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PubMed1992

Effects of H-2 on neural tube defects in congenic mice.

Pregnant mice congenic with C57BL/10 (B10.A, B10.BR, B10.D2, B10.A[2R], B10.A[5R], B10.A[15Rd, B10.A[1R], B10.A[18R], and B10.0L) were fed Purina Mouse Chow or the same diet plus 200 IU of vitamin A daily. The pregnant dams were sacrificed on the eighteenth day of gestation, and the fetuses were sexed and examined for defects in neural tube development. The frequency of neural tube defects was low (mean frequency of all strains, 0.36%) and was not affected by the addition of vitamin A (200 IU/day) to the diet. Twenty-seven of the 29 defects observed occurred in the anterior tube (exencephaly); fourteen were identified in female fetuses, but the sex could not be determined in the other 15 cases because of fetal death and early autolysis. Variations in frequency among the strains suggest that a locus between E beta and H-2D has a moderate influence on the occurrence of neural tube defects. Strains that had H-2d alleles in this segment of the H-2 complex had relatively high frequencies, and those with H-2b or H-2k alleles had significantly lower frequencies.

Animals↗

PubMed1986

Neural tube defects: issues in prenatal diagnosis and counselling.

Neural tube defects are a heterogeneous group of malformations resulting from failure of neural tube closure during early embryogenesis. They range widely in severity from the lethal condition of anencephaly, to severely disabling meningomyeloceles, to completely surgically correctable meningoceles. Occurring in 1.4 to 1.6 per 1000 live births, neural tube defects rank second only to cardiac abnormalities as a cause of major congenital malformations in the United States. Technical developments over the past decade have enabled better detection of these conditions prenatally. Understanding of the etiology, neonatal treatment, and potential prevention of neural tube defects is increasing. Further, the ethical issues of treatment and screening are being widely discussed in both news magazines and the Congressional Record. Thus, it is timely to review this important area of prenatal counselling, diagnosis, and management.

Acetylcholinesterase↗

PubMed1988

Immunobiological methods in the prenatal diagnosis and evaluation of foetal neural tube defects.

In cases of foetal neural tube defects (NTDs) macrophages are present in the amniotic fluid. These mononuclear cells were analysed with immunobiological methods: functional markers as Fc and C3b receptor-mediated phagocytosis and chemoluminescence have been studied. It was found that most of these pathognomic cells ingest haemolysin sensitized sheep red blood cells (sSRBCs) and zymosan (Mannozym) particles opsonized with fresh human serum. Amniotic fluid cell suspensions from pregnancies with and without foetal NTDs were stimulated by opsonized Mannozym; consistently higher chemoluminescence activities were found when open lesion was present. The evaluation of multiple functional markers is likely to provide a better basis for understanding the characteristics of amniotic fluid macrophages and may contribute to the prenatal diagnosis of NTDs.

Amniocentesis↗

PubMed1988

Neutral-red uptake and expression of monocytic antigens in amniotic-fluid mononuclear phagocytes: evaluation of a novel approach for prenatal diagnosis of neural-tube defects.

In cases of fetal neural-tube defects macrophages are present in the amniotic fluid. We found that these viable phagocytic cells take up neutral-red and are easily identified as "red cells" by microscopic examination. This method is suitable for the rapid identification and counting of amniotic-fluid macrophages in suspension. We have studied 298 amniotic fluid samples. In the 226 normal cases studied, 0 to 1,200 macrophages per milliliter amniotic fluid have been found. In contrast, we found 1,250 to 99,000 macrophages per milliliter amniotic fluid in our 70 open neural tube defect (ONTD) cases. Statistical evaluation was performed to estimate the normal and pathologic ranges. Specificity and sensitivity of the neutral-red test and predictive value of positive and negative results have been calculated and presented in comparison with alpha-fetoprotein (AFP) determinations and ultrasonic methods. In 5 cases of anencephaly and 7 normal cases amniotic fluid cells were studied by immunocytochemistry: mononuclear cells present in the abnormal cases showed intense immunoreactivity for the Mo1 and Mo2 surface antigens of the phagocytic cell lineage.

Amniotic Fluid↗

PubMed1992

Folate deficiency alone does not produce neural tube defects in mice.

