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Zappacosta B.,Fondazione Of Ricerca ra Giovanni Paolo Ii University Cattolica Del ore | Graziano M.,Fondazione Of Ricerca ra Giovanni Paolo Ii University Cattolica Del ore | Persichilli S.,University Cattolica Del ore | Mastroiacovo P.,Alessandra Lisi International Center on Birth Defects and Prematurity
Cell Biochemistry and Function | Year: 2014

Two genetic polymorphisms of methylenetetrahydrofolate reductase (MTHFR) gene (C677T and A1298C) can influence the plasma homocysteine (Hcy) levels, especially in the presence of an inadequate folate status. The aim of this study was to evaluate the frequencies of C677T and of A1298C MTHFR polymorphisms and their correlation with Hcy and serum folate concentrations in a population of blood donors living in a region of middle-southern Italy (the Molise Region). One hundred ninety seven blood donors were studied for total plasma Hcy, serum folate and C677T and A1298C MTHFR genotypes. The frequency of C677T genotypes was 20.8% (CC), 49.8% (CT) and 29.4% (TT); for the A1298C genotypes: 48.7% (AA), 43.7% (AC) and 7.6% (CC). Hcy and serum folate concentrations were significantly different among genotypes of the C677T polymorphism (CC versus CT versus TT: <0.0001 both for Hcy and folate), with Hcy values increasing, and serum folate decreasing, from CC to TT subjects. Regarding to A1298C polymorphism, the difference among genotypes (AA versus AC versus CC; p: 0.026 for Hcy and 0.014 for serum folate), showed an opposite trend for both parameters, with Hcy higher in the wild-type and lower in the homozygotes and serum folate higher in CC than in AA subjects. In conclusion, we found a high frequency of MTHFR allele associated with high level of Hcy and low levels of folate in an Italian southern population. © 2013 John Wiley & Sons, Ltd.

Shawe J.,University of Surrey | Delbaere I.,The College of Nursing and Midwifery | Ekstrand M.,Malmö 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.

PubMed | Area Programmazione Rete Ospedaliera e Ricerca, Alessandra Lisi International Center on Birth Defects and Prematurity and University of Warwick
Type: Journal Article | Journal: Annali dell'Istituto superiore di sanita | Year: 2016

To investigate differences by gestational age in emergency department visits and re-hospitalizations during the three years following childbirth discharge.We performed a historical cohort study in Lazio Region, Italy, for infants born in 2007-2008 to resident mothers. Health administrative data were used. Analysis was performed by multinomial logistic regression.Of 90 545 infants, more than 50% had at least one emergency department visit, and 18.8% at least one re-hospitalization. After the exclusion of infants with congenital anomalies, relative risk ratios of re-hospitalization and, to a lesser extent, of emergency department visits increased by decreasing gestational age; the two events were also higher for mothers 35 years of age, with low education and of Italian nationality. Residency outside the metropolitan area was associated with an increased risk of re-hospitalization and a decreased risk of emergency department visits.During the three years following childbirth discharge, re-hospitalizations and, to a lesser extent, emergency department use are inversely related to gestational age at birth; socio-demographic factors have an effect on the risk of infant use of hospital resources independent of gestational age.

Zappacosta B.,University Cattolica Del ore | Persichilli S.,University Cattolica Del ore | Iacoviello L.,University Cattolica Del ore | Di Castelnuovo A.,University Cattolica Del ore | And 5 more authors.
Nutrition, Metabolism and Cardiovascular Diseases | Year: 2013

Background and aims: The relevance of folate, other B-vitamins and homocysteine (Hcy) for the occurrence or prevention of several diseases has induced growing interest. Unfortunately, little evidence is available regarding B-vitamin concentrations in Italy.This study evaluated in a region of middle-southern Italy, folate, vitamin B12 and Hcy concentrations and the prevalence of their ideal blood levels. The main determinants of B-vitamins and Hcy were also considered. Methods and results: Male and female blood donors (n=240), aged 18-66 years and living in Molise region (Italy), were enrolled in the study. They completed a brief questionnaire concerning fruit and vegetables intake, physical activity and smoking; serum and red blood cell (RBC) folate and serum vitamin B12 were measured by an immunoassay on an automated analyzer. Total Hcy was measured by high performance liquid chromatography (HPLC).Geometric means of serum folate, RBC folate and serum vitamin B12 were 10.8nmoll-1, 426.0nmoll-1 and 245.0pmoll-1, respectively. Only 22.5%, 24.2% and 16.3% of blood donors showed an adequate level of serum folate, RBC folate or serum vitamin B12 respectively. When a cut-off of RBC folate ≥906nmoll-1 was used no women of childbearing age had adequate levels. A geometric mean of 14.0μmoll-1 was found for total Hcy, with an ideal concentration in 12.1% of subjects. Folate concentration was higher in women and non-smokers and in subjects with higher consumption of fruit and vegetable. Conclusion: This study shows a low-moderate B-vitamins status in middle-southern Italy, associated with an inadequate fruit and vegetable consumption. A public health strategy should be undertaken to encourage a B-vitamin-rich diet with the addition of vitamin supplements or vitamin fortified foods in population subgroups with special needs. © 2011 Elsevier B.V.

