Low preconception body mass index is associated with birth outcome in a prospective cohort of Chinese women. Preconception homocysteine and B vitamin status and birth outcomes in Chinese women. Periconceptional iron supplementation does not reduce anemia or improve iron status among pregnant women in rural Bangladesh. Establishment of a Low Birth Weight Registry and Initial Outcomes Effects of pre-pregnancy body mass index and gestational weight gain on infant anthropometric outcomes. Preconception Folate and Vitamin B6 Status and Clinical Spontaneous Abortion in Chinese Women Preconception B-vitamin and homocysteine status, conception, and early pregnancy loss. Maternal body mass index and gestational weight gain and their association with perinatal outcomes in Viet Nam. Prevention of neural tube defects: Results of the Medical Research Council Vitamin Study The impact of exposure misclassification on associations between prepregnancy BMI and adverse pregnancy outcomes. A randomised trial of low dose folic acid to prevent neural tube defects. The Irish Vitamin Study Group. Iron Intake and Risk of Ovulatory Infertility Maternal supplemental and dietary zinc intake and the occurrence of neural tube defects in California. Maternal periconceptional biochemical and hematological parameters, vitamin profiles and pregnancy outcome Prevention of iodine deficiency disorders by oral administration of lipiodol during pregnancy. Multicentric study of efficacy of periconceptional folic acid containing vitamin supplementation in prevention of open neural tube defects from India. Periconceptional consumption of vitamins containing folic acid and risk for multiple congenital anomalies Effects of once-a-week or daily folic acid supplementation on red blood cell folate concentrations in women Pregnancy outcomes in a randomised controlled trial of periconceptional multivitamin supplementation Periconceptional vitamin supplementation and neural tube defects; evidence from a case-control study in Western Australia and a review of recent publications. Fortification of flour with folic acid Weekly Iron and Folic Acid Supplementation with Counseling Reduces Anemia in Adolescent Girls: A Large-Scale Effectiveness Study in Uttar Pradesh, India
Low maternal prepregnancy BMI is associated with adverse birth outcomes , but the BMI at which risk increases is not well defined . We assessed whether the relationship between prepregnancy BMI and birth outcomes is influenced by the extent to which mothers were underweight in a prospect i ve study in Anhui , China . The women ( n = 575 ) were 20 - 34 y old , married , nulliparous and nonsmokers . All measures of infant growth increased with increasing maternal BMI until a plateau was reached at a BMI of 22 - 23 kg/m2 . Infants born to the 27 % of women who were severely underweight before pregnancy ( BMI < or = 18.5 kg/m2 ) were at increased risk for fetal growth deficits associated with infant morbidity . Compared with a normal BMI , being severely underweight was associated with mean ( + /- SEM ) reductions of 219 + /- 40 g in infant birthweight and 6.7 + /- 1.3 % in the birthweight ratio and an 80 % increase in risk of intrauterine growth restriction [ odds ratio ( OR ) 1.8 ; 95 % CI : 1.0 , 3.3 ; P = 0.05 ] . Being severely underweight was also associated with smaller infant head circumference and lower ponderal index . Being moderately underweight ( 18.5 < BMI < 19.8 kg/m2 ) was not significantly associated with adverse pregnancy outcomes . Gestational age and risk of preterm birth were not associated with maternal BMI . More than half of the women in this study were underweight before pregnancy . Although being moderately underweight was not associated with increased risk of adverse pregnancy outcomes , being severely underweight was an important risk factor for reduced fetal growth BACKGROUND The associations between homocysteine , B vitamin status , and pregnancy outcomes have not been examined prospect ively . OBJECTIVE We assessed the associations of preconception homocysteine and B vitamin status with  preterm birth and birth of low-birth-weight ( LBW ) and small-for-gestational-age ( SGA ) infants in Chinese women . DESIGN This was a case-control study of women aged 21 - 34 y. Preterm cases ( n = 29 ) delivered living infants at < 37 wk gestation ; term controls ( n = 405 ) delivered infants at > or = 37 wk . LBW cases ( n = 33 ) had infants weighing < 2500 g ; normal-birth-weight controls ( n = 390 ) had infants weighing > or = 2500 g. SGA cases ( n = 65 ) had infants below the 10th percentile of weight-for-gestational-age ; appropriate-for-gestational-age controls ( n = 358 ) had infants above this cutoff .  