Posts Tagged Folic Acid
To determine how pre-conception care (PCC) influenced the outcome of epilepsy, pregnancy and malformation risk in women with epilepsy (WWE)
All primigravida in the Kerala registry of epilepsy and pregnancy (KREP) with the final outcome of pregnancy known who were enrolled prospectively in pre-conception stage (PCC group) or first trimester of pregnancy (PRG group) were included. The two groups were compared for fetal and maternal outcomes including seizure control and complications of pregnancy.
There were 320 (30.4%) in PCC group and 732 in PRG group. Both groups were comparable for epilepsy classification, maternal birth defects and family history of epilepsy but the PCC group had significantly higher education (48.9%, p = .027) and employment (22.1%, p < .001). They had higher usage of folate in pre-pregnancy month (87.5%, p < .001) and first trimester (96.3%, p < .001) than PRG group. Fewer women in the PCC group were off AEDs in first trimester (5% vs 9.3%, p = .018). Within monotherapy group, use of levetiracetam (10.8%, p = .017), valproate ( 34%, p = .002) in PCC group and carbamazepine (39.1%, p = .04), phenobarbitone (13.3%, p = .001) in PRG group was significantly high. More women in this group were seizure free during pregnancy (62.8%, p = .005) than PRG group. Early fetal loss was better captured in PCC (90.6%,p = .025) than in the PRG. There was no difference in malformation rate between PCC (7.2%) and PRG groups (6.1%, p = .3).
PCC reduced the risk of seizures during pregnancy and improved the periconceptional use of folate but did not influence the fetal malformation risk.
[Abstract] Unintended pregnancy, prenatal care, newborn outcomes, and breastfeeding in women with epilepsy.
Objective To compare the proportions of unintended pregnancies, prenatal vitamin or folic acid (PNVF) use, adequate prenatal care visits, and breastfeeding among women with epilepsy (WWE) to women without epilepsy (WWoE).
Methods The Pregnancy Risk Assessment Monitoring System (PRAMS) is an annual survey of randomly sampled postpartum women administered by the Centers for Disease Control and Prevention. We used PRAMS data from 13 states from 2009 to 2014 to compare the primary outcomes in WWE and WWoE, as well as our secondary outcomes of contraception practices, newborn outcomes, and time to recognition of pregnancy. We adjusted for maternal age, race, ethnicity, and socioeconomic status (SES), and we calculated odds ratios for these outcomes using logistic regression.
Results This analysis included 73,619 women, of whom 541 (0.7%) reported epilepsy, representing 3,442,128 WWoE and 26,635 WWE through weighted sampling. In WWE, 55% of pregnancies were unintended compared to 48% in WWoE. After adjustment for covariates, epilepsy was not associated with unintended pregnancy or with inadequate prenatal care. WWE were less likely to report breastfeeding but more likely to report daily PNVF use. Newborns of WWE had higher rates of prematurity.
Conclusions Although planning for pregnancy is of utmost importance for WWE, more than half the pregnancies in WWE were unintended. Maternal age and SES differences likely contribute to the higher rates in WWE compared to WWoE. The proportion of women reporting breastfeeding is lower in WWE despite studies indicating the safety of breastfeeding in WWE.
Women with epilepsy were at no disadvantage in getting pregnant as their peers without epilepsy, the prospective Women with Epilepsy: Pregnancy Outcomes and Deliveries (WEPOD) study found.
About 60% of women in both groups became pregnant within a year of discontinuing contraception, according to Page Pennell, MD, of Brigham and Women’s Hospital in Boston and co-authors.
Median time to pregnancy, sexual activity, and ovulatory rates were similar in each group, too, they reported online in JAMA Neurology.
These findings have two meanings, Pennell noted. First, they tell neurologists “that their female patients with epilepsy in their practice who want to become pregnant will have no additional difficulties becoming pregnant just because of their epilepsy,” she said.
But an equally important message is that women with epilepsy are at risk of unplanned pregnancy.
“It is important to always keep this in mind when choosing which medications to prescribe and to recommend supplemental folic acid,” Pennell told MedPage Today. “Other studies have reported that beginning supplemental folic acid prior to pregnancy is important to lower the risk of neurodevelopmental problems and autistic features in the children of women with epilepsy on anti-epileptic drugs.”
