Children's Heart Centre, Radboud University Nijmegen Medical Centre, PO Box 9101, Nijmegen 6500 HB, The Netherlands.
Eur Heart J. 2010 Feb;31(4):464-71. doi: 10.1093/eurheartj/ehp479. Epub 2009 Dec 1.
To investigate the potentially protective of periconceptional folic acid use on the risk of congenital heart defects (CHDs) relative to other non-folate related malformations.
We analysed data from a large regional register of birth defects (EUROCAT-Northern Netherlands), over a 10 year period (1996-2005) for a case-control study. The cases were mothers who had delivered infants with isolated or complex heart defects, without any related syndrome or genetic abnormality (n = 611). We used two control groups; one from the EUROCAT database and another from the general population. The registry controls consisted of mothers of children with a known chromosomal or genetic defect, and with infants with other non-folate related congenital malformations (n = 2401). Additional folic acid was taken as a single supplement or as a multivitamin containing folic acid in a dose of >or=400 microg daily. Mothers who had used folate antagonists or who had diabetes, and mothers of children with oral clefts, hypospadias, limb reduction- or neural tube defects, were excluded from both groups. Potentially confounding factors of periconceptional folic acid use in relation to CHD were explored, including baby's birth year, maternal body mass index, education, maternal age at delivery of index baby, smoking behaviour, and alcohol use during pregnancy. Periconceptional folic acid use revealed an odds ratio (OR) of 0.82 (95% CI 0.68-0.98) for all types of CHD relative to other malformations. The estimated relative risk for CHDs of additional folic acid use compared with the general population was comparable [OR 0.74 (95%CI 0.62-0.88)]. Subgroup analysis showed an OR of 0.62 (95% CI 0.47-0.82) for isolated septal defects. The proportions of the potential confounders between mothers of case and control infants did not differ significantly.
Our results support the hypothesis that additional periconceptional folic acid use reduces CHD risk in infants. Use of periconceptional folic acid supplements was related to approximately 20% reduction in the prevalence of any CHD. Given the relatively high prevalence of CHD worldwide, our findings are important for public health.
探讨围孕期叶酸的使用对先天性心脏病（CHD）风险的潜在保护作用，与其他非叶酸相关畸形相比。
我们分析了一个大型区域出生缺陷登记处（EUROCAT-荷兰北部）的数据，进行了一项病例对照研究，时间跨度为 10 年（1996-2005 年）。病例组为母亲所生的婴儿有单纯或复杂的心脏缺陷，无任何相关综合征或遗传异常（n=611）。我们使用了两个对照组；一个来自 EUROCAT 数据库，另一个来自一般人群。登记处对照由染色体或遗传缺陷儿童的母亲和其他非叶酸相关先天性畸形（n=2401）的婴儿组成。额外的叶酸作为单一补充剂或含有叶酸的多种维生素，剂量大于或等于 400μg/天。排除了服用叶酸拮抗剂或患有糖尿病的母亲，以及患有口腔裂、尿道下裂、肢体减少或神经管缺陷的儿童的母亲。探讨了围孕期叶酸使用与 CHD 相关的潜在混杂因素，包括婴儿出生年份、母体体重指数、教育程度、指数婴儿的分娩年龄、吸烟行为和孕期饮酒。与其他畸形相比，围孕期叶酸使用的优势比（OR）为 0.82（95%CI 0.68-0.98）。与一般人群相比，额外叶酸使用的 CHD 相对风险相当[OR 0.74（95%CI 0.62-0.88)]。亚组分析显示，单纯间隔缺损的 OR 为 0.62（95%CI 0.47-0.82）。病例组和对照组婴儿母亲的潜在混杂因素比例没有显著差异。
我们的结果支持这样一种假设，即围孕期额外补充叶酸可降低婴儿 CHD 的风险。围孕期叶酸补充剂的使用与任何 CHD 患病率降低约 20%有关。鉴于 CHD 在全球的相对高患病率，我们的研究结果对公共卫生很重要。
