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Biomedical subjects

D Smithells

Publications and source records attributed to D Smithells.

6 recordsLinked to original sources
PubMed1999

Time trends in neural tube defects prevalence in relation to preventive strategies: an international study.

OBJECTIVE: To examine time trends in neural tube defects (NTD) prevalence from 1987 to 1996 in relation to the primary prevention policies for folic acid supplementation strategies in different countries. DESIGN: Retrospective time trends analysis of NTD prevalence. SETTING: 11 birth defect registries of congenital malformations participating in the International Clearinghouse for Birth Defects Monitoring System, in the period from 1 July 1987 to 30 June 1996. SUBJECTS: 8207 live births, stillbirths and terminated pregnancies affected by anencephaly or spina bifida registered by the 11 participating centres 1987-1996. OUTCOME MEASURES: Prevalence rate ratios based on the annual rates, using the Poisson regression model. RESULTS: During the study period a significant fall in prevalence rates for all NTD is present in Atlanta (USA), England and Wales, Hungary and Japan, and a significant rise in Norway and South America. After adjusting for the secular trends observed in the earlier years of the study, no significant trend can be attributed to preventive strategies. Data on NTD prevalence are supplemented with information on folate awareness among some of the populations studied. CONCLUSION: There is no evidence that, up to the middle of 1996, any change in time trend was attributable to the introduction of national folate supplementation policies. The possible effectiveness of folate supplementation policies for the reduction of NTD clearly needs to be tried and studied for several more years. Considering that in the Western world about 50% of pregnancies are unplanned, a policy that rests on action taken before conception can only have limited success. Strategies based on food enrichment, such as was introduced in the USA from the beginning of 1998, may prove to be more successful.

Female↗
PubMed1998

Does thalidomide cause second generation birth defects?

The proposed association between thalidomide and second generation birth defects is an improbable hypotheses which lacks, so far, any credible scientific foundation. However, the media have chosen to give it extensive coverage. So much so that even the hard-headed scientist may start wondering if there is anything in it. However, there is no reason to suppose that people with birth defects caused by exposure to thalidomide during embryonic life have any greater or lesser chance of producing children with birth defects. This appears to be the case in practice. The question could be reworded to, 'Can thalidomide be responsible for identical, or similar, birth defects in 2 generations of the same family?' For such a phenomenon to be possible, a mechanism must be proposed and there appear to be only 2 possible candidates. The first is that the defects in the parent, originating during embryonic life, have somehow been transmitted to the next generation. The second is that thalidomide is a mutagen as well as a teratogen. The first mechanism can be excluded, since Lamarckism has long since been abandoned by scientists. The hypothesis that thalidomide is a mutagen and might be responsible for birth defects in the children of thalidomide-damaged people is without any scientific foundation. Birth defects appear to be no more common amongst the children of thalidomide-affected parents than in the general population. It is important that thalidomide-affected adults are firmly reassured on this point. Most of them have now completed their own families, but they may still worry about their grandchildren. Therefore, unless and until further supportive evidence is reported by a separate and independent source, the answer to the question, 'Can thalidomide cause second generation defects?' is a very definite 'No.'

Abnormalities, Drug-Induced↗