The incidence of neural tube defects was studied in mouse embryos from dams fed an amino acid-based diet containing 45, 91, 136, 181, 227 or 453 nmol folic acid/kg diet (Experiment 1) or 227, 453, 566, 680, 906, 1132, 1698 or 2266 nmol folic acid/kg diet (Experiment 2). Reproductive tracts were examined 12 d postcoitum and gross and microscopic examination of all embryos was performed. A single implantation was found at levels less than or equal to 181 nmol folic acid/kg diet. With one exception, bred mice fed 227 or 453 nmol folic acid/kg diet in Experiment 1 had 100% resorptions. In Experiment 2, 100% of implantations in mice fed 227 nmol folic acid/kg diet and approximately 75% of implantations in mice fed 453 or 566 nmol folic acid/kg diet resorbed. The 906 nmol folic acid/kg diet was sufficient for successful pregnancy. Mice fed 227 nmol folic acid/kg diet in Experiment 2 weighed approximately 80% of mice fed higher levels of folic acid. Inadequate dietary folic acid resulted in fewer and smaller embryos (which developed normally). These results suggest that folate deficiency alone is insufficient to produce neural tube defects in Swiss-Webster mice. Because individual micronutrients (e.g., folate) can be omitted from the amino acid-based diet, the specific role of folic acid in neurulation can now be studied systematically.

Animals↗

PubMed1992

The changing epidemiology of neural tube defects. United States, 1968-1989.

OBJECTIVE: To describe the recent trends and epidemiologic characteristics of neural tube defects in the United States. RESEARCH DESIGN: Ongoing surveillance data. SETTING: Two birth defect surveillance systems: the nationwide Birth Defects Monitoring Program and the Metropolitan Atlanta (Ga) Congenital Defects Program for 1970 through 1989 and 1968 through 1989, respectively. PARTICIPANTS: Between 1970 and 1989, using discharge diagnoses of approximately 1 million live-born and stillborn infants per year, the Birth Defects Monitoring Program identified 15,503 cases of spina bifida and anencephaly. Between 1968 and 1989, using discharge diagnoses and clinical records until age 1 year of 38,000 infants per year, the Metropolitan Atlanta Congenital Defects Program identified 800 cases of spina bifida and anencephaly. INTERVENTIONS: None. MEASUREMENTS/MAIN RESULTS: Nationwide, neural tube defect rates have declined from 1.3 per 1000 births in 1970 to 0.6 per 1000 births in 1989. In Atlanta, neural tube defect rates have declined from 2.0 per 1000 births in 1968 to 0.6 per 1000 births in 1989. Several changes in the epidemiologic characteristics of neural tube defects were observed: (1) the proportion of spina bifida cases has increased; (2) the proportion of neural tube defect cases compared with the proportion of other unrelated defects has increased; (3) the race ratio of whites to other races for isolated neural tube defect cases has declined in Atlanta; and (4) the rate of isolated neural tube defects in females has also decreased. CONCLUSIONS: The declining rates of neural tube defects can be partially explained by increased widespread prenatal diagnostic techniques, strongly suggesting the role of environmental factors in neural tube defects. In particular, the use of multivitamins and folic acid to prevent the occurrence of neural tube defects needs further evaluation. Nevertheless, the changing clinical and epidemiologic characteristics of cases over time points to the etiologic heterogeneity of these conditions.

Anencephaly↗

PubMed1989

Dietary folate as a risk factor for neural-tube defects: evidence from a case-control study in Western Australia.

A population-based case-control study was conducted to test the hypothesis that the risk of the occurrence of neural-tube defects in infants with no other birth defects (isolated neural-tube defects) is associated inversely with the maternal dietary intake of free and/or total folate in early pregnancy. Information was collected from the mothers of 77 case subjects with isolated neural-tube defects who were born in Western Australia from 1982 to 1984, from the mothers of 77 control subjects with birth defects other than neural-tube defects (control group 1) and from the mothers of 154 control subjects with no birth defects (control group 2). The case and control subjects were matched individually by the date of the mother's last menstrual period. Odds ratios were adjusted for a number of potentially-confounding variables, such as the country of birth of the parents, paternal social class, previous pregnancy outcome, interval between index and previous pregnancy and pregnancy order. Crude and adjusted odds ratios showed a protective effect of an increasing intake of free folate in the first six weeks of pregnancy. Adjusted odds ratios, with reference to the lowest quartile of intake, (and their 95% confidence intervals) were 0.72 (0.25-2.08), 0.37 (0.11-1.23) and 0.31 (0.10-0.97) for quartiles 2-4 when control group 1 was used, and 0.44 (0.17-1.13), 0.34 (0.13-0.90) and 0.16 (0.06-0.49) when control group 2 was used. Similar, but weaker, trends were seen when total folate intake was the exposure variable. These findings support the hypothesis that the dietary intake of folate in early pregnancy protects against the occurrence of isolated neural-tube defects in infants. Measures of postpartum dietary folate and of postpartum serum and red-cell folate levels showed no association with the occurrence of neural-tube defects in infants.

Diet↗

PubMed1979

Antenatal diagnosis of neural tube defects in Canada: extension of a collaborative study.

