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Minami-rinkan, Japan

Kondo A.,Tsushima Rehabilitation Hospital | Morota N.,National Center for Child Health and Development | Date H.,Chiba Childrens Hospital | Yoshifuji K.,Childrens Medical Center | And 6 more authors.
British Journal of Nutrition | Year: 2015

The majority of neural tube defects were believed to be folic acid (FA)-preventable in the 1990s. The Japanese government recommended women planning pregnancy to take FA supplements of 400 μg/d in 2000, but the incidence of spina bifida has not decreased. We aimed to evaluate the OR of having an infant with spina bifida for women who periconceptionally took FA supplements and the association between an increase in supplement use and possible promoters for the increase. This is a case-control study which used 360 case women who gave birth to newborns afflicted with spina bifida, and 2333 control women who gave birth to healthy newborns during the first 12 years of this century. They were divided into two 6-year periods; from 2001 to 2006 and from 2007 to 2012. Logistic regression analyses were conducted to compute OR between cases and controls. The adjusted OR of having an infant with spina bifida for supplement users was 0·48 in the first period, and 0·53 in the second period. The proportion of women who periconceptionally consumed supplements significantly increased from 10% in the first period to 30% in the second period. Awareness of the preventive role of FA was a promoter for an increase in supplement use, and thus an FA campaign in high school seems rational and effective. The failure of the current public health policy is responsible for an epidemic of spina bifida. Mandatory food fortification with FA is urgent and long overdue in Japan. Copyright © The Authors 2015. Source

Kondo A.,Tsushima Rehabilitation Hospital | Morota N.,National Center for Child Health and Development | Ihara S.,University of Tsukuba | Saisu T.,Chiba Childrens Hospital | And 6 more authors.
Birth Defects Research Part A - Clinical and Molecular Teratology | Year: 2013

BACKGROUND: The Japanese government recommended in 2000 that women planning pregnancy should take 400 μg of folic acid daily to decrease the risk of having an infant with spina bifida. We aimed to identify risk factors for the occurrence of spina bifida and to evaluate how the prevalence rate has altered over the past 3 decades. METHODS: Subjects comprised 360 women who gave birth to spina bifida-affected offspring and 2333 women who gave birth to offspring without spina bifida between 2001 and 2012. A self-administered questionnaire was used to collect data, which were analyzed by multiple logistic regression models. The prevalence rate of spina bifida was obtained through data provided by international and domestic organizations. RESULTS: Four variables were significantly associated with the increased risk of having newborns afflicted with spina bifida: not taking folic acid supplements (odds ratios [OR], 2.50; 95% confidence interval [CI], 1.72-3.64), presence of spina bifida patients within third-degree relatives (OR, 4.26; 95% CI, 1.12-16.19), taking anti-epileptic drugs without folic acid (OR, 20·20; 95% CI, 2.06-198.17), and low birth weight in the newborns ≤ 2500 g (OR, 4.21; 95% CI, 3.18-5.59). The prevalence rate of spina bifida has remained 5 to 6 per 10,000 total births and has not shown any decreasing trend over the past 11 years. CONCLUSION: Four risk factors were identified among Japanese women. Because recommendations and information have not decreased the occurrence of spina bifida, the Japanese government should implement mandatory food fortification. © 2013 Wiley Periodicals, Inc. Source

Kondo A.,Tsushima Rehabilitation Hospital | Asada Y.,Asada Ladies Clinic | Shibata K.,West Medical Center Johoku Municipal Hospital | Kihira M.,St. Rose Clinic | And 7 more authors.
Journal of Obstetrics and Gynaecology Research | Year: 2011

Aim: To quantify the consumed amount of dietary folate and to evaluate effects of folic acid and balanced diets on serum folate concentrations. Material &Methods: Food records collected from 641 pregnant women were assessed to quantify the consumed amount of dietary folate for a 6-year period from 2003 to 2008. Changes in serum folate concentrations were evaluated among 80 pregnant women who either took folic acid tablets or consumed balanced diets in 2008. Results: Though the dietary folate intake averaged 331 μg daily, 200 women in the 1st trimester consumed the least amount of dietary folate, 294 μg daily. Itwas observed that 42% of the 200 women either consumed at least 440 μg of dietary folate daily or took 400 μg folic acid supplements daily, but that 58% of them neither consumed dietary folate of 440 μg nor took folic acid supplements. Intakes of 400 μg folic acid supplements for 5 weeks resulted in a significant increase in serum folate concentrations but the consumption of balanced diets had no effect on increasing folate concentrations. Conclusions: The average intake of dietary folate did not fulfill the Recommended Dietary Allowance of 440 μg. Serum folate concentration significantly increased only among pregnant women who took folic acid supplements. Recommendations to consume balanced diets do not seem effective to decrease the incidence of neural tube defects. © 2011 Japan Society of Obstetrics and Gynecology. Source