Maternal use of valproate (Depakote) in pregnancy has been tied to autism and impaired cognitive development in children, prompting FDA warnings about using the drug during pregnancy. A European Medicines Agency committee recently advised that valproate use be restricted in fertile women unless they participate in a pregnancy prevention program.
Research indicates that prenatal exposure to newer anti-epileptic drugs like levetiracetam (Keppra) or topiramate (Topamax) is not linked to reduced cognitive abilities in children, but a recent study indicates that women on anti-seizure medications who did not take folic acid supplements before conception had a substantially increased risk of having offspring with autistic traits.
Previous studies also have suggested that women with epilepsy may have lower fertility especially if they use multiple anti-seizure medications, but WEPOD is the first prospective study of pregnancy that included controls, the authors noted. All women in WEPOD planned their pregnancy in advance, distinguishing it from pregnancy registry or population studies.
In WEPOD, the researchers followed women with a steady male partner who wanted to become pregnant within a year of ending contraception, excluding women with a history of infertility or related disorders.
Patients recorded sexual activity and menstrual bleeding through a custom smartphone application, a web-based interface, or a paper diary. Patients in the epilepsy group also tracked their medication use and seizures.
A total of 88 women with epilepsy and 109 healthy controls enrolled in the WEPOD study throughout four U.S. academic centers. Most participants (72.1%) were white. The average age of women with epilepsy was about 32, and the average age of controls was about 31. Most women with epilepsy used monotherapy to control seizures: 44.8% used lamotrigine (Lamictal) and 28.7% used levetiracetam.
In total, 60.7% of women with epilepsy achieved pregnancy, as did 60.2% of controls.
After controlling for key covariates like age, body mass index (BMI), parity, and race, the median time to pregnancy was similar in each group: 6 months (95% CI 3.8-10.1) for women with epilepsy, and 9 months (95% CI 6.5-11.2; P=0.30) for controls. In both groups, the same proportion (81.5%) of pregnancies resulted in a live birth. No epilepsy factors were significant.
These findings allow neurologists “to provide hope, backed up by data, that if a woman with epilepsy does not have a prior gynecologic diagnosis related to infertility, then she will have the same likelihood of achieving pregnancy and same pregnancy outcomes as her female peers,” Pennell said.
The study does not answer whether women with epilepsy have different rates of infertility or polycystic ovary syndrome (PCOS) because women with these diagnoses were excluded, the authors noted. While prior research indicates that PCOS occurs more frequently in women with epilepsy, the researchers did not include these women in the study to give physicians information about the “more common clinical scenario of women with epilepsy without a preexisting diagnosis of infertility or associated disorders” who want to become pregnant.
The authors listed several other limitations: Some women may have become pregnant before they could be recruited. And it’s possible the researchers did not account for unmeasured differences between women with epilepsy and controls that may have occurred because the study used multiple sources of recruitment.
by Viatcheslav Wlassoff, PhD | January 15, 2018
It is often said that we are what we eat. The food we eat is used not only to fuel our body, but also to build it. This applies to the brain as well. Food choices can influence our brain functions in both positive and negative ways. The right food may enhance brain functioning and ameliorate the cognitive decline associated with aging. In addition, some foods can improve our emotional status and prevent conditions like depression.
Lipids are good for brain—myth or reality?
It is a fact that some lipids, including unsaturated fatty acids, are necessary for brain developmentand functioning. This is not surprising if we consider that the brain is the second richest organ in lipids. Approximately 50–60% of the brain is made of lipids. But not all the fatty acids are equally good for the brain. Omega-3 fatty acids found in fatty fish (salmon, mackerel, herring) and seafood are essential for the brain. These fatty acids constitute brain cell membranes. Also, they are main compounds of myelin, a fatty coat that insulates neurons (brain and ensures transmission of signals.
Omega-3 fats play vital functions in improving cognitive functions, providing proper neuronal communication and securing adequate attention. Interestingly, consumption of just one fish meal per weak is believed to decrease the risk of Alzheimer’s disease by up to 60%. Human clinical trials showed that supplementation with omega-3 fatty acids might improve mood, cooperation and cognitive score in subjects with dementia. Omega-3 fatty acids are extremely important for neonatal development as well. A deficit in these fats in pregnant and breastfeeding women, as well as in early childhood, may lead to conditions like autism and attention deficit hyperactivity disorder (ADHD).
