Future Implications
Our findings entails a new focus in the future scientific approach ofthe prediction and prevention of neural crest cell related COD. For example, our results can form the basis for animal studies in which the pathophysiological mechanism for neural crest-related COD can be further explored.
Moreover, it contributes to the recognition of the importance of a life course approach in women’s and offspring’s health. We believe there could be a role for E-health intervention platforms, such as www.smarter pregnancy.co.uk(31), by improving maternal health conditions, such as an adequate intake of vegetables, fruits and folic acid supplements, stop smoking and alcohol consumption, that reduce excessive oxidative stress in women contemplating pregnancy using TL as a marker.
Further studies and replications of our study with larger populations and worldwide collaboration platforms are needed to confirm our findings and identify maternal TL as a sensitive predictive biomarker.
Conclusion Shortening of maternal TL, due to maternal conditions including age, is associated with an almost 30 % increased risk of VSD in the offspring. No association was found between maternal TL and the risk of neural crest-related COD offspring in the total COD group. These findings need further confirmation in other studies and congenital malformations, and on the predictive value of maternal TL before implementation in clinical practice. For example, specify and sensitivity studies using ROC curves.
The demonstration of an underlying role for maternal TL shortening and the association with neural crest- related COD in the offspring, in particular VSD, identifies maternal TL as a possible long term biological marker of the long term oxidative stress status of women in their periconception period. Consequently, after additional research, maternal TL may be used as a biological marker in periconceptional risk assessment.