Factores de riesgo maternos y defectos de tubo neural en la descendencia, en dos hospitales de Nicaragua, 2016-2020. Un estudio de casos y controles.
DOI:
https://doi.org/10.5377/universitas.v14i1.16471Palabras clave:
defectos del tubo neural, factor de riesgo, ácido fólico, planificación del embarazo.Resumen
Los defectos del tubo neural (DTN) son las segundas malformaciones congénitas más comunes que afectan el desarrollo del sistema nervioso central, con alta prevalencia en la región occidental de Nicaragua.Este estudio analiza la asociación entre los factores de riesgos maternos y ambientales y DTN en la descendencia. Método: Se realizó un estudio de casos y controles en los hospitales universitarios de León y Chinandega entre enero 2016 y diciembre de 2020. Los casos (76) se definieron como nacidos vivos o mortinatos con DTN. Los controles (146) recién nacidos sin defectos del tubo neural con una proporción (2:1) se emparejaron por fecha y hospital de nacimiento.Se utilizó un modelo de regresión multivariado para estudiar la asociación entre las características maternas y ambientales con el riesgo de desarrollar defectos del tubo neural. Resultados: 73 casos con DTN y 146 controles sanos fueron incluidos en este estudio. El no tomar suplementos con ácido fólico durante el primer trimestre del embarazo (ORA= 16.0, IC95%: 5.9-43.3), la procedencia rural (ORA= 2.7, IC95% : 1.23-6.21) y el bajo peso al nacer (ORA= 9.9, IC 95%: 3.12-31.60), se determinaron como factores de riesgo con significancia estadística.Conclusión: La falta de consumo de suplementos con ácido fólico durante etapas tempranas del embarazo es un factor de riesgo consistente de defectos de tubo neural, en la región noroccidental de Nicaragua. Fortalecer los planes de información, educación y comunicación sobre consumo de ácido fólico a las mujeres en edad reproductiva deben ser considerados para incrementar el consumo de este micronutriente y disminuir los DTN.
Descargas
361
Citas
Au, K. S., Ashley‐Koch, A., Northrup, H., Ashley-Koch, A., & Northrup, H. (2010). Epidemiologic and genetic aspects of spina bifida and other neural tube defects. Developmental Disabilities Research Reviews, 16(1), 6–15. https://doi.org/10.1002/ddrr.93
Berihu, B. A., Welderufael, A. L., Berhe, Y., Magana, T., Mulugeta, A., Asfaw, S., & Gebreselassie, K. (2018). High burden of neural tube defects in Tigray, Northern Ethiopia: Hospital-based study. PLOS ONE, 13(11), e0206212. https://doi.org/10.1371/JOURNAL.PONE.0206212
Berry, R. J., Li, Z., Erickson, J. D., Li, S., Moore, C. A., Wang, H., Mulinare, J., Zhao, P., Wong, L.-Y. C., Gindler, J., Hong, S.-X., Hao, L., Gunter, E., & Correa, A. (1999). Prevention of neural-tube defects with folic acid in China. New England Journal of Medicine, 341(20), 1485–1490. https://doi.org/10.1056/NEJM199911113412001
Blencowe, H., Kancherla, V., Moorthie, S., Darlison, M. W., & Modell, B. (2018). Estimates of global and regional prevalence of neural tube defects for 2015: a systematic analysis. Ann. N.Y. Acad. Sci. https://doi.org/10.1111/nyas.13548
Castillo-Lancellotti, C., Tur, J. A., & Uauy, R. (2013). Impact of folic acid fortification of flour on neural tube defects: A systematic review. In Public Health Nutrition (Vol. 16, Issue 5, pp. 901–911). Cambridge University Press. https://doi.org/10.1017/S1368980012003576
Christianson, A., Howson, C. P., & Modell, B. (2005). March of Dimes: global report on birth defects, the hidden toll of dying and disabled children. March of Dimes: Global Report on Birth Defects, the Hidden Toll of Dying and Disabled Children.
COMIECO. (2010). Reglamento Tecnico Centroamericano anexo de la resolucion 201-2007 (COMIECO-XLV) Harinas. Harina de trigo fortificada. Espoecificaciones. Gaceta Diario Oficial, 87.
Crider, K. S., Bailey, L. B., & Berry, R. J. (2011). Folic acid food fortification—its history, effect, concerns, and future directions. Nutrients, 3(3), 370–384. https://doi.org/10.3390/nu3030370
Desrosiers, T. A., Lawson, C. C., & Meyer, R. E. (2012). No Title. Occup Environ Med, 69(null), 493.
Ferrazzi, E., Tiso, G., & Di Martino, D. (2020). Folic acid versus 5-methyl tetrahydrofolate supplementation in pregnancy. European Journal of Obstetrics & Gynecology and Reproductive Biology.
Fine, E. L., Horal, M., Chang, T. I., Fortin, G., & Loeken, M. R. (1999). Evidence that elevated glucose causes altered gene expression, apoptosis, and neural tube defects in a mouse model of diabetic pregnancy. Diabetes, 48(12), 2454–2462.
