RESUMO
RESUMEN: La fisura labiopalatina ha tenido una alta frecuencia en la población chilena. A partir del 2000 se inició el programa de fortificación de la harina con ácido fólico a fin de disminuir los defectos del tubo neural. El objetivo de este estudio fue determinar el impacto que presenta la incorporación del ácido fólico en la incidencia de fisuras labiopalatinas de la población del área occidente de la Región Metropolitana. Se recopiló información a partir de las fichas clínicas de la Fundación Gantz seleccionando a los recién nacidos entre 1990 y 2009, correspondientes a las comunas del Servicio de Salud Occidente de la Región Metropolitana. Desde el 2000 hasta el 2004 se observó una disminución importante en las tasas de fisura labiopalatina, con una tasa de 0,88 fisurados por 1000 recién nacidos vivos. Posteriormente se observó un incremento a partir del 2005 hasta el 2009 llegando a una tasa de 1,52 fisurados por 1000 recién nacidos vivos. En conclusión, el efecto protector del ácido fólico se evidencia en la disminución de las tasas de los recién nacidos con fisuras durante los primeros años de su implementación. Sin embargo, posteriormente se observó un aumento de dichas tasas, lo cual podría deberse al incumplimiento de la norma.
ABSTRACT: Cleft lip and palate has had a high frequency in the Chilean population. From the year 2000 a flour fortification program with folic acid was initiated in order to reduce the defects of the neural tube. The objective of this study was to determine the impact of the incorporation of folic acid in the incidence of cleft lip and palate of the population of the western area of the Metropolitan Region. Information was collected from clinical records of the Gantz Foundation, selecting newborns from 1990 to 2009, corresponding to the districts of the western sector of the Metropolitan Region. From 2000 to 2004 there was a significant decrease in cleft lip and palate rates, with a rate of 0.88 cases per 1000 live births. Subsequently, an increase was observed from 2005 to 2009, reaching a rate of 1.52 cases per 1000 live births. In conclusion, the protective effect of folic acid is evidenced in the reduction of the rates of newborns with cleft palate during the first years of its implementation. However, an increase in these rates was subsequently observed, which could be due to noncompliance with the standard.
Assuntos
Humanos , Alimentos Fortificados , Fenda Labial/prevenção & controle , Fenda Labial/epidemiologia , Fissura Palatina/prevenção & controle , Fissura Palatina/epidemiologia , Ácido Fólico/farmacologia , Chile/epidemiologia , PrevalênciaRESUMO
OBJECTIVE: Orofacial clefts (OFC) are the most prevalent craniofacial birth defect. Folic acid (FA) supplementation has been demonstrated as an effective intervention to reduce risk of OFC occurrence. However, the effect of mandatory FA fortification of wheat and/or maize flour on OFC prevalence has shown controversial results among countries adopting this policy. Thus, we performed a meta-analysis to synthesize the available evidence evaluating the global impact of this mandatory policy on OFC occurrence. DESIGN: Literature search in conventional and grey medical/scientific databases showed fifteen studies considering OFC prevalence in pre- and post-fortification periods with FA. The effect of this policy was evaluated by computing relative risk (RR) and separating samples into total OFC, non-syndromic forms, cleft lip with or without cleft palate (CL/P) and cleft palate only (CPO). RESULTS: We found a significant effect of FA fortification only on non-syndromic CL/P (RR=0·88; 95 % CI 0·81, 0·96), whereas neutral effects were detected for total OFC (syndromic plus non-syndromic) and CPO. CONCLUSIONS: Our results may reflect the different aetiology of syndromic OFC with respect to non-syndromic forms and the CL/P related to CPO. Although the number of non-syndromic CL/P samples was lower than that for total OFC, the absence of both between-study heterogeneity and publication bias leads us to conclude that FA fortification may have beneficial effects on non-syndromic CL/P.
Assuntos
Fenda Labial/epidemiologia , Fenda Labial/prevenção & controle , Fissura Palatina/epidemiologia , Fissura Palatina/prevenção & controle , Ácido Fólico/farmacologia , Alimentos Fortificados , Humanos , PrevalênciaRESUMO
BACKGROUND: The effect of food fortification with folic acid on the incidence of lip-palate fissures (FLP) is under discussion. AIM: To calculate the rate of hospital discharges due to cleft lip and palate (CLP) and explore whether they decreased after the start of folic acid fortification in Chile. MATERIAL AND METHODS: The hospital discharge databases published by the Chilean Ministry of Health were analyzed. The trends of discharge rates due to CLP of children of less than one year of life (ICD-10 Q350-379 code) and live births (lb) were calculated from 1986 to 2012. Variables such as incidence of rubella, poverty rate, obesity in pregnant women, and percentage of women who smoked or drank alcohol in the last month were included. The relative risk (RR) of CLP pre-fortification (1986-1999) and post-fortification (2000-2010) was calculated. Mixed and Prais-Winsten models were used to adjust other variables. RESULTS: The hospital discharge rate due to CLP decreased from 1.88 x 1,000 lb during 1986-1996 to 1.68 x 1,000 lb (RR = 1.09 (95% CI 1.05-1.14, p < 0.001). Prais-Winsten and Mixed models, determined that folic acid fortification is the variable explaining this decrease. During 2004-2011, hospital discharge rates for cleft lip decreased but there was an increase in the figures for cleft lip and palate. CONCLUSIONS: The 9% decrease in hospital discharge rates for CLP is concomitant with wheat folic acid fortification.