Experience with the diagnosis of neural tube defects from alpha1-fetoprotein (AFP) concentrations in amniotic fluid is reported from a prospective study of five laboratories testing for 13 Canadian genetic centres. The results of the study indicate that antenatal diagnosis of open neural tube defects is being carried out effectively in Canada (in 99.2% of cases the AFP measurements were interpreted correctly). Amniocentesis should be recommended to women at high risk for having a child with a neural tube defect (i.e., those who have a child, a parent or a sibling with a neural tube defect). The rate of neural tube defects in 182 high-risk pregnancies was 2.2% for an open defect and 1.1% for a closed defect, whereas the rate in 673 pregnancies in which amniocentesis was being performed for other reasons was 0.3%. This suggests that the AFP concentration should be measured in any sample of amniotic fluid collected for other reasons (usually fetal karyotyping). There were three instances of false-negative results, for a rate of 0.4%. Two closed neural tube defects were not detected; this limitation of the test has also been found by others. One of the six fetuses with an open neural tube defect, who died in utero, had a large myelocele in the neck that was not recognized. There were also four instances of false-positive results, for a rate of 0.5%. The findings suggest that AFP values that are more than 2 but less than 7 standard deviations (SDs) above the mean may indicate a neural tube defect, and that values 7 or more SDs above the mean very likely indicate such a defect, although other reasons for such high values (e.g., fetal erythrocytes in the amniotic fluid, intrauterine death and mistaken gestational age) must be ruled out by other methods.

Amniocentesis↗

PubMed1975

Prenatal diagnosis of a neural tube defect: Meckel syndrome.

A severe neural tube defect diagnosed in a 191/2-week-old "at risk" fetus on the evidence of a markedly elevated alpha-fetoprotein level in the amniotic fluid, turned out to be an occipital myelocoele. However, the fetus also had polycystic kidneys and postaxial hexadactyly on all extremities. The karyotype was normal. These are the features of the rare Meckel syndrome, caused by a pleiotropic, autosomal, recessive gene, and one and possibly two other sibs were also affected.

Abnormalities, Multiple↗

PubMed1987

Incidence and distribution of renal anomalies in patients with neural tube defects.

In 190 patients with neural tube defects the sensory levels to pin prick were compared with the incidence and distribution of congenital renal anomalies. 17 such anomalies comprised 3 examples of renal agenesis, 5 horseshoe kidneys, 8 ureteral duplications and one simple ureterocele. The pattern of anomalies showed that renal agenesis was associated with a sensory level in the dermatomes T5-8, horseshoe kidneys with T9-L1 and duplications predominantly with the sacral dermatomes.

Abnormalities, Multiple↗

PubMed1989

Changing incidence of neural tube defects in Aegean Turkey.

The incidence of neural tube defects was monitored among all live- and still-births delivered between June 1986 and July 1988. In all there were 19,115 total births. The incidence of neural tube defects (NTD) was 1.9 per 1000 among those whose conception time was prior to May 1986. However, in conceptions occurring in May, June and July 1986, the NTD rate increased to a level of 8.9 per 1000, subsequently gradually declining to previous levels within 9 months. This dramatic change in incidence, which parallels a previous finding from Turkey, suggests that this finding may be associated with the Chernobyl disaster of May 1986.

Accidents↗

PubMed1985

Analysis of the changing birth prevalence of neural tube defects in Hungary.

The birth prevalence of neural tube defects had a significant decrease in Hungary from the sixties till 1978. After this a slight but not significant increase was registered. The changing pattern had no correlation with the developmental (different groups of neural tube defects, still- and livebirth rate, sex ratio, birth weight distribution and twin rate), demographic (monthly and territorial distribution, maternal age, birth order) and medical (prevention program, genetic counselling) factors. There was only one obvious finding, a negative correlation with the standard of living of the population.

Anencephaly↗

PubMed1991

Importance of accurate diagnosis in counseling for neural tube defects diagnosed prenatally.

In cases of fetal neural tube defects (NTD), termination of pregnancy without ascertainment of specific etiology may lead to provision of incorrect recurrence risks and erroneous diagnosis in future pregnancies. Four patients are presented who illustrate the etiologic diversity of neural tube defects. The patients were referred for prenatal diagnosis because of elevated maternal serum alphafetoprotein (AFP). All four chose pregnancy termination. Diagnostic methods included fetal ultrasound, amniocentesis for fetal karyotyping and amniotic fluid AFP/acetylcholinesterase (AChE) and/or fetal karyotyping after delivery, and dysmorphology evaluation of the fetus after intact delivery. These cases highlight the benefits of fetal karyotype analysis and of an intact delivery and thorough clinical examination of the fetus when patients choose to terminate pregnancies with fetal anomalies.

Abnormalities, Multiple↗

PubMed1978

Neural tube defects: maternal serum screening and prenatal diagnosis.

