Botto L D, Khoury M J, Mulinare J, Erickson J D
Epidemic Intelligence Service, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
Pediatrics. 1996 Nov;98(5):911-7.
The preventive efficacy of the periconceptional use of multivitamins is well established for neural tube defects, much less so for other birth defects. We conducted a population-based, case-control study to assess the effects of multivitamin use on the risk for conotruncal defects, a group of severe heart defects that includes transposition of the great arteries, tetralogy of Fallot, and truncus arteriosus.
From the population-based Atlanta Birth Defects Case-Control Study, we identified 158 case infants with conotruncal defects and 3026 unaffected, randomly chosen control infants, born from 1968 through 1980 to mothers residing in metropolitan Atlanta. Periconceptional multivitamin use was defined as reported regular use from 3 months before conception through the third month of pregnancy. We present the results of the crude analysis, because the multivariate model yielded essentially identical results.
Mothers who reported periconceptional multivitamin use had a 43% lower risk of having infants with conotruncal defects (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.33 to 1.00) than did mothers who reported no use. The estimated relative risk was lowest for isolated conotruncal defects (OR, 0.41; 95% CI, 0.20 to 0.84) compared with those associated with noncardiac defects (OR, 0.91; 95% CI, 0.33 to 2.52) or a recognized syndrome (OR, 1.82; 95% CI, 0.31 to 10.67). Among anatomic subgroups of defects, transposition of the great arteries showed the greatest reduction in risk (OR, 0.36; 95% CI, 0.15 to 0.89).
Periconceptional multivitamin use is associated with a reduced risk for conotruncal defects. These findings could have major implications for the prevention of these birth defects.
围孕期使用多种维生素对神经管缺陷的预防效果已得到充分证实，但对其他出生缺陷的预防效果则知之甚少。我们开展了一项基于人群的病例对照研究，以评估使用多种维生素对圆锥动脉干畸形风险的影响，圆锥动脉干畸形是一组严重的心脏缺陷，包括大动脉转位、法洛四联症和动脉干畸形。
从基于人群的亚特兰大出生缺陷病例对照研究中，我们确定了158例患有圆锥动脉干畸形的病例婴儿以及3026例未受影响的、随机选取的对照婴儿，这些婴儿于1968年至1980年间出生，其母亲居住在亚特兰大大都市地区。围孕期使用多种维生素被定义为报告在受孕前3个月至怀孕第3个月期间定期使用。我们展示了粗分析结果，因为多变量模型得出的结果基本相同。
报告围孕期使用多种维生素的母亲生出患有圆锥动脉干畸形婴儿的风险比未使用的母亲低43%（比值比[OR]，0.57；95%置信区间[CI]，0.33至1.00）。与伴有非心脏缺陷（OR，0.91；95%CI，0.33至2.52）或公认综合征（OR，1.82；95%CI，0.31至10.67）的圆锥动脉干畸形相比，孤立性圆锥动脉干畸形的估计相对风险最低（OR，0.41；95%CI，0.20至0.84）。在缺陷的解剖亚组中，大动脉转位的风险降低幅度最大（OR，0.36；95%CI，0.15至0.89）。
围孕期使用多种维生素与圆锥动脉干畸形风险降低有关。这些发现可能对预防这些出生缺陷具有重要意义。
