PREVENTION OF DISORDERS OF CHILDREN BEFORE .pptVIP

Copyright ? 2003 Delmar Learning, a Thomson Learning company PREVENTION OF DISORDERS OF CHILDREN BEFORE BIRTH Prevention of Disorders of Children Before Birth PRIMARY PREVENTION - preventing the development of the problem Secondary prevention - preventing the problem from causing disease, removing the cause Tertiary prevention - preventing the problem from progressing and causing disability Prevention of Disorders of Children Before Birth Primary Prevention The plumber, the grocer, the politician, the doctor Maternal Nutrition Maternal Immunization Avoidance of environmental teratogens Maternal Disease Management Pre-implantation diagnosis Prevention of Disorders of Children Before Birth Secondary prevention Pregnancy interruption after prenatal diagnosis Inutero medical management of maternal disorders Inutero surgical management Prevention of Disorders of Children Before Birth Tertiary prevention identification of inborn errors of metabolism management of medical disorders surgical management of birth defects Primary Prevention Maternal nutrition Folic Acid 400 micrograms per day neural tube defects 1965 Hibbard and Smithells Northern China 6 per 1000 live births with NTD Berry et al. NEJM 341:1485, 1999 130,142 women who took folic acid 117,689 women who did not take folic acid 1/1000 NTD affected in the North with folic acid 4.8/1000 NTD affected in the North without folic acid 0.6/1000 NTD affected in the South with folic acid 1/1000 NTD affected in the South without folic acid Primary Prevention Maternal Nutrition Folic Acid Reduction in non syndromic cleft lip/palate more controversial Reduction in cardiovascular malformations especially outflow tract malformations Decreased incidence of urinary tract abnormality Decreased risk of imperforate anus in China RR .59 adult benefits - cardiovascular, cancer, Alzheimers Primary Prevention Maternal Nutrition Iodine - requirement of 20 microgram per day to prevent maternal iodine deficiency and cretini