Nonfasting plasma concentrations of homocysteine , folate , and vitamins B-6 and B-12 were measured before conception . RESULTS Elevated homocysteine ( > or = 12.4 micro mol/L ) was associated with a nearly 4-fold higher risk of preterm birth ( OR : 3.6 ; 95 % CI : 1.3 , 10.0 ; P < 0.05 ) . The risk of preterm birth was 60 % lower among women with vitamin B-12 > or = 258 pmol/L than among vitamin B-12-deficient women ( OR : 0.4 ; 95 % CI : 0.2 , 0.9 ; P < 0.05 ) and was 50 % lower among women with vitamin B-6 > or = 30 nmol/L than among vitamin B-6-deficient women ( OR : 0.5 ; 95 % CI : 0.2 , 1.2 ; NS ) . Folate status was not associated with preterm birth , and homocysteine and B vitamin status were not associated with LBW or SGA status . CONCLUSIONS Elevated homocysteine and suboptimal vitamin B-12 and B-6 status may increase the risk of preterm birth . These results need to be confirmed in larger prospect i ve studies BACKGROUND There is a growing interest in periconceptional iron supplementation in developing countries by research ers and policy makers ; however , there are no r and omized controlled trials that examine the effectiveness of this strategy in decreasing  anemia during pregnancy . OBJECTIVE The aim was to determine whether periconceptional iron supplementation reduces anemia during pregnancy . DESIGN A r and omized , double-blind , controlled trial was conducted in rural Bangladesh . Married , nulliparous women were r and omly assigned to receive daily iron and folic acid ( IFA ; 60 mg ferrous fumarate and 400 microg folic acid ) ( n = 134 ) or folic acid ( FA ; 400 microg ) ( n = 138 ) in the form of a powdered supplement added to food . Women were followed until pregnancy or the end of 9 mo . Primary outcomes included hemoglobin , plasma ferritin , and plasma transferrin receptor concentrations . RESULTS Among 88 pregnant women , periconceptional IFA in comparison with FA did not affect anemia or iron status at 15 wk gestation . However , each 1 % increase in adherence was associated with a 10-g/L increase in change in hemoglobin from baseline ( P = 0.03 ) , and those who initiated supplementation at a mean ( + /-SD ) time of 72.9 + /- 57.8 d before conception showed a 7.3-g/L increase in change in hemoglobin from baseline compared with those who initiated supplementation at 26.3 + /- 12.3 d after conception ( P = 0.01 ) . Among 146 nonpregnant women , IFA decreased anemia ( odds ratio : 0.19 ; 95 % CI : 0.04 , 0.95 ) and improved iron stores ( P = 0.001 ) more than did FA . CONCLUSION Good adherence and initiation of supplementation before conception are needed to reduce anemia during early pregnancy . This trial was registered at www . clinical trials.gov as NCT00953134 The study was conducted to evaluate a regional , prospect i ve data base of information on mothers of low birth weight ( LBW ) infants . The data base informs on unidentified or under-reported modifiable risk factors from which evidence -based , targeted community intervention strategies could be design ed to lower the rate of low birth weight in the region . The LBW Registry is based on informed consent , a semi-structured face-to-face ( FTF ) interview with the mother of the newborn LBW infant , medical record review , and birth certificate worksheet data collection . Descriptive statistics were used to summarize data from the registry . High rates of modifiable risk factors among mothers of low birth weight infants ( October 2007–October 2008 ) include smoking ( 44 % ) , alcohol consumption ( 16 % ) , and drug abuse ( 14 % ) . Preconception vitamin use was low ( 34 % ) . The reported use of fertility drugs in FTF interviews was notably higher than information reported on the birth certificate worksheets by the same set of interviewed mothers ( 5.4 vs. 1.5 % ) , as was alcohol use during pregnancy ( 16 vs. 1.3 % ) . More than half ( 52 % ) of the mothers of low birth weight infants reported a vaginal or urinary tract infection during pregnancy . Additionally there were higher than average rates of unmarried mothers ( 62 % ) , unintended pregnancies ( 67 % ) , and Medicaid beneficiaries ( 57 % ) . Mothers repeatedly expressed excessive dem and s in their lives , straining their coping abilities and re sources . The LBW Registry provides exp and ed local data on potentially modifiable risk factors to aid in design ing targeted prevention and intervention strategies OBJECTIVE To determine whether pre-pregnancy body mass index ( BMI ) and gestational weight gain ( GWG ) influence infant postnatal growth . STUDY DESIGN Participants were from the Pregnancy , Infection , and Nutrition study , a prospect i ve pregnancy cohort . Term infants with weight or length measurements