susceptible to rubella [OR 0.33 (CI 0.20;0.58)] and to be consuming alcohol [OR 0.47 (CI 0.31;0.70)] or cigarettes [OR 0.48 (CI 0.26;0.90)].Appropriate knowledge was associated with a correct behavior regarding smoking, drinking alcohol and folic acid supplementation.Conclusions: This study shows that the prevalence of risk factors for APOs in our population is high.Interventions aimed at reducing risk factors for APOs are needed and, to this purpose, a web intervention may represent a feasible tool to integrate tailored information and to inform preconception counseling targeting a specific group of women planning a pregnancy who are engaged on the web. © 2014 Pandolfi et al.; licensee BioMed Central Ltd.

Agricola E.,Bambino Gesu Childrens Hospital IRCCS | Gesualdo F.,Bambino Gesu Childrens Hospital IRCCS | Pandolfi E.,Bambino Gesu Childrens Hospital IRCCS | Gonfiantini M.V.,Bambino Gesu Childrens Hospital IRCCS | And 3 more authors.
BMC Medical Informatics and Decision Making | Year: 2013

Background: Preconception counseling is effective in reducing the risk of adverse pregnancy outcomes. The Internet is commonly used by women and health professionals to search for health information. We compared the consistency of preconception information found on the Internet with the recommendations published by American Journal of Obstetrics and Gynecology (AJOG) simulating a web search by women of childbearing age and health professionals. Methods. We reviewed websites resulting from a Google search performed using search strings selected by Italian women of childbearing age and health professionals. We investigated if retrieved information was consistent with AJOG recommendations for preconception care. Logistic regression was used to compare presence of consistent recommendations between women and health professionals. Results: The highest frequency of correct recommendations was found for folic acid supplementation (39.4% of websites). Consistency of preconception information did not significantly differ between search strategies except for folic acid supplementation. "Communities and blogs" website category provided less frequently correct recommendations compared with "Medical/Public Agency" category (i.e. folic acid supplementation (aOR 0.254; CI 0.098-0.664; p = <0.01). Commercial links, found in 60% of websites, were associated with presence of correct recommendations excepting few items (i.e. physical exercise (aOR 1.127; CI 0.331-3.840; p = 0.848). Conclusions: Preconception information found is poor and inaccurate regardless of the search is performed by women or health professionals. It is unlikely that information found on the web have any positive impact among women and health professionals in our setting. Strategies to improve preconception information on the web and education of health professionals for web searching of health information should be considered. © 2013 Agricola et al.; licensee BioMed Central Ltd.

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