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Folic Acid in Preconceptual Period May Have a Preventive Effect on Congenital Heart Disease: Presented at AHA

By Emma Hitt, PhD

ORLANDO, FL -- November 6, 2007 -- The recent increase in folic acid intake has resulted in a decrease in the prevalence of infants born with severe congenital heart disease (CHD), supporting the idea that folic acid taken preconceptually may prevent CHD.

Lead author Raluca Ionescu-Ittu, a PhD candidate, Department of Epidemiology, McGill University, Montreal, Quebec, Canada, presented the findings here on November 4 at the American Heart Association (AHA) 2007 Scientific Sessions. The study's principal investigator was Louise Pilotte, MD, Associate Professor of Medicine and Director, Division of General Internal Medicine, McGill University Health Centre.

According to the researchers, who conducted the study in the Quebec population, guidelines to recommend folic acid supplements were released in Canada in 1993, and fortification of flour was recommended in 1996 and became mandatory in 1998.

The study represents the first population-based effort to assess this issue. A randomized, controlled trial conducted in Hungary in 1998 was the first to identify an increased association between folic acid intake and CHD incidence, Ionescu-Ittu noted during the presentation.

The researchers evaluated changes in the birth prevalence of severe CHD over time during the four periods defined by the initiation of presupplementation, prefortification, transition to fortification, and postfortification of folic acid.

The study population consisted of live births from 1990 to 2001 diagnosed with severe CHD, including Tetralogy of Fallot, endocardial cushion defect, univentricular hearts, truncus arteriosus, or transposition complexes coded by a cardiovascular specialist.

Birth prevalence was measured quarterly as live births with CHD per 1,000 live births in the population of Quebec. The researchers used linear regression to determine the changes in birth prevalence in different periods.

Among the entire population, there were 2,238 live births with severe CHD. Compared with the presupplementation period, the average birth prevalence did not decrease significantly until the postfortification period (1.94 vs 1.72 /1,000 live births [P =.04]), representing a 7% reduction in severe CHD.

"Our results support the hypothesis that folic acid intake during the periconceptual period reduces the birth prevalence of severe CHD," Dr. Ionescu-Ittu said during her talk. "This is likely to impact recommendations with respect to public health measures which may result in decreasing birth prevalence of severe CHD," she said.


[Presentation title: Increases in Folic Acid Intake in the Preconceptual Period Reduce Birth Prevalence of Severe Congenital Heart Disease. Abstract 1777]

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