ÜÇÜNCÜ DÜZEY KLİNİKTE NÖRAL TÜP DEFEKTİ SAPTANAN OLGULARIN DEĞERLENDİRİLMESİ

Year 2021, Volume: 23 Issue: 1, 68 - 74, 30.04.2021

Haççe Yeniçeri , Mehmet Murat Işıkalan , Ali Acar

https://doi.org/10.24938/kutfd.766270

Cited By: 2

Abstract

Amaç: Üçüncü düzey kliniğimizdeki nöral tüp defektli fetüslerin maternal risk faktörlerini ve postnatal kliniklerini değerlendirmeyi amaçladık.

Gereç ve Yöntemler: Bu prospektif gözlemsel kohort çalışması, Mayıs 2019 – Şubat 2020 tarihleri arasında perinatoloji kliniğimize başvuran nöral tüp defektli fetusa sahip 60 gebeyi içermektedir. Katılımcılarımızın yaşı, vücut kitle indeksi ve nöral tüp defekti risk faktörleri (diyabetes mellitus, sigara, folik asit kullanımı, vs.) sorgulandı. Ultrasonografik değerlendirme ile nöral tüp defekti büyüklüğü ve yeri tespit edildi. Risk faktörleri ve nöral tüp defektli fetüslerin gebelik sonuçları değerlendirildi.

Bulgular: Hastaların 5 (%8.3)’inde pregestasyonel diyabet, 30 (%50)’unda sigara kullanımı mevcuttu. Katılımcıların 26 (%43.3)’sı folik asit desteği almamıştı. Fetüslerin 34 (%56.7)’ü kız, 26 (%43.3)’sı erkek idi. Annenin vücut kitle indeksi ile nöral tüp defekti büyüklüğü arasında zayıf korelasyon saptandı (r=0.219, p=0.09). Obez hastalarda daha geniş defekt boyutu izlendi (p<0.001). Katılımcıların %60’ının ağırlığı normalden fazlaydı.

Sonuç: Nöral tüp defektleri intrauterin hayatta veya doğumdan kısa süre sonra ölümcül olabilmektedir. Bu gebeliklerde erken tanı konması ve terminasyon seçeneğinin sunulması önemlidir. Ayrıca nöral tüp defektlerinin engellenebilir risk faktörlerinin belirlenmesi ve gebe adaylarının prekonsepsiyonel dönemde bilinçlendirilmesi önem arzetmektedir.

Keywords

gebelik, nöral tüp defekti, nöral tüp defekti risk faktörleri

Supporting Institution

YOK

Project Number

YOK

Thanks

YOK

Evaluation of Patients with Neural Tube Defect in A Tertiary Clinic

Abstract

Objective: We aimed to evaluate the maternal risk factors and postnatal clinical status of fetuses with neural tube defects in our tertiary clinic.

Material and Methods: This prospective observational cohort study includes 60 pregnant women with fetuses neural tube defects who referred to our perinatology clinic between May 2019-February 2020. The age, body mass index and neural tube defect risk factors (diabetes mellitus, smoking, folic acid use, etc.) were questioned. The size and location of the neural tube defects were determined by ultrasonographic evaluation. Risk factors and pregnancy outcomes of fetuses with neural tube defects were evaluated.

Results: Five (8.3%) of the patients had pregestational diabetes and 30 (50%) were smokers. Twenty-six (43.3%) of the participants had not received folic acid support. Thirty-four (56.7%) of the fetuses were female and 26 (43.3%) were male. A weak correlation was found between body mass index of the mother and neural tube defect size (r=0.219, p=0.09). Wider defect size was observed in obese patients (p<0.001). The weight of 60%of the participants was more than normal.

Conclusion: Neural tube defects can be fatal in intrauterine life or shortly after birth. In these pregnancies, early diagnosis of the condition and provision of termination option has importance. In addition, determining the preventable risk factors of neural tube defects and raising awareness of pregnant candidates in the preconceptional period is important.

