Maternal use of folic acid and multivitamin supplements and infant risk of birth defects in Norway, 1999–2013

Published on Apr 2, 2020in British Journal of Nutrition3.334
· DOI :10.1017/S0007114520001178
Trude Gildestad3
Estimated H-index: 3
(University of Bergen),
Tone Bjørge59
Estimated H-index: 59
(University of Bergen)
+ 3 AuthorsNina Øyen36
Estimated H-index: 36
(University of Bergen)
Sources
Abstract
The association between folic acid supplementation and birth defects other than neural tube defects remains unclear. We used a log-binomial regression model to investigate if periconceptional folic acid and/or multivitamin use was associated with birth defects in Norway with prospectively collected data from the Medical Birth Registry of Norway (MBRN) during 1999-2013. We used the EUROCAT classification system to define 11 organ-specific major birth defect groups (nervous system, eye, ear-face-neck, cardiovascular system, respiratory system, oral clefts, digestive system, abdominal wall, urinary system, genital organs, and limb), with additional subgroups. Fetuses or infants whose mothers used folic acid and/or multivitamin supplements before and during pregnancy were classified as exposed. During the years 1999-2013, 888,294 (99.0%) live born infants, 6,633 (0.7%) stillborn infants, and 2,135 (0.2%) fetuses from terminated pregnancies due to fetal anomalies were registered in the MBRN. Among the live- and stillborn infants of women who used vitamin supplements compared to infants of non-users, the adjusted relative risk (aRR) was 0.94 (95% confidence intervals (CIs) 0.91-0.98) for total birth defects (n=18,382). Supplement use was associated with reduced risk of abdominal wall defects (aRR 0.58; 0.42-0.80, n=377), genital organ defects (aRR 0.81; 0.72-0.91, n=2,299), and limb defects (aRR 0.81; 0.74-0.90, n=3,409). Protective associations were also suggested for neural tube defects, respiratory system defects, and digestive system defects although CIs included the null value of 1. During the full study period, statistically significant associations between supplement use and defects in the eye, ear-face-neck, heart or oral clefts were not observed.
📖 Papers frequently viewed together
13 Citations
20035.36Pediatrics
59 Citations
130 Citations
References54
Newest
#1Roy Miodini Nilsen (Bergen University College)H-Index: 8
#2Anne Kjersti Daltveit (University of Bergen)H-Index: 57
Last. Vigdis AasheimH-Index: 6
view all 9 authors...
This study examines how preconception folic acid supplement use varied in immigrant women compared with non-immigrant women. We analyzed national population-based data from Norway from 1999–2016, including 1,055,886 pregnancies, of which 202,234 and 7,965 were to 1st and 2nd generation immigrant women, respectively. Folic acid supplement use was examined in relation to generational immigrant category, maternal country of birth, and length of residence. Folic acid supplement use was lower overall...
2 CitationsSource
#1Kari Klungsøyr (University of Bergen)H-Index: 41
#2Tone Irene Nordtveit (Haukeland University Hospital)H-Index: 2
Last. Anne-Karin Vik (Oslo University Hospital)H-Index: 1
view all 6 authors...
Background Following the Thalidomide disaster, the Medical Birth Registry of Norway (MBRN) was established in 1967, with epidemiological surveillance of congenital anomalies as one main aim. Limb reduction defects (LRD) constitute a rare and heterogeneous anomaly group, where correct registration and classification is important for surveillance and research. We aimed at reviewing and recoding LRD cases in the MBRN using the same classification system for all years, and evaluate time trends, char...
9 CitationsSource
#1Nina Øyen (University of Bergen)H-Index: 36
#2Sjurdur F. Olsen (SSI: Statens Serum Institut)H-Index: 69
Last. Mads Melbye (Stanford University)H-Index: 126
view all 12 authors...
Background Evidence linking individual‐level maternal folic acid supplementation to offspring risk of congenital heart defects is lacking. We investigated whether folic acid supplementation in earl...
16 CitationsSource
BACKGROUND: In 2016, the Norwegian National Nutrition Council concluded that inadequate iodine intake is widespread in sections of the Norwegian population, and that effective measures should be undertaken immediately. This literature review aims to summarise articles published since January 2016 that describe the iodine intake in Norway. MATERIAL AND METHOD: Literature searches were conducted in PubMed and Embase. Altogether thirteen articles that reported intake of iodine from the diet or urin...
3 CitationsSource
#1Annelies Tuenter (EUR: Erasmus University Rotterdam)H-Index: 1
#2Paula K. Bautista Nino (EUR: Erasmus University Rotterdam)H-Index: 3
Last. Janine F. Felix (EUR: Erasmus University Rotterdam)H-Index: 57
view all 7 authors...
textabstractSmoking exposure is associated with pregnancy complications, as are levels of folate, vitamin B12, and homocysteine. In nonpregnant adults, smoking exposure is associated negatively with folate and vitamin B12 levels and positively with homocysteine levels. A complete overview of the literature on this topic in pregnant women is lacking. To evaluate evidence of associations of maternal smoking exposure during pregnancy and levels of folate, homocysteine, and vitamin B12 in pregnancy ...