at approximately 6 months were included ( n = 363 ) . Multivariable regression estimated associations for weight-for-age ( WAZ ) , length-for-age ( LAZ ) , and weight-for-length z-scores ( WLZ ) and rapid infant weight gain with categorical maternal exposures defined with the 2009 Institute of Medicine recommendations . RESULTS Pre-pregnancy overweight and obesity were associated with higher WAZ ( linear regression coefficient [ β ] , 0.32 ; 95 % CI , 0.04 - 0.61 ) and WLZ ( β , 0.39 ; 95 % CI , 0.02 - 0.76 ) , respectively . Pre-pregnancy BMI was not associated with LAZ . Excessive GWG was associated with higher WAZ ( β , 0.39 ; 95 % CI , 0.15 - 0.62 ) and LAZ ( β , 0.34 ; 95 % CI , 0.12 - 0.56 ) . Excessive GWG ≥ 200 % of recommended amount was associated with higher WAZ ( β , 0.68 ; 95 % CI , 0.28 - 1.07 ) , LAZ ( β , 0.45 ; 95 % CI , 0.06 - 0.83 ) , and WLZ ( β , 0.43 ; 95 % CI , 0.04 - 0.82 ) . Risk of rapid weight gain increased across maternal exposure categories ; however , none of the estimates were significant . CONCLUSIONS Pre-pregnancy BMI and GWG are modifiable intrauterine exposures that influence infant postnatal anthropometric outcomes . Further investigation with infant body composition measurements is warranted OBJECTIVE To assess the association between preconception homocysteine and B vitamin status and risk of clinical spontaneous abortion in women from Anqing , China . METHODS All women were aged 21–34 years , had never smoked , and were primigravid . Patients ( n = 49 ) were women with a clinical ly recognized pregnancy who experienced a fetal death before 100 days ' gestation . Controls ( n = 409 ) were women who maintained a pregnancy that ended in a live birth .  Homocysteine , folate , and vitamins B6 and B12 concentrations were measured in plasma obtained before conception . RESULTS Mean vitamin B6 concentration was lower in patients than in controls ( 34.0 versus 37.9 nmol/L , P = .04 ) . In addition , the risk of spontaneous abortion tended to increase with decreasing plasma vitamin B6 and folate concentration ( P for trend = .06 and .07 , respectively ) , although the significance of these trends was further reduced in logistic models that included age , body mass index , and both vitamins . The risk of spontaneous abortion was four‐fold higher among women with suboptimal plasma concentrations of both folate and vitamin B6 ( folate less than or equal to 8.4 nmol/L and vitamin B6 less than or equal to 49 nmol/L ) than in those with higher plasma concentrations of both vitamins ( odds ratio 4.1 , 95 % confidence interval 1.2 , 14.4 ) . Homocysteine and vitamin B12 status were not associated with spontaneous abortion risk . CONCLUSION Suboptimal preconception folate and vitamin B6 status , especially when they occur together , may increase the risk of clinical spontaneous abortion . Additional prospect i ve studies are needed to confirm these findings and to determine whether antenatal B vitamin supplementation reduces spontaneous abortion risk Maternal vitamin status contributes to clinical spontaneous abortion , but the role of B-vitamin and homocysteine status in sub clinical early pregnancy loss is unknown . Three-hundred sixty-four textile workers from Anqing , China , who conceived at least once during prospect i ve observation ( 1996 - 1998 ) , provided daily urine specimens for up to 1 year , and urinary human chorionic gonadotropin was assayed to detect conception and early pregnancy loss .  Homocysteine , folate , and vitamins B6 and B12 were measured in preconception plasma . Relative to women in the lowest quartile of vitamin B6 , those in the third and fourth quartiles had higher adjusted proportional hazard ratios of conception ( hazard ratio (HR)=2.2 , 95 % confidence interval ( CI ) : 1.3 , 3.4 ; HR=1.6 , 95 % CI : 1.1 , 2.3 , respectively ) , and the adjusted odds ratio for early pregnancy loss in conceptive cycles was lower in the fourth quartile ( odds ratio=0.5 , 95 % CI : 0.3 , 1.0 ) . Women with sufficient vitamin B6 had a higher adjusted hazard ratio of conception ( HR=1.4 , 95 % CI : 1.1 , 1.9 ) and a lower adjusted odds ratio of early pregnancy loss in conceptive cycles ( odds ratio=0.7 , 95 % CI : 0.4 , 1.1 ) than did women with vitamin B6 deficiency . Poor vitamin B6 status appears to decrease the probability of conception and to contribute to the risk of early pregnancy loss in this population OBJECTIVE To examine the association between gestational weight gain and maternal body mass index ( BMI ) among Vietnamese women and the risk of delivering an infant too small or too large for gestational age . METHODS A prospect i ve health-facility-based study of 2989 pregnant Vietnamese women was conducted in the city of Nha Trang in 2007 - 2008 .  