Keywords

Pregnancy, neural tube defect, neural tube defect risk factors

Project Number

YOK

References

• 1. Sawin KJ, Liu T, Ward E, Thibadeau J, Schechter MS, Soe MM et al. The national spina bifida patient registry: profile of a large cohort of participants from the first 10 clinics. J Pediatr. 2015;166(2):444-50.e1.
• 2. Wang Y, Liu G, Canfield MA, Mai CT, Gilboa SM, Meyer RE et al. Racial/ethnic differences in survival of United States children with birth defects: a population-based study. J Pediatr. 2015;166(4):819-26.e1-2.
• 3. Kinsner-Ovaskainen A, Lanzoni M, Garne E, Loane M, Morris J, Neville A et al. A sustainable solution for the activities of the European network for surveillance of congenital anomalies: EUROCAT as part of the EU Platform on Rare Diseases Registration. Eur J Med Genet. 2018;61(9):513-7.
• 4. McLone DG. The etiology of neural tube defects: the role of folic acid. Child's nervous system: ChNS: official journal of the International Society for Pediatric Neurosurgery. 2003;19(7-8):537-9.
• 5. Ghi T, Pilu G, Falco P, Segata M, Carletti A, Cocchi G et al. Prenatal diagnosis of open and closed spina bifida. Ultrasound in Obstetrics Gynecology. 2006;28(7):899-903. 6. Deak KL, Siegel DG, George TM, Gregory S, Ashley-Koch A, Speer MC. Further evidence for a maternal genetic effect and a sex-influenced effect contributing to risk for human neural tube defects. Birth Defects Res A Clin Mol Teratol. 2008;82(10):662-9.
• 7. Yin Z, Xu W, Xu C, Zhang S, Zheng Y, Wang W et al. A population-based case-control study of risk factors for neural tube defects in Shenyang, China. Childs Nerv Syst. 2011;27(1):149-54.
• 8. Meng X, Sun Y, Duan W, Jia C. Meta-analysis of the association of maternal smoking and passive smoking during pregnancy with neural tube defects. Int J Gynaecol Obstet. 2018;140(1):18-25.
• 9. Suarez L, Ramadhani T, Felkner M, Canfield MA, Brender JD, Romitti PA et al. Maternal smoking, passive tobacco smoke, and neural tube defects. Birth Defects Res A Clin Mol Teratol. 2011;91(1):29-33.
• 10. Wang M, Wang ZP, Zhang M, Zhao ZT. Maternal passive smoking during pregnancy and neural tube defects in offspring: a meta-analysis. Arch Gynecol Obstet. 2014;289(3):513-21.
• 11. Li ZW, Liu JM, Ren AG, Zhang L, Guo ZY, Li Z. Maternal passive smoking and the risk of neural tube defects: a case-control study in Shanxi province, China. Zhonghua Liu Xing Bing Xue Za Zhi. 2008;29(5):417-20.
• 12. Bibbins-Domingo K, Grossman DC, Curry SJ, Davidson KW, Epling JW Jr, García FA et al. Folic Acid Supplementation for the Prevention of Neural Tube Defects: US Preventive Services Task Force Recommendation Statement. JAMA. 2017;317(2):183-9.
• 13. Practice Bulletin No. 187: Neural tube defects. Obstetrics and Gynecology. 2017;130(6):e279-e90.
• 14. Bailey LB, Rampersaud GC, Kauwell GP. Folic acid supplements and fortification affect the risk for neural tube defects, vascular disease and cancer: evolving science. J Nutr. 2003;133(6):1961s-8s.
• 15. Sukanya S, Bay BH, Tay SS, Dheen ST. Frontiers in research on maternal diabetes-induced neural tube defects: Past, present and future. World J Diabetes. 2012;3(12):196-200.
• 16. Gabbay-Benziv R, Reece EA, Wang F, Yang P. Birth defects in pregestational diabetes: Defect range, glycemic threshold and pathogenesis. World J Diabetes. 2015;6(3):481-8.
• 17. Garne E, Loane M, Dolk H, Barisic I, Addor MC, Arriola L et al. Spectrum of congenital anomalies in pregnancies with pregestational diabetes. Birth Defects Res A Clin Mol Teratol. 2012;94(3):134-40.
• 18. Macintosh MC, Fleming KM, Bailey JA, Doyle P, Modder J, Acolet D et al. Perinatal mortality and congenital anomalies in babies of women with type 1 or type 2 diabetes in England, Wales, and Northern Ireland: population based study. BMJ (Clinical research ed). 2006;333(7560):177.
• 19. Lupo PJ, Canfield MA, Chapa C, Lu W, Agopian AJ, Mitchell LE et al. Diabetes and obesity-related genes and the risk of neural tube defects in the national birth defects prevention study. Am J Epidemiol. 2012;176(12):1101-9.
• 20. Deputy NP, Kim SY, Conrey EJ, Bullard KM. Prevalence and changes in preexisting diabetes and gestational diabetes among women who had a live birth-United States, 2012-2016. MMWR Morb Mortal Wkly Rep. 2018;67(43):1201-7.
• 21. Suarez L, Felkner M, Hendricks K. The effect of fever, febrile illnesses, and heat exposures on the risk of neural tube defects in a Texas-Mexico border population. Birth Defects Res A Clin Mol Teratol. 2004;70(10):815-9.
• 22. Chambers CD. Risks of hyperthermia associated with hot tub or spa use by pregnant women. Birth Defects Res A Clin Mol Teratol. 2006;76(8):569-73.
• 23. Huang HY, Chen HL, Feng LP. Maternal obesity and the risk of neural tube defects in offspring: A meta-analysis. Obes Res Clin Pract. 2017;11(2):188-97.
• 24. Zhang L, Zhang Y, Li Z, Ren A, Liu J, Ye R. Maternal periconceptional body mass index and risk for neural tube defects: results from a large cohort study in China. J Matern Fetal Neonatal Med. 2021;34(2):274-80.
• 25. Gao LJ, Wang ZP, Lu QB, Gong R, Sun XH, Zhao ZT. Maternal overweight and obesity and the risk of neural tube defects: a case-control study in China. Birth Defects Res A Clin Mol Teratol. 2013;97(3):161-5.
• 26. Wang M, Wang ZP, Gao LJ, Gong R, Sun XH, Zhao ZT. Maternal body mass index and the association between folic acid supplements and neural tube defects. Acta Paediatrica (Oslo, Norway: 1992). 2013;102(9):908-13.
• 27. McMahon DM, Liu J, Zhang H, Torres ME, Best RG. Maternal obesity, folate intake, and neural tube defects in offspring. Birth Defects Res A Clin Mol Teratol. 2013;97(2):115-22.
• 28. Erem C. Prevalence of overweight and obesity in Turkey. IJC Metabolic & Endocrine. 2015;8:38-41.