Risk of neural tube defect linked to metabolic syndrome features
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Maternal obesity and pre-pregnancy diabetes mellitus have been shown to be distinct, folate metabolism-independent, risk factors for neural tube defects (NTD). To examine whether maternal obesity and pre-pregnancy diabetes, both components of the metabolic syndrome phenotype, are additively associated with an increased risk of NTD, a population-based case-control study was conducted in the province of Ontario, Canada, with cases and controls derived from women having undergone antenatal maternal screening at 15 to 20 weeks’ gestation. Maternal features of metabolic syndrome were defined by the presence of pre-pregnancy diabetes mellitus, body weight ≥ to the 90th centile of controls, non-white ethnicity and/or serum highly sensitive C-reactive protein (hsCRP) ≥ to the 75th centile of controls. Analyses were performed with and without the inclusion of hsCRP. When excluding hsCRP from the model, the adjusted odds ratios for NTD were 1.9 in the presence of 1 feature, and 6.1 in the presence of ≥2 features of the metabolic syndrome. When including hsCRP in the model, the respective risk estimates were attenuated to 1.6 and 3.1.
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