10 CitationsSource
#1Arezoo JahanbinH-Index: 13
#2Elaheh ShadkamH-Index: 4
Last. Mostafa AbtahiH-Index: 7
view all 5 authors...
Introduction:There is controversial evidence from the literature regarding the protective effect of folic acid supplementation during pregnancy against orofacial clefts. The authors undertook this meta-analysis to assess whether folate supplementation during pregnancy can reduce the risk of nonsyndr
29 CitationsSource
#1Joan K. Morris (QMUL: Queen Mary University of London)H-Index: 67
#2Anna Springett (QMUL: Queen Mary University of London)H-Index: 9
Last. Helen Dolk (Ulster University)H-Index: 69
view all 30 authors...
Background: Surveillance of congenital anomalies is important to identify potential teratogens. Methods: This study analysed the prevalence of 61 congenital anomaly subgroups (excluding chromosomal) in 25 population-based EUROCAT registries (1980 – 2012). Live births, fetal deaths and terminations of pregnancy for fetal anomaly were analysed with multilevel random-effects Poisson regression models. Results: Seventeen anomaly subgroups had statistically significant trends from 2003 – 2012; 12 inc...
63 CitationsSource
: Preventing neural tube defects (NTDs) easily qualifies as a high-value opportunity to improve childhood survival and health: the unmet need is significant (major preventable burden), the intervention is transformative (providing sufficient folic acid), and delivery strategies (e.g., fortification) are effective in low-resource countries. Yet, NTD prevention is lagging. Can public health surveillance help fix this problem? Critics contend that surveillance is largely unnecessary, that limited r...
13 CitationsSource
#1Lynn B. Bailey (UGA: University of Georgia)H-Index: 58
#2Dorothy B. Hausman (UGA: University of Georgia)H-Index: 46
Reliable folate status data for women of reproductive age (WRA) to assess global risk for neural tube defects (NTDs) are needed. We focus on a recent recommendation by the World Health Organization that a specific “optimal” red blood cell (RBC) folate concentration be used as the sole indicator of NTD risk within a population and discuss how to best apply this guidance to reach the goal of assessing NTD risk globally. We also emphasize the importance of using the microbiologic assay (MBA) as the...
10 CitationsSource
#1Hanne Trap Wolf (Copenhagen University Hospital)H-Index: 5
#2Hanne Kristine Hegaard (Copenhagen University Hospital)H-Index: 21
Last. Anja Pinborg (Copenhagen University Hospital)H-Index: 22
view all 4 authors...
Background In high-income countries, a healthy diet is widely accessible. However, a change toward a poor-quality diet with a low nutritional value in high-income countries has led to an inadequate vitamin intake during pregnancy. Objective We conducted a systematic review and meta-analysis to evaluate the association between multivitamin use among women in high-income countries and the risk of adverse birth outcomes (preterm birth [primary outcome], low birthweight, small for gestational age, s...
28 CitationsSource
Cited By3
Newest
#10Hanmin Liu (Sichuan University)H-Index: 2
Maternal periconceptional folic acid supplementation (FAS) has been documented to be associated with decreased risk of nonsyndromic oral clefts (NsOC). However, the results remain inconclusive. In this population-based case-control study of 807 singletons affected by NsOC and 8070 healthy neonates who were born between October 2010 and September 2015 in Chengdu, China, we examined the association of maternal FAS with the risk of nonsyndromic cleft lip with or without cleft palate (NsCL/P), and c...
1 CitationsSource
#1Jie Zhang (PKU: Peking University)H-Index: 1
#2Lei JinH-Index: 16
Last. Aiguo Ren (PKU: Peking University)H-Index: 31
view all 8 authors...
BACKGROUND Associations between the periconceptional folic acid only (FAO) or multiple micronutrients containing folic acid (MMFA) supplementation and risk for limb defects are inconsistent. OBJECTIVE To explore the association between periconceptional folic acid supplements use and risk for limb defects, including clubfoot, polydactyly, syndactyly, and limb deficiencies. METHODS Data were derived from a cohort based on a pregnancy registry in a district of Beijing, China, from 2013 to 2018. Inf...
Source
#1Jufen LiuH-Index: 19
#2Zhiwen LiH-Index: 25
Last. Jianmeng LiuH-Index: 21
view all 5 authors...
Folic acid (FA) can reduce the risk for selected birth defects other than neural tube defects (NTDs). We examined whether FA has preventive effects against foetal abdominal wall defects (AWDs) in a unique intervention cohort in China. Birth outcomes of 247 831 singleton births from a population-based cohort study with detailed preconceptional FA intake information were collected in China in 1993-1996. Information on births at 20 complete gestational weeks, including live births, stillbirths, and...
Source