Kondo A.,Tsushima Rehabilitation Hospital | Fukuda H.,Aichi University of Education | Matsuo T.,Kinki University | Shinozaki K.,Yamaguchi University | Okai I.,Tsushima Rehabilitation Hospital
Congenital Anomalies | Year: 2014

We analyzed the role of maternal C677T mutation in methylenetetrahydrofolate reductase (MTHFR) gene on spina bifida development in newborns. A total of 115 mothers who had given birth to a spina bifida child (SB mothers) gave 10mL of blood together with written informed consent. The genotype distribution of C677T mutation was assessed and compared with that of the 4517 control individuals. The prevalence of the homozygous genotype (TT) among SB mothers was not significantly different from that among the controls (odds ratio [OR]=0.65; 95% confidence interval [CI]=0.31-1.25; P=0.182), suggesting that MTHFR 677TT genotype in Japan is not associated with spina bifida development in newborns. The T allele frequency was not increased in SB mothers (34.8%) as compared to that of the control individuals (38.2%). Further, the internationally reported association between the two groups was found to be similar in all 15 countries studied except the Netherlands, where the TT genotype was found to be a genetic risk factor for spina bifida. For the prevention of affected pregnancy every woman planning to conceive has to take folic acid supplements 400μg a day and the government is asked to take action in implementing food fortification with folic acid in the near future. In conclusion, it is not necessary for Japanese women to undergo genetic screening C677T mutation of the MTHFR gene as a predictive marker for spina bifida prior to pregnancy, because the TT genotype is not a risk factor for having an affected infant. © 2013 Japanese Teratology Society. Source

Kondo A.,Tsushima Rehabilitation Hospital | Iwagaki S.,Mizunami Iwagaki Obstetric and Gynecology Clinic | Kihira M.,St. Rose Clinic | Nakanishi Y.,Nakanishi Womens Clinic | And 3 more authors.
Japanese Journal of Urology | Year: 2013

(Aims): Though periconceptional intakes of folic acid could prevent the occurrence of spina bifida by 50 to 70%. the prevalence has not shown any decreasing tendency during the past 30 years in Japan. We aim to analyze various parameters through life style questionnaires and 3-day food records obtained from pregnant women the last 10 years, and to examine whether their life styles have been shifting to the direction of lowering the incidence of spina bifida. (Materials and methods): Life style questionnaires inquired of knowledge of folic acid in relation to preventing spina bifida during a pregnancy and other relevant parameters, which were collected from 11, 861 participants during a period of from 2002 to 2011. Food records asked participants to semi-quantitatively describe diets and beverages they consumed for a 3-day period, which were collected from 1, 081 pregnant women from 2003 to 2011. (Results): Life style questionnaires demonstrated that knowledge of folic acid and the proportion of those who took folic acid supplements elevated from 15.3 and 9.1% in 2002 to 43.7 and 61.5% in 2011, respectively, that comparison of those who took folic acid supplements from 2008 to 2011 residing in one of 8 districts of Japan showed a significant difference, i.e., the proportion of those in the Chugoku or Kyushu district being significantly lower compared to that in the Hokkaido district, and that other life style parameters have not much altered the past 9 years, e.g., those who conceived as planed being 67%, those who confirmed own pregnancy within 6 weeks of pregnancy being 70%, those who took balanced diets being 65%, and those who did not smoke or drink being 95% and 96%, respectively. Three-day food records revealed that the mean dietary folate intakes ranged from 260 to 360 μg/day in each year which were less than the recommended dietary allowance (RDA) publicized by the government, but that the proportion of pregnant women in the first trimester who consumed folic acid supplements from 4 weeks prior to to 12 weeks after conception increased from 7.4% in 2003 to 69.6% in 2011. (Conclusions): As a whole it could be stated that life styles of pregnant women have been shifting toward the direction the past 10 years where the risk for having a pregnancy afflicted with spina bifida is to be decreased. Medical doctors, nurses, midwives, dietitians and pharmacists are asked to repeatedly supply important information on folic acid and to advise taking folic acid supplements 400 ug a day to women planning to conceive or women in the reproductive age. © 2013 The Japanese Urological Association. Source

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