Neural tube defects represent some of the most common and serious of the congenital malformations. Although elevation of alpha-fetoprotein in amniotic fluid is not diagnostic, it does indicate an abnormality of the fetus in a very high proportion of cases. A normal level, however, does not exclude the possibility of a closed neural tube defect. It is therefore recommended that all amniocenteses performed between 15 and 20 weeks of gestation include measurement of alpha-fetoprotein. Maternal serum alpha-fetoprotein assay is a screening test and pilot studies will be necessary to determine its value as a routine prenatal blood test.

Amniocentesis↗

PubMed1986

Neural tube defects in spontaneous abortions.

Nine specimens with neural tube defects (NTDs) were ascertained in a consecutive series of spontaneous abortions in New York City, giving a rate of 10.2 per 1,000 testable embryos and fetuses. All seven successfully karyotyped abortions had a chromosome anomaly. The rate of NTDs in miscarriages in New York is only one-third the rate in miscarriages in London, and the difference is due entirely to a deficit of fetuses with normal chromosomes. Our data, together with data from three other centers, indicate that there is a strongly positive association (r = 0.96) between rates of neural tube defects in early pregnancy and at term. The implications of these findings for genetic counseling and for etiologic studies are discussed.

Abortion, Spontaneous↗

PubMed1992

Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation.

BACKGROUND: The risk of recurrent neural-tube defects is decreased in women who take folic acid or multivitamins containing such during the periconceptional period. The extent to which folic acid supplementation can reduce the first occurrence of defects is not known. METHODS: We conducted a randomized, controlled trial of periconceptional multivitamin supplementation to test the efficacy of this treatment in reducing the incidence of a first occurrence of neural-tube defects. Women planning a pregnancy (in most cases their first) were randomly assigned to receive a single tablet of a vitamin supplement (containing 12 vitamins, including 0.8 mg of folic acid; 4 minerals; and 3 trace elements) or a trace-element supplement (containing copper, manganese, zinc, and a very low dose of vitamin C) daily for at least one month before conception and until the date of the second missed menstrual period or later. RESULTS: Pregnancy was confirmed in 4753 women. The outcome of the pregnancy (whether the fetus or infant had a neural-tube defect or congenital malformation) was known in 2104 women who received the vitamin supplement and in 2052 who received the trace-element supplement. Congenital malformations were significantly more prevalent in the group receiving the trace-element supplement than in the vitamin-supplement group (22.9 per 1000 vs. 13.3 per 1000, P = 0.02). There were six cases of neural-tube defects in the group receiving the trace-element supplement, as compared with none in the vitamin-supplement group (P = 0.029). The prevalence of cleft lip with or without cleft palate was not reduced by periconceptional vitamin supplementation. CONCLUSIONS: Periconceptional vitamin use decreases the incidence of a first occurrence of neural-tube defects.

Cleft Lip↗

PubMed1987

Valproic acid-induced neural tube defects: reduction by folinic acid in the mouse.

Neural tube defects were induced dose-dependently by single injections of the anticonvulsant drug valproic acid (VPA) as sodium salt in mice on gestational day 8. Folinic acid (5-CHO-THF) coadministration by i.p. injection or by a constant rate infusion via osmotic minipumps, implanted s.c., significantly reduced the exencephaly rates using a randomized double-blind experimental procedure. 5-CHO-THF supplementation cut the exencephaly rates into half even at high maternal plasma levels of VPA (p less than 0.005, chi 2-test); resorption rates were not affected. The VPA plasma kinetics were not changed by any of the application regimens of 5-CHO-THF. The investigation of the folate metabolite pattern (determined by HPLC) showed that 5-CHO-THF and 5-methyl-tetrahydrofolic acid (5-CH3-THF) were the main metabolites in untreated mice. After supplementation with 5-CHO-THF, only the concentrations of this folate vitamer were increased in the plasma from 0.3 microgram/ml (normal) to 0.6 or 1.9 micrograms/ml (after injection of 3 x 1 mg/kg or 3 X 4 mg/kg) and to 4.2 micrograms/ml (after infusion via osmotic minipumps). Our results indicate that VPA-induced exencephaly in mice combined with the investigation of the plasma levels of VPA and the different folate metabolites could be an appropriate animal model to study protective effects of folates on the occurrence of neural tube defects.

Animals↗

PubMed1987

Epidemiological studies of neural tube defects in Newfoundland.

A 9-year survey of neural tube defects in Newfoundland showed (1) evidence for secular variation, with a peak in 1980, but no general downward trend as seen in some other populations; (2) significant geographic variation which did not correlate with hardness or nitrate content of the lake water; (3) a tendency for the proportion of females among anencephalic births to increase with increasing frequency of anencephaly among geographic regions. This supports previous evidence for a female-specific contribution to the causes of increased liability to neural tube defect.

Abortion, Spontaneous↗