Assuntos
Fenda Labial/epidemiologia , Fissura Palatina/epidemiologia , Ácido Fólico/administração & dosagem , Alimentos Fortificados , Alta do Paciente/estatística & dados numéricos , Chile/epidemiologia , Fenda Labial/prevenção & controle , Fissura Palatina/prevenção & controle , Farinha/análise , Humanos , Incidência , Lactente , Recém-Nascido , Análise Multivariada , Defeitos do Tubo Neural/prevenção & controleRESUMO
Background: The effect of food fortification with folic acid on the incidence of lip-palate fissures (FLP) is under discussion. Aim: To calculate the rate of hospital discharges due to cleft lip and palate (CLP) and explore whether they decreased after the start of folic acid fortification in Chile. Material and Methods: The hospital discharge databases published by the Chilean Ministry of Health were analyzed. The trends of discharge rates due to CLP of children of less than one year of life (ICD-10 Q350-379 code) and live births (lb) were calculated from 1986 to 2012. Variables such as incidence of rubella, poverty rate, obesity in pregnant women, and percentage of women who smoked or drank alcohol in the last month were included. The relative risk (RR) of CLP pre-fortification (1986-1999) and post-fortification (2000-2010) was calculated. Mixed and Prais-Winsten models were used to adjust other variables. Results: The hospital discharge rate due to CLP decreased from 1.88 x 1,000 lb during 1986-1996 to 1.68 x 1,000 lb (RR = 1.09 (95% CI 1.05-1.14, p < 0.001). Prais-Winsten and Mixed models, determined that folic acid fortification is the variable explaining this decrease. During 2004-2011, hospital discharge rates for cleft lip decreased but there was an increase in the figures for cleft lip and palate. Conclusions: The 9% decrease in hospital discharge rates for CLP is concomitant with wheat folic acid fortification.
Assuntos
Humanos , Recém-Nascido , Lactente , Alta do Paciente/estatística & dados numéricos , Alimentos Fortificados , Fenda Labial/epidemiologia , Fissura Palatina/epidemiologia , Ácido Fólico/administração & dosagem , Chile/epidemiologia , Incidência , Análise Multivariada , Fenda Labial/prevenção & controle , Fissura Palatina/prevenção & controle , Farinha/análise , Defeitos do Tubo Neural/prevenção & controleRESUMO
BACKGROUND: Orofacial clefts (OFCs) have complex and multifactorial etiologies. Periconceptional folic acid supplementation can significantly reduce the risk of OFC. OBJECTIVE: To evaluate the role of folate and other factors in preventing OFC by analyzing the health and socio-demographic data collected from a population sample. METHODS: Retrospective case-control study in which mothers with children with or without OFC were evaluated for the following main parameters: nutritional factors, socio-demographic characteristics, pregnancy and family history, use of folate, and counseling by healthcare professionals. RESULTS: Socio-epidemiological analysis of the 80 participants, 40 in the case group and 40 in the control group, found a significant impact on the risk of OFC related to economic and educational status. The mothers who had a diet rich in vegetables and white meat had a lower risk of having children with OFC. A short interval between pregnancies, subsequent pregnancy while still breastfeeding, and family history also increased risk of OFC. CONCLUSIONS: Limited family planning, diet low in folate, and inadequate use of folate during the periconceptional period and during the first trimester of pregnancy were demonstrated a potential correlation with a high incidence of OFC in this study.
Assuntos
Fenda Labial/epidemiologia , Fissura Palatina/epidemiologia , Ácido Fólico/administração & dosagem , Adolescente , Adulto , Brasil/epidemiologia , Estudos de Casos e Controles , Fenda Labial/prevenção & controle , Fissura Palatina/prevenção & controle , Suplementos Nutricionais , Feminino , Humanos , Masculino , Fenômenos Fisiológicos da Nutrição Materna , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Adulto JovemRESUMO
This article presents general aspects of risk factors and particularities of the management of individuals with oral clefts (OCs). A practical manual of prevention and management of this congenital defect was prepared based on a review of the literature and using data from Brazilian multicenter studies. Since OCs require efforts from all levels of healthcare, the data herein presented permits appropriate follow-up for affected individuals and their families. Also, the recognition of risk factors is crucial for planning and implementing preventive measures at the individual and population levels.