Cubic logistic regression was used to investigate the association of interest . Infants were classified into weight-for-gestational-age categories according to weight centiles for the Asian population . Gestational age was based on the date of last menstrual period and adjusted by the results of first-trimester ultrasound . FINDINGS BMI was low ( < 18.5 ) , normal ( 18.5 - 22.9 ) and high ( ≥ 23.0 ) in 26.1 % , 65.4 % and 8.5 % of the women , respectively . In each of these BMI categories , the percentage of women who delivered infants too small for gestational age was 18.1 , 10.0 and 9.4 , respectively , and the mean gestational weight gain was 12.5 kg ( st and ard deviation , SD : ± 3.6 ) , 12.2 kg ( SD : ± 3.8 ) and 11.5 kg ( SD : ± 4.7 ) , respectively . Among women with low BMI , the risk of delivering an infant too small for gestational age ranged from approximately 40 % if the gestational weight gain was < 5 kg to 20 % if it was 5 - 10 kg . CONCLUSION Having a low BMI , commonly found in Viet Nam , puts women at risk of delivering an infant too small for gestational age , especially when total maternal gestational weight gain is < 10 kg A r and omised double-blind prevention trial with a factorial design was conducted at 33 centres in seven countries to determine whether supplementation with folic acid ( one of the vitamins in the B group ) or a mixture of seven other vitamins ( A , D , B1,B2,B6,C and nicotinamide ) around the time of conception can prevent neural tube defects ( anencephaly , spina bifida , encephalocele ) . A total of 1817 women at high risk of having a pregnancy with a neural tube defect , because of a previous affected pregnancy , were allocated at r and om to one of four groups -- namely , folic acid , other vitamins , both , or neither .  1195 had a completed pregnancy in which the fetus or infant was known to have or not have a neural tube defect ; 27 of these had a known neural tube defect , 6 in the folic acid groups and 21 in the two other groups , a 72 % protective effect ( relative risk 0.28 , 95 % confidence interval 0.12 - 0.71 ) . The other vitamins showed no significant protective effect ( relative risk 0.80 , 95 % Cl 0.32 - 1.72 ) . There was no demonstrable harm from the folic acid supplementation , though the ability of the study to detect rare or slight adverse effects was limited . Folic acid supplementation starting before pregnancy can now be firmly recommended for all women who have had an affected pregnancy , and public health measures should be taken to ensure that the diet of all women who may bear children contains an adequate amount of folic acid Prepregnancy BMI is a widely used marker of maternal nutritional status that relies on maternal self-report of prepregnancy weight and height . Pregravid BMI has been associated with adverse health outcomes for the mother and infant , but the impact of BMI misclassification on measures of effect has not been quantified . The authors applied published probabilistic bias analysis methods to quantify the impact of exposure misclassification bias on well-established associations between self-reported prepregnancy BMI category and five pregnancy outcomes ( small for gestational age ( SGA ) and large for gestational age ( LGA ) birth , spontaneous preterm birth ( sPTB ) , gestational diabetes mellitus ( GDM ) , and preeclampsia ) derived from a hospital-based delivery data base in Pittsburgh , PA ( 2003 - 2005 ; n = 18,362 ) . The bias analysis method recreates the data that would have been observed had BMI been correctly classified , assuming given classification parameters . The point estimates derived from the bias analysis account for r and om error as well as systematic error caused by exposure misclassification bias and additional uncertainty contributed by classification errors . In conventional multivariable logistic regression models , underweight women were at increased risk of SGA and sPTB , and reduced risk of LGA , whereas overweight , obese , and severely obese women had elevated risks of LGA , GDM , and preeclampsia compared with normal-weight women . After applying the probabilistic bias analysis method , adjusted point estimates were attenuated , indicating the conventional estimates were biased away from the null . However , the majority of relations remained readily apparent . This analysis suggests that in this population , associations between self-reported prepregnancy BMI and pregnancy outcomes are slightly overestimated A r and omised trial was initiated in Irel and in 1981 to determine if periconceptional supplementation with either folic acid alone or a multivitamin preparation alone