Folic acid in pregnant women associated with reduced prevalence of severe congenital heart defects in their children: a national population-based case-control study
Folic acid in pregnant women associated with reduced prevalence of severe congenital heart defects in their children: a national population-based case-control study
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DOI：
10.1016/j.ejogrb.2015.06.024
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发表时间：
2015-10-01
影响因子：
2.6
通讯作者：
Szabo, Istvan
中科院分区：
文献类型：
--
作者：
Czeizel, Andrew E.;Vereczkey, Attila;Szabo, Istvan
目的：先前的匈牙利干预试验表明，围受孕期补充含叶酸的多种维生素与显着降低先天性心脏病（CHD）的风险之间存在关联。这些发现在美国的观察性复合维生素研究以及荷兰和中国关于叶酸的研究中得到了证实。这项基于人群的观察性研究的目的是评估叶酸补充剂对不同CHD在其关键发育期可能的预防作用。研究设计：叶酸使用的医学记录评价（计算每日平均5.6 mg）在8种类型的CHD发展的关键期（通过尸检报告或导管检查和/或手术矫正后证实），1980-1996年匈牙利先天性畸形病例对照监测（HCCSCA），包含22例，843例先天性畸形病例和38，151例无任何CHD的人群对照，包括3567例患有各种CHD的活产病例的5395例匹配对照。采用条件Logistic回归模型估计不同类型CHD病例母亲及其配对对照者服用叶酸的相对风险/保护[比值比（OR）和95%可信区间（CI）]。室间隔缺损的患病率明显下降（OR 0.57，95% CI 0.45-0.73），法洛四联症（OR 0.53，95% CI 0.17-0.94），d-大动脉转位（OR 0.47，95%CI 0.26-0.86）和继发性房间隔缺损（OR 0.63，95%CI 0.40-0.98）。结论：补充叶酸的孕妇患某些类型冠心病的风险显著降低。因此，在神经管缺陷预防计划中，CHD应作为次要评估。(C)2015爱思唯尔爱尔兰有限公司版权所有。
Objective: Previous Hungarian intervention trials have shown an association between periconceptional folic-acid-containing multivitamin supplementation and significantly reduced risk of congenital heart defects (CHDs). These findings were confirmed in observational multivitamin studies in the USA, and studies in the Netherlands and China regarding folic acid. The objective of this observational population-based study was to estimate the possible preventive effect of folic acid supplementation for different CHDs during their critical period of development.Study design: Evaluation of medically recorded use of folic acid (calculated daily average 5.6 mg) during the critical period of development of eight types of CHD (verified through autopsy reports or after catheter examination and/or surgical correction) in the population-based Hungarian Case-Control Surveillance of Congenital Abnormalities (HCCSCA), 1980-1996, containing 22,843 cases with congenital abnormalities and 38,151 population controls without any CHDs, including 5395 matched controls of 3567 live-born cases with various CHDs. A conditional logistic regression model was used to estimate the relative risk/protection [odds ratio (OR) with 95% confidence intervals (CI)] of folic acid in the mothers of cases with various types of CHD and their matched controls.Results: There was a significant decrease in the prevalence of cases with ventricular septal defect (OR 0.57, 95% CI 0.45-0.73), tetralogy of Fallot (OR 0.53, 95% CI 0.17-0.94), d-transposition of great arteries (OR 0.47,95% CI 0.26-0.86) and atrial septal defect secundum (OR 0.63,95% CI 0.40-0.98) in infants born to mothers who had taken high doses of folic acid during the critical period of CHD development.Conclusions: The risk of development of certain types of CHD was significantly reduced in pregnant women who were supplemented with folic acid. Thus, CHDs should be included as a secondary assessment in neural-tube-defect preventive programs. (C) 2015 Elsevier Ireland Ltd. All rights reserved.