Polyunsaturated (omega-3) and monounsaturated fatty acids also regulate the brain’s dopamine system. This is how they improve levels of dopamine and serotonin—the chemicals that make us feel happy. This is why diets with high fish consumption are associated with a low prevalence of depression. Cross-national analyses declared Japan as a country with the highest fish intake on the one hand and the lowest depression score on the other.
Apart from fish meals, walnuts (and nuts in general) are rich sources of omega-3 fatty acids. They contain essential alpha-linolenic fatty acids that cannot be synthesized inside our body and need to be obtained from our diet. Flaxseed and flaxseed oils are other valuable sources of this fatty acid. In addition to omega-3 fats, walnuts contain potential brain antioxidants—vitamin E and polyphenols.
Olive oil is an especially rich source of monounsaturated fatty acids, with oleic acid as the main representative. Like omega-3, monounsaturated fatty acids help to improve cognitive functions and prevent age-related cognitive decline. These fats are also found in avocados. This is why avocado is commonly labeled as a brain superfood. It is assumed that eating just a quarter or half of a avocado daily can help maintain brain health.
Antioxidants: food for thought
Brain membranes are rich in polyunsaturated fatty acids that are highly susceptible to oxidation. The oxidation of fatty acids leads to changes in membrane structure that can jeopardize brain functioning. When fatty acids are oxidized, membranes are damaged or even ruptured. This makes the intake of nutrients into brain cells quite difficult. The lack of nutrients stops normal functions of brain cells and eventually causes their death.
Oxidation of brain lipids occurs when the production of free radicals is greater than their removal by antioxidants present in the body. Thus, the adequate intake of antioxidants can prevent oxidation of brain lipids and slow down the loss of brain functions. This is why berries and fruits with high antioxidant potential are often recommended as good foods for the brain. Some findings suggest that high intake of blueberries and strawberries can halt the onset of age-related cognitive decline by up to 2.5 years. What makes berries powerful antioxidants is the presence of polyphenols, chemicals that give color to these fruits. Berries can decrease aging-related vulnerability to oxidative stress. These decrease further manifests with improvements in behavior. Human trials in people with mild cognitive impairments suggested the positive impact of berries on verbal memory performance. Apart from combating oxidative stress in the brain, polyphenols can also improve microcirculation. By enhancing blood flow, polyphenols help the proper nourishment of the brain that is important for its functioning.
Another food rich in polyphenols (more precisely epicatechin) that is believed to enhance cognition is dark chocolate. It is assumed that by decreasing oxidative stress and inflammation, dark chocolate improves memory and confers neuroprotection. Still, human trials are required to establish if dark chocolate can be considered as a brain superfood.
Curcuminoids are phenolic compounds from turmeric (popular curry spice) that can enhance memory and protect from neurodegenerative diseases, like Alzheimer’s. Although this opinion is mostly based on animal studies, it is likely that prevalence of Alzheimer’s disease in India is very low due to the common consumption of curry.
A diet rich in vitamins, minerals, and antioxidants, such as polyphenols and their subclass flavonoids, is assumed to suppress the incidence of Alzheimer’s disease. One of the foods containing all of these components is spinach. Spinach, like other leafy green vegetables, contains folic acid and vitamin K that are believed to help keep the brain sharp. Although vitamin K is important for producing myelin, the substance that insulates neurons, the effects of dietary vitamin K supplementation on the function of brain myelin have not been tested so far.
Other cognitive enhancers
Another possible brain stimulator representing one of the most popular drinks worldwide is tea. An interesting study in Chinese adults tracked the association between tea consumption and cognitive decline. The higher tea intake was associated with lower prevalence of cognitive impairments, suggesting that regular tea consumption may slow down cognitive decline. Interestingly, the association was most evident for black tea. The same study showed no association between coffee intake and cognitive status.
Extracts from herb Ginkgo biloba have been traditionally used for memory and concentration problems, but also for dealing with depression and anxiety. A recent meta-analysis found no impact of ginkgo on cognitive functions in healthy subjects, suggesting that the effects of Ginko may be rather minor. Nonetheless, some earlier studies showed that ginkgo together with ginseng may acutely enhance memory in a dose-dependent manner. Unlike ginkgo, human trials with ginseng showed that its consumption can improve working memory performance and mood in terms of calmness.