Assuntos
Fenda Labial/etiologia , Fenda Labial/prevenção & controle , Fissura Palatina/etiologia , Fissura Palatina/prevenção & controle , Brasil , Humanos , Fatores de RiscoRESUMO
This article presents general aspects of risk factors and particularities of the management of individuals with oral clefts (OCs). A practical manual of prevention and management of this congenital defect was prepared based on a review of the literature and using data from Brazilian multicenter studies. Since OCs require efforts from all levels of healthcare, the data herein presented permits appropriate follow-up for affected individuals and their families. Also, the recognition of risk factors is crucial for planning and implementing preventive measures at the individual and population levels.
Assuntos
Humanos , Fenda Labial/etiologia , Fenda Labial/prevenção & controle , Fissura Palatina/etiologia , Fissura Palatina/prevenção & controle , Brasil , Fatores de RiscoRESUMO
OBJECTIVE: We report on the risk of miscarriage with high- and low-dosage periconceptional folic acid (FA) supplementation from a double-blind randomized clinical trial for prevention of orofacial cleft recurrence in Brazil. METHODS: Women at risk of recurrence of orofacial clefts in their offspring were randomized into high (4 mg/day) and low (0.4 mg/day) doses of FA supplementation. The women received the study pills before pregnancy, and supplementation continued throughout the first trimester. Miscarriage rates were compared between the two FA groups and with the population rate. RESULTS: A total of 268 pregnancies completed the study protocol, with 141 in the 4.0-mg group and 127 in the 0.4-mg group. The miscarriage rate was 14.2% in the low-dose FA group (0.4 mg/day) and 11.3% for the high-dose group (4 mg/day) (P=0.4877). These miscarriage rates are not significantly different from the miscarriage rate in the Brazilian population, estimated to be around 14% (P=0.311). CONCLUSIONS: These results indicate that high-dose FA does not increase miscarriage risk in this population and add further information to the literature on the safety of high FA supplementation for prevention of birth defect recurrence.
Assuntos
Aborto Espontâneo/etiologia , Fenda Labial/prevenção & controle , Fissura Palatina/prevenção & controle , Ácido Fólico/administração & dosagem , Cuidado Pré-Concepcional/métodos , Aborto Espontâneo/epidemiologia , Adulto , Brasil/epidemiologia , Método Duplo-Cego , Feminino , Ácido Fólico/efeitos adversos , Humanos , Recém-Nascido , Masculino , Gravidez , Recidiva , Adulto JovemRESUMO
OBJECTIVES: To evaluate the effects of folic acid supplementation on isolated oral cleft recurrence and fetal growth. PATIENTS AND METHODS: The study included 2,508 women who were at-risk for oral cleft recurrence and randomized into two folic acid supplementation groups: 0.4 and 4 mg per day before pregnancy and throughout the first trimester. The infant outcome data were based on 234 live births. In addition to oral cleft recurrence, several secondary outcomes were compared between the two folic acid groups. Cleft recurrence rates were also compared to historic recurrence rates. RESULTS: The oral cleft recurrence rates were 2.9% and 2.5% in the 0.4 and 4 mg groups, respectively. The recurrence rates in the two folic acid groups both separately and combined were significantly different from the 6.3% historic recurrence rate post the folic acid fortification program for this population (p = 0.0009 when combining the two folic acid groups). The rate of cleft lip with palate recurrence was 2.9% in the 0.4 mg group and 0.8% in the 4 mg group. There were no elevated fetal growth complications in the 4 mg group compared to the 0.4 mg group. CONCLUSIONS: The study is the first double-blinded randomized clinical trial (RCT) to study the effect of high dosage folic acid supplementation on isolated oral cleft recurrence. The recurrence rates were similar between the two folic acid groups. However, the results are suggestive of a decrease in oral cleft recurrence compared to the historic recurrence rate. A RCT is still needed to identify the effect of folic acid on oral cleft recurrence given these suggestive results and the supportive results from previous interventional and observational studies, and the study offers suggestions for such future studies. The results also suggest that high dosage folic acid does not compromise fetal growth.