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.

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.

Mastroiacovo P.,Alessandra Lisi International Center on Birth Defects and Prematurity | Corchia C.,Alessandra Lisi International Center on Birth Defects and Prematurity
Quaderni ACP | Year: 2016

It is well known that pre-conceptional folic acid intake decreases the risk of neural tube defects and probably of other serious birth conditions. The strategy adopted by European Countries provides that women take 0,4 mg folic acid/die before conception. Data from studies analyzing a) the relationship between pre-conceptional erythrocyte folate concentration and risk of neural tube defects and b) the time interval needed to reach the erythrocyte folate levels that maximizes the reduction in risk, that is 1400 nmol/l, suggest that the best strategy to be adopted in Italy is to actively prescribe the supplementation to all women planning or not excluding the possibility of a pregnancy. Because the average time required to reach the erythrocyte folate concentration that maximizes the risk reduction may be as long as 40 weeks, indications given to women such as “start the supplementation 1 or 3 months before conception” should be avoided. © 2016, Associazione Culturale Pediatri. All rights reserved.

Corchia C.,Alessandra Lisi International Center on Birth Defects and Prematurity | Mastroiacovo P.,Alessandra Lisi International Center on Birth Defects and Prematurity
Italian Journal of Pediatrics | Year: 2013

About 90,000 preterm infants or babies with birth defects are born in Italy every year, nearly 250 per day. These congenital conditions and their outcomes represent the most important burden of disease affecting the health status and the quality of life during infancy, childhood and beyond. In many cases they are fostered by the presence of maternal and/or paternal preconception risk factors whose effects can be modified by primary prevention.In the contemporary vision of maternal and child health, the traditional gap between preconception period and pregnancy is overcome through promotion of reproductive health and wellness in women, men and couples, regardless of their reproductive plans and possible future pregnancies. This paradigm should become the basic foundation to improve and protect infants', children's and adolescents' health. Useful interventions belong to four broad areas: a) promotion of women's and couples' health in general, and protection from risk of adverse events in future pregnancies (if any); b) identification and treatment of conditions that increase the risk of adverse reproductive outcomes; c) help for women (couples) planning for pregnancy; d) identification of genetic risks, and help for independent and responsible decision making.Pediatricians and neonatologists can effectively promote primary prevention in the interconception period, when parents seek consultation for their previous child, in adolescent medicine, in family health education, in socio-sanitary network, and in advocacy activities in favor of infants and children. These actions should be part of an operational framework including perinatal outreach programs, information campaigns, and focus on problems of high-risk women, children and families. © 2013 Corchia and Mastroiacovo; licensee BioMed Central Ltd.

Pandolfi E.,Bambino Gesu Childrens Hospital IRCCS | Agricola E.,Bambino Gesu Childrens Hospital IRCCS | Gonfiantini M.V.,Bambino Gesu Childrens Hospital IRCCS | Gesualdo F.,Bambino Gesu Childrens Hospital IRCCS | 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.

PubMed | University of Verona, National Agency for Regional Health Services, Clinical Genetics Unit, Alessandra Lisi International Center on Birth Defects and Prematurity and Bambino Gesu Childrens Hospital IRCCS
Type: Journal Article | Journal: BMC pregnancy and childbirth | Year: 2017

Preconception care involves health promotion to reduce risk factors that might affect women and couples of childbearing age. The risk factors of adverse reproductive outcomes include recognized genetic diseases in the family or the individual, previous congenital diseases, miscarriage, prematurity, fetal growth restriction, infertility, chronic maternal diseases, lifestyle, and occupational or environmental factors. Effective preconception care involves a range of preventive, therapeutic and behavioural interventions. Although in Italy there are national preconception care recommendations concerning the general population, they are usually encouraged informally and only for single risk factors. At present there is increasing interest in offering a global intervention in this field. The aim of this study was to investigate attitudes and behaviours of Italian women of childbearing age and healthcare professionals regarding preconception health.We conducted a qualitative study among women of childbearing age and healthcare professionals between February 2014 and February 2015. Five focus groups were held: 2 with non-pregnant women aged 22 to 44years and 3 with healthcare professionals. Discussion topics included womens questions about preconception health, worries and barriers regarding preconception care interventions, attitudes and behaviours of women and healthcare professionals towards preconception health, womens information sources. In the analysis of the focus groups priority was given to what was said by the women, supplemented by information from the healthcare professionals focus groups.Fourteen women of childbearing age (8 nulliparae and 6 multiparae) and 12 healthcare professionals (3 nurses, 4 midwives, 5 doctors) participated in the focus groups. The results indicate the presence of many barriers and a lack of awareness of preconception health relating to women, healthcare professionals and policies. Womens knowledge and attitudes towards primary preconception care information are described. The main reference source of information in this field for Italian women seems to be their obstetric-gynaecologist.The study indicates that several barriers influence preconception care in Italy. Moreover, a lack of awareness of preconception health and care among Italian women of childbearing age and healthcare professionals emerges. The findings might contribute to strategies for the implementation of preconception care guidelines.

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