Although further clinical trials are needed to confirm the cognitive enhancement by many foods, it is evident that diet represents a promising tool for maintaining and improving brain health.
Muldoon, M.F., Ryan, C.M., Sheu, L., Yao, J.K., Conklin, S.M., Manuck, S.B. (2010). Serum phospholipid docosahexaenonic acid is associated with cognitive functioning during middle adulthood. Journal of Nutrition. 140(4): 848-853. doi: 10.3945/jn.109.119578
Terano, T., Fujishiro, S., Ban, T., Yamamoto, K., Tanaka, T., et al. (1999). Docosahexaenoic acid supplementation improves the moderately severe dementia from thrombotic cerebrovascular diseases. Lipids. 34 Supplement: S345-S346. PMID: 10419198
Gómez-Pinilla, F. (2008). Brain foods: the effects of nutrients on brain function. Nature Reviews. Neuroscience. 9(7): 568-578. doi: 10.1038/nrn2421
Joseph, J.A., Shukitt-Hale, B., Willis, L.M. (2009). Grape juice, berries, and walnuts affect brain aging and behavior. Journal of Nutrition. 139(9): 1813S-1817S. doi: 10.3945/jn.109.108266
Ahmed, T., Enam, S.A., Gilani, A.H. (2010). Curcuminoids enhance memory in an amyloid-infused rat model of Alzheimer’s disease. Neuroscience. 169(3): 1296-1306. doi: 10.1016/j.neuroscience.2010.05.078
Ng, T.P., Feng, L., Niti, M., Kua, E.H., Yap, K.B. (2008). Tea consumption and cognitive impairment and decline in older Chinese adults. American Journal of Clinical Nutrition. 88(1): 224-231. PMID: 18614745
Laws, K.R., Sweetnam, H., Kondel, T.K. (2012). Is Ginkgo biloba a cognitive enhancer in healthy individuals? A meta-analysis. Human Psychopharmacology. 27(6):527-533. doi: 10.1002/hup.2259
[WEB SITE] Pregnant Women with Epilepsy Who Take Folic Acid Reduce the Risk of Having an Autistic Child.
BY SARAH OWENS
Pregnant women taking antiepileptic drugs (AEDs) who supplemented their diets with folic acid had a reduced risk of having a child with autistic traits, according to a study published online on December 26 in JAMA Neurology.
Folic Acid’s Importance
Folic acid supplements are generally recommended to all pregnant women to reduce the risk of birth complications, such as spina bifida, as well as neurodevelopmental complications.
Supplementation may be especially important for pregnant women who take AEDs, which treat epilepsy and seizures, since anti-seizure drugs are known to interfere with folate absorption and metabolism.
Additionally, research has shown that children born to mothers who took AEDs during pregnancy have an increased risk of developing autistic traits, including repetitive behaviors and impaired social skills and communication.
Studying Mothers with Epilepsy
To find out if folic supplementation would decrease the risk of having a child with autistic traits for women taking AEDs during pregnancy, researchers at several universities in Norway assessed data on participants in the Norwegian Mother and Child Cohort study, a long-running study of the health of pregnant women and their children in Norway. Participants had an ultrasonographic examination between June 1999 and December 2008 and provided information on their use of AEDs and folic acid supplementation during pregnancy as well as follow-up information on the health of their children.
A total of 104,946 children between the ages of 18 and 36 months who were born between March 2016 and June 2017, were included. As part of the study, the mothers answered questions about their children’s health using a test that measures autistic traits. The mothers were asked questions such as, “Does your child enjoy being bounced on your knee?” and “Does your child take interest in other children?”
The researchers then compared the mothers’ information on AED use and folic acid supplementation with their answers on the test to look for associations.
A Clear Connection
The researchers discovered that women who took AEDs during pregnancy and also took folic acid supplements were significantly less likely to have a child with autistic traits than pregnant women who took AEDs but did not supplement with folic acid. In particular, they found that higher folic acid levels between weeks 17 and 19 of pregnancy were associated with a reduced risk of autistic traits.
The findings, the study authors conclude, suggest that all women of childbearing age who take AEDs should take folic acid supplementation to reduce the risk of autistic traits in their children.
via Neurology Now