Assuntos
Fenda Labial/prevenção & controle , Fissura Palatina/prevenção & controle , Desenvolvimento Fetal/efeitos dos fármacos , Ácido Fólico/administração & dosagem , Complexo Vitamínico B/administração & dosagem , Adulto , Brasil , Suplementos Nutricionais , Método Duplo-Cego , Feminino , Humanos , Gravidez , Adulto JovemRESUMO
By January 1998, most of Canada's cereal grain products were being fortified with folic acid. Among 336963 women who underwent antenatal maternal serum screening, the prevalence of orofacial clefts did not change from before (1.15 per 1000) to after (1.21 per 1000) food fortification (prevalence ratio, 1.06; 95% confidence interval, 0.86-1.30).
Assuntos
Fenda Labial/prevenção & controle , Fissura Palatina/prevenção & controle , Ácido Fólico/administração & dosagem , Alimentos Fortificados , Hematínicos/administração & dosagem , Canadá/epidemiologia , Fenda Labial/epidemiologia , Fissura Palatina/epidemiologia , Feminino , Humanos , Recém-Nascido , Gravidez , Avaliação de Programas e Projetos de Saúde , Estudos RetrospectivosRESUMO
OBJECTIVES: The evidence linking low levels of folic acid and orofacial clefting (OFC) is presently equivocal. There is stronger evidence for the role of folic acid supplementation in protection against the occurrence and recurrence of neural tube defects. The present investigation tested the hypotheses that cleft lip, cleft palate, or both are inversely associated with maternal intake of dietary and supplemental vitamins during the periconceptional period and first 4 months of pregnancy in a Brazilian population. DESIGN: A population-based, case-control study of cleft lip with or without cleft palate (CL(P)) and isolated cleft palate (CP) in a Brazilian population. In structured interviews, case histories were taken from the mothers of a consecutive sample of 450 infants born with nonsyndromic OFC. RESULTS: Mothers who had children with CL(P) were less likely to have been supplemented during the periconceptional period. The statistical significance of the difference in prevalence of the use of supplements between mothers of patients and of controls was greater for the CL(P) group: p < .05 for CP and p < .001 for CL(P). Multivariate analysis confirmed this finding of a protective effect for both types of orofacial cleft. CONCLUSIONS: The use of vitamin supplements in the first 4 months of pregnancy was suggestive of a protective effect against the occurrence of CP and CL(P) in this population. The significance of an association between multivitamin supplementation and OFC and the possible role of gene/environment interaction are discussed.
Assuntos
Fenda Labial/epidemiologia , Fissura Palatina/epidemiologia , Suplementos Nutricionais , Substâncias Protetoras/uso terapêutico , Vitaminas/uso terapêutico , Brasil , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Fenda Labial/genética , Fenda Labial/prevenção & controle , Fissura Palatina/genética , Fissura Palatina/prevenção & controle , Intervalos de Confiança , Fatores de Confusão Epidemiológicos , Meio Ambiente , Feminino , Ácido Fólico/uso terapêutico , Humanos , Lactente , Entrevistas como Assunto , Funções Verossimilhança , Masculino , Análise Multivariada , Defeitos do Tubo Neural/prevenção & controle , Razão de Chances , Fenótipo , Vigilância da População , Cuidado Pré-Concepcional , Gravidez , Cuidado Pré-Natal , Inquéritos e QuestionáriosRESUMO
La fisuras labiales, maxilares y/o palatinas constituyen una malformación de frecuencia considerable en nuestro medio. Su manejo y tratamiento compete a todo el equipo de salud. Un momento crítico ocurre durante los primeros días de vida, dado que en la mayoría de las oportunidades el parto coincide con el diagnóstico de la malformación. Se exponen algunas consideraciones respecto a la patología, su etiopatogenia y las conductas apropiadas durante los primeros meses de vida. Se indica la cronología del tratamiento quirúrgico ideal basado en las características morfofuncionales normales, nociones útiles para orientación del pediatra que controla al niño
Assuntos
Humanos , Criança , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Fenda Labial/diagnóstico , Fenda Labial/epidemiologia , Fenda Labial/prevenção & controle , Fissura Palatina/diagnóstico , Fissura Palatina/epidemiologia , Fissura Palatina/prevenção & controle , Equipe de Assistência ao Paciente , Diagnóstico Pré-Natal , Procedimentos de Cirurgia PlásticaRESUMO
O conhecimento sobre saúde bucal de pais de crianças portadoras de fissura de lábio e/ou palato com até 3 anos de idade foi avaliado através de um questionário. Verificou-se que essas informaçöes eram superficiais e estanques, sendo necessária uma abordagem com vistas à motivaçäo para a educaçäo sobre os cuidados odontológicos em fases precoces da vida, especialmente para bebês fissurados, em que o sucesso da reabilitaçäo relaciona-se diretamente a obtençäo e manutençäo da saúde bucal