could reduce the recurrence risk of neural tube defects ( NTDs ) in women with a previously affected pregnancy from 5.0 % to 1.0 % or less . The trial was concluded before the initial target number of study subjects was reached and without a clear treatment effect being observed . A total of 354 women were r and omised to receive one of three treatments : folic acid , multivitamins without folic acid , and folic acid plus multivitamins . At the end of the trial 257 women had had a first trial pregnancy outcome ( 261 infants/fetuses ) where the presence or absence of NTDs was ascertainable . There was one NTD recurrence in the 89 infants/fetuses of women in the multivitamin group and no recurrence in the 172 infants/fetuses of women in the folic acid groups , a non-significant difference . Otherwise eligible women who were pregnant when first contacted constituted a non-r and omised control group ; there were three recurrences among the 103 infants in this group . The difference in the recurrence rate between the folic acid groups and the non-r and omised controls was statistically significant but we have reservations about the validity of this comparison . Although our findings do not provide clear evidence of a protective effect of folic acid supplementation they are consistent with those of the Medical Research Council ( MRC ) trial which demonstrated the efficacy of folic acid in preventing recurrence of NTDs and they raise the possibility that folic acid may be protective at a much lower dosage than that used in the MRC trial OBJECTIVE : To evaluate whether iron supplement use or greater intake of total , heme and nonheme iron is associated with lower risk of ovulatory infertility . METHODS : We conducted a prospect i ve cohort study among 18,555 married , premenopausal women without a history of infertility who attempted a pregnancy or became pregnant between 1991 and 1999 ( mean baseline age±st and ard deviation 32.6±3.6 ) . Diet was assessed twice during follow-up and prospect ively related to the incidence of infertility due to ovulatory disorder . RESULTS : During the 8 years of follow-up , 438 women reported infertility  due to ovulatory disorder . Women who consumed iron supplements had a significantly lower risk of ovulatory infertility than women who did not use iron supplements ( relative risk 0.60 , 95 % confidence interval 0.39–0.92 ) , after adjusting for potential confounders . Total nonheme iron  intake , primarily consumed as multivitamins and iron supplements , was inversely associated with the risk of infertility ( relative risk Quintile 1 compared with 5 , 95 % confidence interval 0.39–0.92 ; P , trend .005 . ) Heme iron intake was unrelated to ovulatory infertility in multivariable adjusted analyses . CONCLUSION : Consumption of iron supplements and nonheme iron from other sources may decrease the risk of ovulatory infertility . LEVEL OF EVIDENCE : The authors investigated the association between maternal preconceptional  supplemental and dietary zinc intake and risk of  neural tube defects ( NTDs ) in a population -based case-control study conducted between 1989 and 1991 in California . Cases were 430 NTD-affected fetuses/infants , and controls were 429 r and omly selected non-malformed infants . Mothers reported their preconceptional use of vitamin , mineral , and food supplements , and completed a 98-item food frequency question naire . Increased total preconceptional zinc intake was associated with a reduced risk for NTDs ( quintile 5 vs. quintile 1 , odds ratio ( OR ) = 0.65 , 95 % confidence interval ( CI ) 0.43 , 0.99 ) . Phytate intake , a constituent of the diet known to impede zinc absorption , appeared to modify the zinc - NTD association . In addition , increased servings of animal products , the most bioavailable food source of zinc , was associated with a reduced risk for NTDs ( quintile 5 vs. quintile 1 , OR = 0.49 , 95 % CI 0.32 , 0.76 ) . Risk estimates for  zinc intake were changed little after controlling for multiple sociodemographic factors and total folate intake , but were attenuated after controlling for nutrients highly correlated with dietary sources of zinc , such as protein . In sum , the analyses indicate that risk of NTDs in infants and fetuses decreased with increasing maternal preconceptional zinc intake . However , it remains unclear whether increased zinc intake , or another nutrient or combination of nutrients highly correlated with zinc intake in the diet , is causally associated with reduced NTD risk Objectives : To evaluate periconceptional maternal biochemical and hematological parameters and vitamin profiles in relation to the risk of early pregnancy loss and birth weight . Design : Prospect i ve longitudinal study . Setting : University Medical Centre Nijmegen , Academic Medical Centre , Amsterdam , Maria and Elisabeth Hospitals , Tilburg , and Catharina Hospital , Eindhoven , The Netherl and s . Subjects : A cohort of 240 women recruited before pregnancy . Interventions : Blood sample s were taken preconceptional and at 6 and 10 weeks amenorrhea in which the concentrations of hemoglobin , hematocrit , creatinin , uric acid , total protein , serum iron , total iron-binding capacity , ferritin , and the concentrations of retinol , tocopherol , thiamine , riboflavin , pyridoxal-5′-phosphate , cobalamin and folate were analyzed . Main outcome measures : Risk of early pregnancy loss and birth weight . Results : The risk of early pregnancy loss increased with increasing prepregnancy weight , and when the periconceptional decline in hematocrit , creatinin and uric acid was less profound ( slope : P<0.01 ) . Maternal smoking was negatively associated with birth weight ( mean reduction of 183 g , P<0.05 ) . Maternal age and prepregnancy weight were positively associated with birth weight ( P<0.01 ) . No significant associations were found between vitamin concentrations and risk of early pregnancy loss or birth weight . Conclusions : Several periconceptional biochemical parameters are significantly associated with early pregnancy loss . The effects of maternal periconceptional health on embryonic development and subsequent pregnancy outcome should be further explored . Sponsorship : Dutch Prevention fund , grants no. 28.1358 and 28.1006 The prevalence of iodine deficiency disorders and the thyroid status of the population were studied in an endemic goitre area in Algeria . After oral administration of lipiodol ( 0.5 ml ) , three treated groups of mother-newborn couples were compared to an untreated group : group A , mothers treated 1 - 3 months before conception ; group B , mothers treated during the first month of pregnancy ; group C , mothers treated during the third month of pregnancy . Untreated mothers were used as a control ( group D ) . After lipiodol treatment , all newborn babies and mothers were clinical ly euthyroid . All tested newborn babies were full term and no goitre was observed in the four groups . In the mothers , goitre prevalence and thyrotrophin levels decreased significantly , whereas maternal milk and urinary iodine and serum-free thyroxine levels were significantly higher after treatment . The rate of prematurity , stillbirths and abortions in the treated groups was reduced when compared to the untreated group , whereas placental and birth weights were significantly higher . In group D two cases of neonatal hypothyroidism were detected . Their re-evaluation confirmed that hypothyroidism was transient . Groups A , B and C were statistically different from group D with regard to neonatal thyrotrophin and thyroxine . Positive correlations were found between neonatal thyroxine and birth weights and placental weights on the one h and , and maternal urinary iodine and free thyroxine on the other . Consequently , these data indicate that oral administration of lipiodol before or during the first trimester of pregnancy normalizes thyroid function in newborn babies and mothers , increases placental and birth weight and reduces the frequency of iodine deficiency disorders . ( ABSTRACT TRUNCATED AT 250 WORDS BACKGROUND & OBJECTIVES A folic acid containing multivitamin preparation was evaluated for its efficacy in preventing recurrence of open neural tube defect ( NTD )  in a blind , placebo-controlled r and omized trial . The trial was carried out at the five centres in India , viz . , Bangalore , Mumbai , Lucknow , New Delhi and Pune . METHODS The preparation contained 4 mg of folic acid besides calcium , iron , zinc and vitamins A , B1 , B2 , B6 , C , D and nicotinamide . The placebo contained calcium and iron only .  A total of 466 women with previous history of giving birth to a child with open NTD were included in the trial ( 231 in the vitamin group and 235 in the placebo group ) . The supplementation was given for at least one month prior to conception and up to three months after conception . All women were offered antenatal diagnosis with screening of maternal serum alpha foetoprotein ( AFP ) and ultrasound . RESULTS Pregnancy outcome with reference to recurrence of NTD was unknown in 137 women in the vitamin group and 142 in the placebo group . The recurrence of open NTD in the vitamin group was 2.92 per cent compared to 7.04 per cent in the placebo group , a reduction by about 60 per cent . The difference , however , was not statistically significant ( P = 0.06 ) . INTERPRETATION & CONCLUSIONS The study seems