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Canadian Journal of Public Health

, Volume 99, Issue 4, pp 271–275 | Cite as

Changes in Frequencies of Select Congenital Anomalies since the Onset of Folic Acid Fortification in a Canadian Birth Defect Registry

  • Kimberly A. Godwin
  • Barbara Sibbald
  • Tanya Bedard
  • Boris Kuzeljevic
  • R. Brian Lowry
  • Laura ArbourEmail author
Article
  • 1 Downloads

Abstract

Objectives

Fortification of grain products with folic acid has been shown to significantly reduce the occurrence of neural tube defects (NTDs) in Canada and elsewhere. However, the impact on non-NTD anomalies has not been well studied.

Methods

Using the Alberta Congenital Anomalies Surveillance System (ACASS), we examined changes in occurrence of select congenital anomalies where folic acid supplementation with multivitamins had previously been suggested to have an effect. Anomalies documented in the ACASS 1992–1996 (pre-fortification) were compared to 1999–2003 (post-fortification).

Results

A significant decrease in spina bifida (OR 0.51, 95% CI 0.36–0.73) and ostium secundum atrial septal defects (OR 0.80, 95% CI 0.69–0.93) was evident, but there was a significant increase in obstructive defects of the renal pelvis and ureter (OR 1.45, 95% CI 1.24–1.70), abdominal wall defects (OR 1.40, 95% CI 1.04–1.88) and pyloric stenosis (OR 1.49, 95% CI 1.18–1.89).

Conclusions

Consistent with other studies, a 50% reduction in spina bifida was associated with the post-fortification time period. Supporting the possibility that folic acid fortification may play a role in preventing other birth defects, a 20% reduction in atrial septal defects was also associated. The increase in abdominal wall defects, most notably gastroschisis, is likely related to pre-existing increasing trends documented in several regions around the world. The increase in pyloric stenosis and obstructive urinary tract defects was not expected and any causal relationship with folic acid fortification remains unclear. Similar studies by other birth defects surveillance systems in Canada and elsewhere are needed to confirm these trends.

Key words

Folic acid heart septal defects atrial congenital abnormalities pyloric stenosis gastroschisis 

Résumé

Objectifs

Il est prouvé que l’enrichissement en acide folique des produits céréaliers réduit la fréquence des anomalies du tube neural (ATN) au Canada et ailleurs dans le monde. Cependant, l’impact d’un apport supplémentaire en acide folique sur les autres anomalies congénitales n’a pas été suffisamment étudié.

Méthode

À l’aide du système de surveillance des anomalies congénitales de l’Alberta (ACASS), nous avons examiné les variations dans la fréquence de certaines anomalies congénitales pour lesquelles on pense qu’une supplémentation multivitaminique contenant de l’acide folique aurait un effet. Les anomalies répertoriées dans l’ACASS de 1992 à 1996 (avant l’enrichissement) ont été comparées aux données de 1999–2003 (après l’enrichissement).

Résultats

Des baisses significatives du spina bifida (RC=0,51, IC de 95 % = 0,36-0,73) et de la persistance de l’ostium secundum [variété la plus fréquente de communication interauriculaire] (RC=0,80, IC de 95 % = 0,69-0,93) ont été observées, avec par contre des augmentations significatives des malformations obstructives du bassinet du rein et de l’uretère (RC=1,45, IC de 95 % = 1,24-1,70), des malformations de la paroi abdominale (RC=1,40, IC de 95 % = 1,04-1,88) et de la sténose du pylore (RC=1,49, IC de 95 % = 1,18-1,89).

Conclusion

Conformément aux résultats d’autres études, une diminution de 50 % dans la fréquence du spina bifida était associée à la période suivant l’enrichissement en acide folique. Un tel enrichissement pourrait jouer un rôle dans la prévention d’autres anomalies congénitales, comme en témoigne la baisse de 20 % dans la fréquence de la communication interauriculaire. L’augmentation des malformations de la paroi abdominale, en particulier du laparoschisis, est probablement liée à des tendances haussières préexistantes signalées dans plusieurs régions du monde. Les augmentations de la sténose du pylore et des malformations obstructives du tractus urinaire n’étaient pas prévues, mais une relation causale entre ces anomalies et l’enrichissement en acide folique n’est pas encore établie. Il faudrait mener des études semblables à partir d’autres systèmes de surveillance des anomalies congénitales au Canada et ailleurs dans le monde pour confirmer ou infirmer ces tendances.

Mots clés

acide folique communication interauriculaire anomalies congénitales sténose du pylore laparoschisis 

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Copyright information

© The Canadian Public Health Association 2008

Authors and Affiliations

  • Kimberly A. Godwin
    • 1
  • Barbara Sibbald
    • 2
  • Tanya Bedard
    • 2
  • Boris Kuzeljevic
    • 3
  • R. Brian Lowry
    • 2
  • Laura Arbour
    • 4
    Email author
  1. 1.UBC Department of Medical GeneticsChildren’s and Women’s Health CentreVancouverVictoriaCanada
  2. 2.Alberta Congenital Anomalies Surveillance System, Department of Medical GeneticsAlberta Children’s HospitalCalgaryCanada
  3. 3.BC Research Institute for Children’s and Women’s HealthVancouverCanada
  4. 4.UBC Department of Medical Genetics, Island Medical ProgramUniversity of VictoriaVictoriaCanada

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