Finnell, R. H., Caiaffa, C. D., Kim, S.-E., Lei, Y., Steele, J., Cao, X., Tukeman, G., Lin, Y. L., Cabrera, R. M., & Wlodarczyk, B. J. (2021). Gene Environment Interactions in the Etiology of Neural Tube Defects. Frontiers in Genetics, 12, 659612. https://doi.org/10.3389/fgene.2021.659612
Greene, N. D. E., & Copp, A. J. (2014). Neural Tube Defects. Annual Review of Neuroscience, 37, 221. https://doi.org/10.1146/ANNUREV-NEURO-062012-170354
Houk, V. N., Oakley, G. P., Erickson, J. D., Mulinare, J., & James, L. M. (1992). Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects. In MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control (Vol. 41, Issue RR-14, pp. 1–7).
Hoyt, A. T., Canfield, M. A., Romitti, P. A., Botto, L. D., Anderka, M. T., Krikov, S. V, Tarpey, M. K., & Feldkamp, M. L. (2016). Associations between maternal periconceptional exposure to secondhand tobacco smoke and major birth defects. American Journal of Obstetrics and Gynecology, 215(5), 613.e1-613.e11. https://doi.org/10.1016/j.ajog.2016.07.022
Imbard, A., Benoist, J.-F. F., & Blom, H. J. (2013). Neural Tube Defects, Folic Acid and methylation. International Journal of Environmental Research and Public Health, 10(9), 4352–4389. https://doi.org/10.3390/ijerph10094352
Iskandar, B. J., & Finnell, R. H. (2022). Spina Bifida. The New England Journal of Medicine, 387(5), 444–450. https://doi.org/10.1056/NEJMra2116032
Kalra, S., Dewan, P., Batra, P., Sharma, T., Tyagi, V., & Banerjee, B. D. (2016). Organochlorine pesticide exposure in mothers and neural tube defects in offsprings. Reproductive Toxicology, 66, 56–60.
Kancherla, V. (2023). Neural tube defects: a review of global prevalence, causes, and primary prevention. Child’s Nervous System, 1–8.
Kondo, A., Matsuo, T., Morota, N., Kondo, A. S., Okai, I., & Fukuda, H. (2017). Neural tube defects: Risk factors and preventive measures. Congenital Anomalies, 57(5), 150–156.
López‐Camelo, J. S., Orioli, I. M. I. M., Dutra, M. da G., Nazer‐Herrera, J., Rivera, N., Ojeda, M. E. M. E., Canessa, A., Wettig, E., Fontannaz, A. M., Mellado, C. C., Lopez-Camelo, J. S., Orioli, I. M. I. M., Da Grace Dutra, M., Nazer-Herrera, J., Rivera, N., Ojeda, M. E. M. E., Canessa, A., Wettig, E., Fontannaz, A. M., … Castilla, E. E. (2005). Reduction of birth prevalence rates of neural tube defects after folic acid fortification in Chile. American Journal of Medical Genetics Part A, 135(2), 120–125. https://doi.org/10.1002/ajmg.a.30651
McDowell, M. A., & Center for Health Statistics, N. (2008). Blood folate levels; the latest NHANES results. NCHS.
Medveczky, E., Puhó, E., & Czeizel, A. E. (2004). An evaluation of maternal illnesses in the origin of neural-tube defects. Archives of Gynecology and Obstetrics, 270(4), 244–251. https://doi.org/10.1007/s00404-003-0553-2
MIFIC. (2011). Norma Tecnica Nicaraguense, foritficacion del arroz. NTON – 03 091 11.
Molloy, A. M. (2018). Should vitamin B(12) status be considered in assessing risk of neural tube defects? Annals of the New York Academy of Sciences, 1414(1), 109–125. https://doi.org/10.1111/nyas.13574
Mulinare, J., Cordero, J. F., Erickson, J. D., & Berry, R. J. (1988). Periconceptional Use of Multivitamins and the Occurrence of Neural Tube Defects. JAMA, 260(21), 3141–3145. https://doi.org/10.1001/jama.1988.03410210053035
Mundial, B. (2019). Tasa de mortalidad, neonatal (por cada 1.000 nacidos vivos). Recuperado de Https://Datos. Bancomundial. Org/Indicador/SH. DYN. NMRT. https://datos.bancomundial.org/indicator/SP.DYN.IMRT.IN?locations=NI
Nasri, H. Z., Houde Ng, K., Westgate, M.-N., Hunt, A.-T., & Holmes, L. B. (2018). Malformations among infants of mothers with insulin-dependent diabetes: Is there a recognizable pattern of abnormalities? Birth Defects Research, 110(2), 108–113. https://doi.org/10.1002/bdr2.1155
Orioli, I. M., Dolk, H., Lopez-Camelo, J., Groisman, B., Benavides-Lara, A., Gimenez, L. G., Correa, D. M., Ascurra, M., de Aquino Bonilha, E., Canessa-Tapia, M. A., de França, G. V. A., Hurtado-Villa, P., Ibarra-Ramírez, M., Pardo, R., Pastora, D. M., Zarante, I., Soares, F. S., de Carvalho, F. M., & Piola, M. (2020). The Latin American network for congenital malformation surveillance: ReLAMC. American Journal of Medical Genetics. Part C, Seminars in Medical Genetics, 184(4), 1078–1091. https://doi.org/10.1002/ajmg.c.31872
Ramya, S., Shyamasundar, S., Bay, B. H., & Dheen, S. T. (2017). Maternal diabetes alters expression of microRNAs that regulate genes critical for neural tube development. Frontiers in Molecular Neuroscience, 10, 237.
