Document Detail


Maternal hyperphenylalaninemias in healthy Czech population of pregnant women: 30 years experience with screening, prevention and treatment.
MedLine Citation:
PMID:  15633889     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: The increased level of phenylalanine (Phe) in maternal blood--hyperphenylalaninemia (mHPA) has a detrimental effect on the early development of healthy foetus (1965). The toxic effect causes spontaneous abortion or retards intrauterine growth, skeletal malformation, cardiac anomalies can appear. However the most frequent are microcephaly, mental retardation and hypotrophy. PATIENTS AND METHODS: Simultaneously with the introduction of obligatory "Newborn Screening Program" in CR also the facultative screening for mHPA was introduced ("Maternal Hyperphenylalaninemia Preventive Screening Program"). Since 1975 till now 222,990 healthy pregnant women (16-47 yrs) from city Prague and its area (cca 2 mil. inh.) have been screened for increased Phe in blood by Efron's chromatographic screening test (1964); Phe cut off value: 240 micromol/l. Nonfasting venous blood has been taken in 2nd-3rd month of pregnancy during the first antenatal visit. All positive cases have been verified with quantitative Phe estimation on amino acid analyzer incl. pterines analysis in urine. For differentiation of detected mHPAs the Güttler's scheme (1980) has been used. Mutations for Phe-hydroxylase gene analyzed by restriction enzyme digestion after Guldberg (1994). RESULTS: The average incidence of mHPA detected at the beginning of pregnancy was found 1:8675. The major part (65.3%) of all detected mHPA belongs to mild or moderate form of phenylketonuria (PKU) with most frequent PAH gene mutations R408W, Y414C, IVS11 nt8g-a, R158Q, IVS12ntlg-a and R261Q. 19.2% corresponds to atypical or classical PKU with prevailing mutation R408W. Only in 15.3% were detected non-PKU (persistent HPA) with mutations R408W, Y414C, IVS12ntlg-a, IV11nt8g-a and A403V. 28 offsprings born from pregnancies on low-phenylalanine diet (LPD) introduced at least 2 months before the conception and during the whole pregnancy show normal psychomotoric development. In 7 offsprings without LPD or after delayed introducing or on PLD or badly monitored showed malformations (microcephaly, hypotrophy, skeletal malformations) or died. DISCUSSION: Relatively high incidence of mHPA detected in healthy population of pregnant women of Prague area differs from findings of Buist (1989) or Levy (1994) from American pregnant women screened for mHPA from umbilical blood. We consider that screening performed at the beginning of pregnancy from nonfasting venous blood is more effective compared to umbilical blood from two reasons: the Phe level in maternal blood is increased during first trimester of pregnancy due to succing effect of placenta in comparison to decreased Phe level at the end of labour. Umbilical blood for screening of mHPA is not quite suitable to detect the atypical or mild forms of Phe disturbances which prevailed in our Slavonic population of pregnant women. (Tab. 5, Fig. 7, Ref. 16.)
Authors:
J Hyanek; L Kozak; E Hrabincova; V Trnka; J Kobilkova; A Dolezal; K Soukup; J Zeman; S Stastna; L Vadurova; J Krijt; H Viletova; M Cervena; T Paterova
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Bratislavské lekárske listy     Volume:  105     ISSN:  0006-9248     ISO Abbreviation:  Bratisl Lek Listy     Publication Date:  2004  
Date Detail:
Created Date:  2005-01-06     Completed Date:  2005-02-04     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0065324     Medline TA:  Bratisl Lek Listy     Country:  Slovakia    
Other Details:
Languages:  eng     Pagination:  291-8     Citation Subset:  IM    
Affiliation:
Institute for Inherited Metabolic Disorders, Obstetric and Gynaecologic Clinic of 1st Medical School Charles University Prague, Czech Republic. josef.hyanek@homolka.cz
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Czech Republic
Female
Humans
Incidence
Mass Screening
Middle Aged
Phenylketonurias / diagnosis*,  epidemiology,  therapy
Pregnancy
Pregnancy Complications / diagnosis*,  epidemiology,  therapy

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