to support the role of periconceptional folic acid supplementation in prevention of recurrence of NTDs in the Indian population . The reason for high recurrence rate observed in the placebo group requires further investigation Although it has been well established that periconceptional use of multivitamins containing folic acid ( FA ) reduces the risk for neural tube defects , two recent U.S. studies have shown an increased risk for multiple congenital anomalies ( MCAs ) associated with periconceptional use of vitamins containing FA . This study assessed the association between the periconceptional use of vitamins containing FA and MCAs in a third U.S. population . Mothers of infants with MCAs and a r and om sample of live births ( control infants ) born in Iowa during 1993–1995 were eligible to participate in the Birth Defects Risk Factor Surveillance case‐control study . During a telephone interview , participants reported on exposure to FA through vitamins , cereal , and food supplements . There was no association between taking vitamins containing FA during the periconceptional period ( 3 months before conception through the first trimester ) and MCAs in the crude estimates or after adjusting for maternal race or ethnicity , education , gravidity , smoking , or alcohol use in the first trimester , or body mass index prior to pregnancy [ adjusted odds ratio ( aOR ) = 1.12 , 95 % confidence interval ( CI ) 0.75–1.69 ] . There was also no association between vitamin exposure beginning in the first trimester and MCAs outcome ( aOR = 1.05 , 95 % CI 0.59–1.87 ) . In contrast to the two recently published reports , there was no association between periconceptional vitamin exposure and MCAs in the Iowa population . Published 2007 Wiley‐Liss , Objective : Our aim was to determine if a once-a-week folic acid supplement increases women 's red blood cell folate to concentrations ( > 905 nmol/l ) that are associated with a low risk of bearing a child with a neural tube defect . Design : R and omized control trial . Setting : General community . Subjects : In total , 114 nonpregnant women ( 18–40 y ) volunteers , with red blood cell folate concentrations between 295 and 905 nmol/l at screening . Interventions : Women were r and omized to receive a once-a-week 2800 μg folic acid supplement , a daily 400 μg folic acid supplement or a daily placebo for 12 weeks . Results : The mean ( 95 % CI ) red blood cell folate concentrations increased during the 12-week intervention from 608 ( 553–668 ) to 900 ( 828–978 ) in the weekly folic acid group ( P<0.05 ) and from 615 ( 560–677 ) to 1053 ( 957–1158 ) nmol/l in the daily group ( P<0.05 ) during the trial . At week 12 , 49 % of women ingesting the weekly folic acid supplement had red blood cell folate concentrations greater than 905 nmol/l compared to 74 % of women ingesting the daily supplement . Conclusions : A once-a-week 2800 μg folic acid supplement can increase women 's red blood cell folate to concentrations associated with a reduced risk of bearing a child with a neural tube defect , but is less effective than a 400 μg daily supplement . Use of a weekly folic acid supplement over at least 12 weeks before conception by women of child-bearing age may prevent neural tube defects . Funding : The Otago Medical Research Foundation ( Laurenson Award ) . Healtheries ( New Zeal and ) provided the supplements The effect of periconceptional multivitamin/trace element supplementation on pregnancy outcomes was evaluated in a r and omised controlled trial . The final data -base included 5,502 females with confirmed pregnancy . A multivitamin including 0.8 mg folic acid or a trace element were supplemented for at least 28 days before conception and continuing for at least until the second missed menstrual period . Number of pregnancies , terminations of pregnancies , four types of fetal deaths , livebirths including low birth weight , preterm birth and sex ratio were analysed . Periconceptional multivitamin supplementation  increased fertility ( higher rates of cumulative conceptions and multiple births ) , had no significant effect on the rate of different groups of fetal deaths , low birth weight and preterm birth in singletons . This primary preventive method can reduce the occurrence and recurrence of neural-tube defects and had no other significant effect on pregnancy outcomes except multiple births STUDY OBJECTIVE --The aim was to assess the association of  neural tube defects  with periconceptional vitamin supplementation . DESIGN --This was a matched , population based case-control study . SETTING --Western Australia , 1982 - 1984 . PARTICIPANTS --Mothers of 77 cases ( 93 % of those eligible ) with isolated neural tube defects , mothers of 77 matched control infants with defects other than neural tube defects ( control group I ) , and mothers of 154 liveborn , matched , control infants with no birth defects ( control group II ) participated in the study . MEASUREMENTS AND MAIN RESULTS --Information was collected by interview and self administered question naire .  