Prevalence of severe congenital heart disease after folic acid fortification of grain products: time trend analysis in Quebec, Canada.
Prevalence of severe congenital heart disease after folic acid fortification of grain products: time trend analysis in Quebec, Canada.
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DOI：
10.1136/bmj.b1673
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发表时间：
2009-05-12
期刊：
影响因子：
--
通讯作者：
Pilote L
中科院分区：
文献类型：
--
作者：
Ionescu-Ittu R;Marelli AJ;Mackie AS;Pilote L
目的调查1998年政府强制强化面粉和面食产品中叶酸的政策是否降低了严重先天性心脏病的患病率。设计时间趋势分析。背景加拿大魁北克省。参与者出生于1990-2005年的婴儿在魁北克行政数据库中被鉴定为严重的先天性心脏缺陷（法洛四联症、内膜垫缺陷、单心室心脏、动脉干或转位复合体）。方法分强化前、强化后两个时间段进行分析。魁北克每年每1000名新生儿中严重先天性心脏缺陷婴儿（活产和死产）的出生率。用Poisson回归估计强化前后出生患病率的变化。结果在1990-2005年魁北克的1 324 440名新生儿中，有2083名新生儿患有严重先天性心脏病，平均出生患病率为1.57/1000。时间趋势分析显示，在强化前9年，严重出生缺陷的出生率没有变化（率比1.01，95%置信区间0.99至1.03），而在强化后7年，每年有6%的显着下降（0.94，0.90至0.97）。结论：采取公共卫生措施增加叶酸摄入量后，严重先天性心脏病的出生率下降。这些发现支持了叶酸对心脏缺陷具有预防作用的假设。
Objective To investigate whether the 1998 government policy for mandatory fortification of flour and pasta products with folate was followed by a reduction in the prevalence of severe congenital heart defects. Design Time trend analysis. Setting Province of Quebec, Canada. Participants Infants born in 1990-2005 identified with severe congenital heart defects (tetralogy of Fallot, endocardial cushion defects, univentricular hearts, truncus arteriosus, or transposition complexes) in Quebec administrative databases. Methods Data analysed in two time periods (before and after fortification). Birth prevalence measured annually as infants (live and stillbirths) with severe congenital heart defects per 1000 births in Quebec. Changes in the birth prevalence from the period before to the period after fortification were estimated with Poisson regression. Results Among the 1 324 440 births in Quebec in 1990-2005 there were 2083 infants born with severe congenital heart defects, corresponding to an average birth prevalence of 1.57/1000 births. Time trend analysis showed no change in the birth prevalence of severe birth defects in the nine years before fortification (rate ratio 1.01, 95% confidence interval 0.99 to 1.03), while in the seven years after fortification there was a significant 6% decrease per year (0.94, 0.90 to 0.97). Conclusions Public health measures to increase folic acid intake were followed by a decrease in the birth prevalence of severe congenital heart defects. These findings support the hypothesis that folic acid has a preventive effect on heart defects.
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