{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T07:02:15Z","timestamp":1780124535512,"version":"3.54.0"},"reference-count":10,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"vor","delay-in-days":148,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Rheumatology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sulfasalazine is a widely used disease\u2010modifying antirheumatic drug (DMARD) for inflammatory arthritis and is generally considered safe in pregnancy when co\u2010prescribed with folic acid. However, its antifolate effects may influence folate metabolism, which is a recognised pathway associated with neural tube defects, particularly when folate supplementation is inadequate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>A 34\u2010year\u2010old woman conceived shortly after starting sulfasalazine without folic acid supplementation. Her pregnancy was complicated by fetal spina bifida and ventriculomegaly detected at 20\u2009weeks\u2019 gestation, leading to termination. She had borderline\u2010low serum folate before conception (3.7\u2009\u03bcg\/L). No other teratogenic exposures were identified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights the importance of preconception counselling and adherence to high\u2010dose folic acid (5\u2009mg daily) in women of childbearing potential receiving sulfasalazine. While causality cannot be inferred, it draws attention to a potentially modifiable factor within the multifactorial aetiology of neural tube defects. It also reinforces that medications regarded as safe in pregnancy may still be associated with preventable risk when recommended supplementation is omitted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/crrh\/8352167","type":"journal-article","created":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T06:23:26Z","timestamp":1780122206000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Case of Neural Tube Defect in Early Pregnancy Following Sulfasalazine Exposure Without Folic Acid Supplementation"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3940-6166","authenticated-orcid":false,"given":"Francesca","family":"Holden","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6879-0761","authenticated-orcid":false,"given":"Rodney","family":"Hughes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"key":"e_1_2_8_1_2","first-page":"i37","article-title":"Treatment With DMARDs During Pregnancy and Lactation","volume":"58","author":"Ostensen M.","year":"2019","journal-title":"Rheumatology"},{"key":"e_1_2_8_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keac551"},{"key":"e_1_2_8_3_2","first-page":"639","article-title":"Folate Metabolism and Its Interaction With Drugs","volume":"39","author":"Suh J. 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P.","year":"1981","journal-title":"British Medical Journal"},{"key":"e_1_2_8_7_2","first-page":"547","article-title":"The Safety of Sulfasalazine Use During Pregnancy: A Prospective Controlled Cohort Study","volume":"52","author":"Diav-Citrin O.","year":"2005","journal-title":"Arthritis & Rheumatism"},{"key":"e_1_2_8_8_2","first-page":"1591","article-title":"Congenital Abnormalities in Children Born to Women With Inflammatory Bowel Disease","volume":"125","author":"N\u00f8rg\u00e5rd B.","year":"2003","journal-title":"Gastroenterology"},{"key":"e_1_2_8_9_2","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/0140-6736(91)90133-A","article-title":"Prevention of Neural Tube Defects: Results of the Medical Research Council Vitamin Study","volume":"338","author":"Wald N.","year":"1991","journal-title":"Lancet."},{"key":"e_1_2_8_10_2","doi-asserted-by":"publisher","DOI":"10.2217\/17455057.3.3.309"}],"container-title":["Case Reports in Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/crrh\/8352167","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/crrh\/8352167","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/crrh\/8352167","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T06:23:28Z","timestamp":1780122208000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/crrh\/8352167"}},"subtitle":[],"editor":[{"given":"Ankit","family":"Dhoundiyal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":10,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1155\/crrh\/8352167"],"URL":"https:\/\/doi.org\/10.1155\/crrh\/8352167","archive":["Portico"],"relation":{},"ISSN":["2090-6889","2090-6897"],"issn-type":[{"value":"2090-6889","type":"print"},{"value":"2090-6897","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2026-02-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"8352167"}}