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Cardiology |
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| 14 Oct 2009 | Viewed: 29 | |
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Pregnant women are advised to take vitamin supplements containing
folic acid as part of their routine pre-natal care. Now, a new study
warns that taking medications that reduce or block the actions of folic
acid during the first trimester of pregnancy increase the risk that the
growing baby will develop abnormalities. The large collaborative cohort
study was conducted by researchers at Ben-Gurion University of the
Negev.
This conclusion just published in the British Journal of Clinical Pharmacology
was reached by a team of epidemiologists, pediatricians, clinical
pharmacologists, obstetricians and gynecologists who examined birth and
abortion data collected in Israel between 1998 and 2007.
The study obtained medication data from pregnant mothers
registered at Clalit HMO, Southern District, and drew information from
84,832 babies born at Soroka University Medical Center in Beer-Sheva,
Israel. It was carried out as part of the Ph.D. dissertation of Ilan
Matok, and supervised by principal investigators Dr. Amalia Levy and
Prof. Rafael Gorodischer from Ben-Gurion University of the Negev in
Israel, in collaboration with Prof. Gideon Koren from the Division of
Clinical Pharmacology, Hospital for Sick Children in Toronto, Canada
(the BeMORE collaboration).
"After studying the data, we concluded that first trimester
exposure to folic acid antagonists is associated with increased risk
for neural tube, cardiovascular and urinary tract defects," according
to the pediatrician and clinical pharmacologist, principal investigator
Dr. Rafael Gorodischer, professor emeritus at Ben-Gurion University of
the Negev.
Healthcare professionals now encourage women to take folic
acid supplements or eat food fortified with folic acid if they are
planning to get pregnant, as well as during early pregnancy because
there is clear evidence that this reduces the risk of any resulting
baby having neural tube defects and possibly other birth defects
(congenital malformations).
The team considered the effects of two groups of medications
on pregnancy. Each group consists of drugs that prevent folic acid
working in the body. One group (dihydrofolate reductase inhibitors)
prevents folate from being converted into its active metabolites and
includes trimethoprim (antibiotic),
sulfasalazine (for ulcerative colitis) and methotrexate
(chemotherapeutic). The other medications are known to lower serum and
tissue concentrations of folate by various mechanisms, and include
antiepileptics (carbamazepine, phenytoin, lamotrigine, primidone,
valproic acid and phenobarbital) and cholestyramine (reduces cholesterol).
"The study shows that exposure to folic acid antagonists in the first
trimester of pregnancy more than doubles the risk of congenital
malformations in the fetus, and that neural tube defects, such as spina
bifida and malformations of the brain, increase by more than six-fold
after exposure to these antagonists," said Dr. Amalia Levy, an
epidemiologist with the BGU Faculty of Health Sciences and chair of the
BeMORE collaboration.
"Clinicians should try to avoid the use of these drugs
whenever possible in women contemplating pregnancy," concluded
Gorodischer.
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| News Source: medical news today |
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