title: Frequency of Down's syndrome and neural-tube defects in the same family.
abstract: BACKGROUND
  There is evidence that some mothers of infants with Down's syndrome have abnormal metabolism of folate and methyl, as well as mutations in folate genes, which are features that are also seen in neural-tube defects (NTD). We therefore investigated whether Down's syndrome and NTD arise more often in the same family than would be expected from the incidence of each disorder considered separately.
  
  
  METHODS
  We studied two series of families using information obtained from medical records about maternal age, pregnancy outcome, congenital malformations, and karyotype: the first, 493 families from Israel who were at high risk of NTD (445 with a history of NTD and 48 with isolated hydrocephalus); and the second, 516 families from the Ukraine at high risk of Down's syndrome.
  
  
  RESULTS
  In the families at risk of NTD, there were a total of 11 pregnancies affected by Down's syndrome in 1492 at-risk pregnancies (compared with 1.87 expected on the basis of maternal age), which was a significant increase (p<0.00001). In the families at risk of Down's syndrome, there were seven NTD pregnancies in 1847 at risk, compared with 1.37 expected (p<0.001).
  
  
  CONCLUSIONS
  In this study, we provide direct evidence of a link between Down's syndrome and NTD. Folate supplementation before conception has the potential to reduce the frequency of Down's syndrome.
authors.affiliation: Danek Gertner Institute of Human Genetics, Sheba Medical Centre, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, 52621, Tel Aviv, Israel. gbarkaig@sheba.health.gov.il <gbarkaig@sheba.health.gov.il>
authors.forename: Gad
authors.initials: G
authors.lastname: Barkai
authors.forename: Svetlana
authors.initials: S
authors.lastname: Arbuzova
authors.forename: Michal
authors.initials: M
authors.lastname: Berkenstadt
authors.forename: Sigal
authors.initials: S
authors.lastname: Heifetz
authors.forename: Howard
authors.initials: H
authors.lastname: Cuckle
mesh_terms: D000328:Adult; D015897:Comorbidity; D004314:Down Syndrome / Q000453:epidemiology / Q000235:genetics*; D005260:Female; D005287:Ferredoxin-NADP Reductase / Q000235:genetics; D005492:Folic Acid / Q000031:analogs & derivatives* / Q000235:genetics; D005817:Genetic Counseling; D006801:Humans; D006849:Hydrocephalus / Q000453:epidemiology / Q000235:genetics; D007231:Infant, Newborn; D007621:Karyotyping; D008297:Male; D009436:Neural Tube Defects / Q000453:epidemiology / Q000235:genetics*; D011110:Polymorphism, Genetic / Q000235:genetics; D011247:Pregnancy; D011256:Pregnancy Outcome; D018570:Risk Assessment
chemical_list: C032418:5,11-methenyltetrahydrohomofolate; D005492:Folic Acid; C111241:methionine synthase reductase; D005287:Ferredoxin-NADP Reductase