Recent Decrease in the Prevalence of Congenital Heart Defects in Europe

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• 作者：Babak Khoshnood ; MD ; PhD¹ ; ² ; ^{babak.khoshnood@inserm.fr} ; Maria Loane ; MSc³ ; Ester Garne ; MD⁴ ; Marie-Claude Addor ; MD⁵ ; Larraitz Arriola ; MD⁶ ; Marian Bakker ; PhD⁷ ; Ingeborg Barisic ; MD⁸ ; Sebastiano Bianca ; MD⁹ ; Patricia Boyd ; MD¹⁰ ; Elisa Calzolari ; MD¹¹ ; Berenice Doray ; MD¹² ; Elizabeth Draper ; PhD¹³ ; Miriam Gatt ; MD¹⁴ ; Martin Haeusler ; MD¹⁵ ; Kari Klungsoyr Melve ; MD¹⁶ ; Anna Latos-Bielenska ; MD¹⁷ ; Bob McDonnell ; MD¹⁸ ; Carmel Mullaney ; MD¹⁹ ; Vera Nelen ; MD²⁰ ; Mary O'Mahony ; MD²¹ ; Anna Pierini ; MD²² ; Annette Queisser-Luft ; MD²³ ; Hanitra Randrianaivo ; MD²⁴ ; Judith Rankin ; PhD²⁵ ; Anke Rissmann ; MD²⁶ ; Joaquin Salvador ; MD²⁷ ; David Tucker ; MPH²⁸ ; Christine Verellen-Dumoulin ; MD²⁹ ; Diana Wellesley ; MD³⁰ ; Natalya Zymak-Zakutnya ; MD³¹ ; Helen Dolk ; DrPH³
• 关键词：ASD ; Atrial septal defect ; CHD ; Congenital heart defect ; EUROCAT ; European Surveillance of Congenital Anomalies ; ICD ; International Classification of Diseases ; NTD ; Neural tube defect ; PR ; Prevalence ratio
• 刊名：The Journal of Pediatrics
• 出版年：2013
• 出版时间：January, 2013
• 年：2013
• 卷：162
• 期：1
• 页码：108-113.e2
• 全文大小：221 K

文摘

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Objectives

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.

Study design

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.

Results

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.

Conclusions

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.