Crude and adjusted odds ratios ( and their 95 % confidence intervals ) showed a small but non-significant protective effect of folate supplementation in comparisons with both control groups . The adjusted ratios for the three months before pregnancy were 0.69 ( 0.06 , 8.53 ) with control group I , and 0.11 ( 0.01 , 1.33 ) with control group II . In the first six weeks of pregnancy , the adjusted odds ratios were 0.70 ( 0.32 , 1.52 ) with control group I and 0.74 ( 0.29 , 1.88 ) with control group II . The odds ratios for  vitamin supplementation of any kind were all very close to or greater than one , and all confidence intervals embraced unity . CONCLUSIONS --These data do not provide evidence of an association between periconceptional vitamin supplementation and neural tube defects , although a protective effect of folate supplementation can not be excluded with confidence , due to the low power of the study . Of three other observational studies of vitamins and neural tube defects , two have shown an association . While further studies of this kind may be of value , evidence must now be sought from r and omised controlled trials Thirty three years ago Hibbard and Smithells linked folate deficiency in pregnancy with neural tube defects.1 Smithells then led a series of observational and intervention studies which showed that improving folic acid status early in the pregnancy of mothers who had previously had a child with neural tube defects reduced the recurrence in that pregnancy.2 A r and omised trial by Britain 's Medical Research Council confirmed that finding3 and a Hungarian trial showed a reduction in the first occurrence too . 4 To reach almost all women in the very early stages of pregnancy , when few would be sure they were pregnant , folic acid fortification of a staple food has been advocated , and a Department of Health committee has now recommended universal fortification of flour in the United Kingdom . Though the benefits are clear , the possible harms of such a policy are not . We need to be cautious in implementing a universal policy . After the initial British and Hungarian studies several others gave mostly similar results . 5 6 As a result a campaign led by the Health Education Authority in the UK aim ed to improve folate status from before conception to 12 weeks of pregnancy by increasing folic acid intake from foods and supplements . A third of Background Weekly iron – folic acid supplementation in small-scale research trials and as administered in institutions has been demonstrated to be effective in reducing anemia in adolescent girls . Objective To assess the effectiveness of weekly iron – folic acid supplementation in a large-scale project in reducing the prevalence of anemia in adolescent girls . Methods The project provided weekly iron – folic acid tablets , family life education , and deworming tablets every 6 months to 150,700 adolescent school girls and non-schoolgirls of a total district population of 3,647,834 . Consumption of the iron – folic acid tablets was supervised for schoolgirls but not for non-schoolgirls . Hemoglobin levels were assessed in a r and om sample of non-schoolgirls at 6 and 12 months and schoolgirls at 6 months . The effect of supplementation on the prevalence of anemia and the compliance rate were assessed over a 4-year period . Results In 4 years , the overall prevalence of anemia was reduced from 73.3 % to 25.4 % . Hemoglobin levels and anemia prevalence were influenced significantly at 6 months . No difference in the impact on hemoglobin or anemia prevalence was observed between supervised and unsupervised girls . Counseling on the positive effects of regular weekly iron – folic acid intake contributed to a high compliance rate of over 85 % . The cost of implementation was US$ 0.36 per beneficiary per year . Conclusions Weekly iron – folic acid supplementation combined with monthly education sessions and deworming every 6 months is cost-effective in reducing the prevalence of anemia in adolescent girls . Appropriate counseling , irrespective of supervision , is critical for achieving positive outcomes
Current underst and ing of biologic processes indicates that women 's nutritional status before and during early pregnancy may play an important role in determining early developmental processes and ensuring successful pregnancy outcomes .