Wondemagegn Amsalu Taye, Afework Mekbeb
Department of Biomedical Sciences, School of Medicine, Debre Markos University, Debre Markos, Ethiopia.
Department of Anatomy, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
SAGE Open Med. 2022 Mar 4;10:20503121221081069. doi: 10.1177/20503121221081069. eCollection 2022.
Various trial and epidemiological studies consistently documented the association between maternal folic acid supplementations and neural tube defects. However, existing literatures revealed inconclusive findings about maternal periconceptional folic acid supplementations and the risk of congenital heart defects. Thus, the current systematic review and meta-analysis was aimed to estimate the pooled association between maternal periconceptional folic acid supplementations and congenital heart defects.
Electronic searches of PubMed, Web of Science/Scopus, Cochrane library and Google Scholar databases were conducted to access the required studies published up to March 2021. Predetermined eligibility criteria were used for study selections. Data extraction were independently done on excel. STATA version 14 software was used to calculate the pooled effect size with 95% confidence intervals (95% CI) of maternal periconceptional folic acid supplementations on congenital heart defects using the DerSimonian and Laird random effects meta-analysis (random effects model). Statistical heterogeneity was checked using the Cochran Q test (chi-squared statistic), I statistic, and by visual inspection of the funnel plot.
A total of 37 studies of case-control, cohort and randomized controlled trial in nature were included in the review. The finding of the present systematic review and meta-analysis indicated that periconceptional folic acid supplementation significantly decreases the risk of congenital heart defects (risk ratio (RR), 0.79; CI, 0.71, 0.89). Both Cochrane Q test statistic (χ = 19.33, p = 0.962) and I test statistic (I = 0.0%, p = 0.962) did not reveal statistically significant heterogeneity among included studies. In this meta-analysis, traditional funnel plot, Begg's funnel plot, Egger's weighted regression (p = 0.13) as well as Begg's rank correlation statistic (p = 0.676) revealed no evidence of publication bias.
The present systematic review and meta-analysis found that maternal periconception folic acid supplementation was significantly associated with the risk of congenital heart defects. The risk of congenital heart defects was significantly reduced by 21% among those children of mothers who use periconceptional folic acid supplementations in high-income countries. We recommend that a large prospective study be conducted to investigate the association between maternal periconceptional folic acid supplementation and occurrence of congenital heart defect of various types, especially in the developing countries.
多项试验和流行病学研究一致证实了孕妇补充叶酸与神经管缺陷之间的关联。然而，现有文献对于孕妇围孕期补充叶酸与先天性心脏病风险之间的关系尚无定论。因此，本系统评价和荟萃分析旨在评估孕妇围孕期补充叶酸与先天性心脏病之间的综合关联。
通过对PubMed、科学网/Scopus、Cochrane图书馆和谷歌学术数据库进行电子检索，以获取截至2021年3月发表的相关研究。使用预先确定的纳入标准进行研究筛选。在Excel中独立进行数据提取。使用STATA 14软件，采用DerSimonian和Laird随机效应荟萃分析（随机效应模型）计算孕妇围孕期补充叶酸对先天性心脏病的合并效应量及95%置信区间（95%CI）。使用Cochrane Q检验（卡方统计量）、I统计量并通过漏斗图的视觉检查来检验统计异质性。
本评价共纳入37项病例对照研究、队列研究和随机对照试验。本系统评价和荟萃分析的结果表明，围孕期补充叶酸可显著降低先天性心脏病风险（风险比（RR）为0.79；CI为0.71，0.89）。Cochrane Q检验统计量（χ = 19.33，p = 0.962）和I检验统计量（I = 0.0%，p = 0.962）均未显示纳入研究之间存在统计学显著异质性。在本荟萃分析中，传统漏斗图、Begg漏斗图、Egger加权回归（p = 0.13）以及Begg秩相关统计量（p = 0.676）均未显示有发表偏倚的证据。
本系统评价和荟萃分析发现，孕妇围孕期补充叶酸与先天性心脏病风险显著相关。在高收入国家，母亲围孕期补充叶酸的儿童中，先天性心脏病风险显著降低了21%。我们建议开展一项大型前瞻性研究，以调查孕妇围孕期补充叶酸与各种类型先天性心脏病发生之间的关联，特别是在发展中国家。
