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• W2141189672 abstract "Ernest Hook and Andrew Czeizel1Hook EB Czeizel AE Can terathanasia explain the protective effect of folic acid supplementation on birth defects?.Lancet. 1997; 350: 513-515Summary Full Text Full Text PDF PubMed Scopus (78) Google Scholar choose terathanasia as the most likely explanation for the excess of spontaneous abortions and the decrease in birth defects in the vitamin intervention group in the Hungarian and UK studies. This is not a new idea. We considered it in our 1980 paper.2Smithells RW Sheppard S Schorah CJ et al.Possible prevention of neural-tube defects by periconceptional vitamin supplementation.Lancet. 1980; i: 339-340Summary Scopus (300) Google Scholar However, terathanasia by increased folic acid intake seems biologically implausible because it is folate antagonists3Thiersh JB Therapeutic abortions with folic acid antagonists, 4 amino pteroylglutamic acid administered by the oral route.Am J Obstet Gynecol. 1952; 63: 1298-1304PubMed Google Scholar and low levels of folate4Bendich A Importance of vitamin status to pregnancy outcomes.in: Bendich A Butterworth CE Micronutrients in health and in disease prevention. Marcel Dekker, New York1991: 251Google Scholar that are abortifacients. Furthermore, multivitamin supplementation was acknowledged in the Hungarian study to be associated with increased fertility,1Hook EB Czeizel AE Can terathanasia explain the protective effect of folic acid supplementation on birth defects?.Lancet. 1997; 350: 513-515Summary Full Text Full Text PDF PubMed Scopus (78) Google Scholar and in other studies it is impaired folate metabolism, rather than folate excess, that has been associated with neural-tube defects.5Hibbard ED Smithells RW Folic acid metabolism and human embryopathy.Lancet. 1965; i: 1254-1256Abstract Scopus (265) Google Scholar This evidence, along with the metabolic role of folate in cell division and its apparent lack of toxicity both in culture and in therapeutic use, implies a protective role rather than one which encourages termination of pregnancy.If there is a real increase in recognised abortions associated with the multivitamins and folate in intervention studies, the more likely explanation is that the vitamins permit the survival of otherwise non-viable embryos to a point when they are recognised as abortions. Hook and Czeizel give this explanation less emphasis than the terathanasia hypothesis. They say that terathanasia as the explanation for the reduction in birth defects can only be proved by examining the spontaneously aborted fetuses. We have done this,2Smithells RW Sheppard S Schorah CJ et al.Possible prevention of neural-tube defects by periconceptional vitamin supplementation.Lancet. 1980; i: 339-340Summary Scopus (300) Google Scholar on a small group of pregnancies, finding no neural-tube defects in abortuses in the supplemented group but one in the unsupplemented women. Ernest Hook and Andrew Czeizel1Hook EB Czeizel AE Can terathanasia explain the protective effect of folic acid supplementation on birth defects?.Lancet. 1997; 350: 513-515Summary Full Text Full Text PDF PubMed Scopus (78) Google Scholar choose terathanasia as the most likely explanation for the excess of spontaneous abortions and the decrease in birth defects in the vitamin intervention group in the Hungarian and UK studies. This is not a new idea. We considered it in our 1980 paper.2Smithells RW Sheppard S Schorah CJ et al.Possible prevention of neural-tube defects by periconceptional vitamin supplementation.Lancet. 1980; i: 339-340Summary Scopus (300) Google Scholar However, terathanasia by increased folic acid intake seems biologically implausible because it is folate antagonists3Thiersh JB Therapeutic abortions with folic acid antagonists, 4 amino pteroylglutamic acid administered by the oral route.Am J Obstet Gynecol. 1952; 63: 1298-1304PubMed Google Scholar and low levels of folate4Bendich A Importance of vitamin status to pregnancy outcomes.in: Bendich A Butterworth CE Micronutrients in health and in disease prevention. Marcel Dekker, New York1991: 251Google Scholar that are abortifacients. Furthermore, multivitamin supplementation was acknowledged in the Hungarian study to be associated with increased fertility,1Hook EB Czeizel AE Can terathanasia explain the protective effect of folic acid supplementation on birth defects?.Lancet. 1997; 350: 513-515Summary Full Text Full Text PDF PubMed Scopus (78) Google Scholar and in other studies it is impaired folate metabolism, rather than folate excess, that has been associated with neural-tube defects.5Hibbard ED Smithells RW Folic acid metabolism and human embryopathy.Lancet. 1965; i: 1254-1256Abstract Scopus (265) Google Scholar This evidence, along with the metabolic role of folate in cell division and its apparent lack of toxicity both in culture and in therapeutic use, implies a protective role rather than one which encourages termination of pregnancy. If there is a real increase in recognised abortions associated with the multivitamins and folate in intervention studies, the more likely explanation is that the vitamins permit the survival of otherwise non-viable embryos to a point when they are recognised as abortions. Hook and Czeizel give this explanation less emphasis than the terathanasia hypothesis. They say that terathanasia as the explanation for the reduction in birth defects can only be proved by examining the spontaneously aborted fetuses. We have done this,2Smithells RW Sheppard S Schorah CJ et al.Possible prevention of neural-tube defects by periconceptional vitamin supplementation.Lancet. 1980; i: 339-340Summary Scopus (300) Google Scholar on a small group of pregnancies, finding no neural-tube defects in abortuses in the supplemented group but one in the unsupplemented women. Terathanasia, folic acid, and birth defectsAuthor's reply Full-Text PDF" @default.
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• W2141189672 title "Terathanasia, folic acid, and birth defects" @default.
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