INSERM, UMR S953, Epidemiological Research on Perinatal Health and Women's and Children's Health, Hôpital Saint Vincent de Paul, Paris, France.
J Pediatr. 2013 Jan;162(1):108-13.e2. doi: 10.1016/j.jpeds.2012.06.035. Epub 2012 Jul 24.
To examine trends in the prevalence of congenital heart defects (CHDs) in Europe and to compare these trends with the recent decrease in the prevalence of CHDs in Canada (Quebec) that was attributed to the policy of mandatory folic acid fortification.
We used data for the period 1990-2007 for 47 508 cases of CHD not associated with a chromosomal anomaly from 29 population-based European Surveillance of Congenital Anomalies registries in 16 countries covering 7.3 million births. We estimated trends for all CHDs combined and separately for 3 severity groups using random-effects Poisson regression models with splines.
We found that the total prevalence of CHDs increased during the 1990s and the early 2000s until 2004 and decreased thereafter. We found essentially no trend in total prevalence of the most severe group (group I), whereas the prevalence of severity group II increased until about 2000 and decreased thereafter. Trends for severity group III (the most prevalent group) paralleled those for all CHDs combined.
The prevalence of CHDs decreased in recent years in Europe in the absence of a policy for mandatory folic acid fortification. One possible explanation for this decrease may be an as-yet-undocumented increase in folic acid intake of women in Europe following recommendations for folic acid supplementation and/or voluntary fortification. However, alternative hypotheses, including reductions in risk factors of CHDs (eg, maternal smoking) and improved management of maternal chronic health conditions (eg, diabetes), must also be considered for explaining the observed decrease in the prevalence of CHDs in Europe or elsewhere.
研究欧洲先天性心脏病（CHD）患病率的变化趋势，并将其与加拿大（魁北克）最近因强制叶酸强化政策而导致 CHD 患病率下降的趋势进行比较。
我们使用了 1990 年至 2007 年期间来自欧洲 16 个国家的 29 个基于人群的先天性畸形监测机构的 730 万例无染色体异常的 CHD 数据，其中包括 47508 例病例。我们使用随机效应泊松回归模型和样条函数估计了所有 CHD 合并以及 3 个严重程度组的趋势。
我们发现，CHD 的总患病率在 1990 年代和 21 世纪初一直上升，直到 2004 年才开始下降。我们发现，最严重的一组（I 组）的总患病率基本没有趋势，而 II 组的患病率则在 2000 年前后增加，之后又下降。III 组（最常见的一组）的趋势与所有 CHD 合并的趋势相似。
近年来，欧洲 CHD 的患病率在没有强制叶酸强化政策的情况下有所下降。这种下降的一个可能解释是，欧洲妇女叶酸摄入量的增加，可能是由于叶酸补充和/或自愿强化的建议，尽管这一增加尚未记录在案。然而，其他假设，包括 CHD 危险因素的减少（如孕妇吸烟）和对孕妇慢性健康状况（如糖尿病）的管理改善，也必须考虑在内，以解释欧洲或其他地区 CHD 患病率的下降。