Rehman, L., Shiekh, M., Afzal, A., & Rizvi, R. (2020). Risk factors, presentation and outcome of meningomyelocele repair. Pakistan Journal of Medical Sciences, 36(3), 422.
Ren, A., Qiu, X., Jin, L., Ma, J., Li, Z., Zhang, L., Zhu, H., Finnell, R. H., Zhu, T., & Smith, K. R. (2011). Association of selected persistent organic pollutants in the placenta with the risk of neural tube defects. Proceedings of the National Academy of Sciences of the United States of America, 108(31), 12770–12775. https://doi.org/10.1073/pnas.1105209108
Salazar-Reviakina, A., Sierra-Bretón, M., Rumbo, J., Madariaga, I., Tovar, C., Uribe, M., Sequera, C., Rodríguez, C., Holguín, J., & Sarmiento, K. (2021). Characterization of Risk Factors for Neural Tube Defects: A Case-Control Study in Bogota and Cali, Colombia, 2001-2018. Journal of Child Neurology, 36(7), 509–516.
Smithells, R. W., Sheppard, S., Schorah, C. J., Seller, M. J., Nevin, N. C., Harris, R., Read, A. P., & Fielding, D. W. (1980). Possible prevention of neural-tube defects by periconceptional vitamin supplementation. The Lancet, 315(8164), 339–340.
Suarez, L., Felkner, M., Brender, J. D., Canfield, M., & Hendricks, K. (2008). Maternal exposures to cigarette smoke, alcohol, and street drugs and neural tube defect occurrence in offspring. Maternal and Child Health Journal, 12(3), 394–401. https://doi.org/10.1007/s10995-007-0251-y
Teratogenicity of antiepileptic drugs, 32 Current Opinion in Neurology 246 (2019). https://doi.org/10.1097/WCO.0000000000000659
Waller, D. K., Hashmi, S. S., Hoyt, A. T., Duong, H. T., Tinker, S. C., Gallaway, M. S., Olney, R. S., Finnell, R. H., Hecht, J. T., & Canfield, M. A. (2018). Maternal report of fever from cold or flu during early pregnancy and the risk for noncardiac birth defects, National Birth Defects Prevention Study, 1997–2011. Birth Defects Research, 110(4), 342–351. https://doi.org/10.1002/bdr2.1147
Wallingford, J. B., Niswander, L. A., Shaw, G. M., & Finnell, R. H. (2013). The continuing challenge of understanding, preventing, and treating neural tube defects. Science, 339(6123), 1222002. https://doi.org/10.1126/science.1222002
Watkins, M. L., Rasmussen, S. A., Honein, M. A., Botto, L. D., & Moore, C. A. (2003). Maternal obesity and risk for birth defects. Pediatrics, 111(Supplement 1), 1152–1158.
WHO. (2018). GHO | By category | Number of deaths by region - Congenital anomalies. WHO; World Health Organization. https://apps.who.int/gho/data/view.main.CM1002015REG6-CH15?lang=en
Williams, J., Mai, C. T., Mulinare, J., Isenburg, J., Flood, T. J., Ethen, M., Frohnert, B., Kirby, R. S., & Centers for Disease Control and Prevention. (2015). Updated Estimates of Neural Tube Defects Prevented by Mandatory Folic Acid Fortification — United States, 1995–2011. Morbidity and Mortality Weekly Report, 64(1), 1.
World Health Organization. (2020). Children: improving survival and well-being. OMS Perú. https://www.who.int/news-room/fact-sheets/detail/children-reducing-mortality
Zaganjor, I., Sekkarie, A., Tsang, B. L., Williams, J., Razzaghi, H., Mulinare, J., Sniezek, J. E., Cannon, M. J., & Rosenthal, J. (2016). Describing the prevalence of neural tube defects worldwide: a systematic literature review. PloS One, 11(4).
Zaheri, F., Ranaie, F., Shahoei, R., Hasheminasab, L., & Roshani, D. (2017). Risk factors associated with neural tube defects in infants referred to western Iranian obstetrical centers; 2013–2014. Electronic Physician, 9(6), 4636.
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2023 Universidad Nacional Autonoma de Nicaragua
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-CompartirIgual 4.0.
Copyright © Universidad Nacional Autónoma de Nicaragua, León. VRIIE
