Dietary intake of B-vitamins in mothers born a child with a congenital heart defect
Periconceptional use of multivitamins reduces the risk of a child with a congenital heart defect (CHD). Data on the impact of maternal diet, however, are lacking.
Aim of the study
We investigated the association between the maternal dietary intake of B-vitamins and having a child with a CHD.
A case-control study was performed in 192 mothers of a child with a CHD and 216 mothers of a healthy child. Mothers filled out food frequency questionnaires covering the current dietary intake, and general questionnaires at 17 months after the index-pregnancy. Maternal blood samples were taken to determine B-vitamin and plasma total homocysteine (tHcy) concentrations as nutritional biomarkers. Pregnant and lactating mothers and those with another diet compared with the preconceptional period were excluded for analysis. Case-mothers and controls were compared using the Mann-Whitney U test and logistic regression.
The dietary intake of macronutrients and B-vitamins was comparable between both groups, but all mothers had a substantially lower median folate intake (cases 161 μg, controls 175 μg) than the Dutch recommended dietary allowance of 300 μg. Within the case-group, the intake of proteins and vitamin B6 and the concentrations of serum vitamin B12 and folate were significantly lower in hyperhomocysteinemics (tHcy ≥ 14.5 μmol/l) than in normohomocysteinemics. The maternal educational level was positively associated with B-vitamin intake, except for vitamin B12 in controls. Low educated case-mothers showed a significantly lower median vitamin B12 intake than controls (2.8 μg and 3.8 μg, P = 0.01). The CHD risk doubled if vitamin B12 intake in these mothers reduced by 50% (OR 2.0; 95% CI: 1.1–3.5).
A diet low in vitamin B12 is associated with an increased risk of a child with a CHD, especially in low educated women. A disbalance in the maternal intake of proteins and low folate intake may play a role as well, but needs further investigation. As hyperhomocysteinemia is a strong risk factor for adult cardiovascular disease, these data may imply that the hyperhomocysteinemic mothers and their children should be targeted for nutritional interventions.
Keywordsfood heart defects congenital vitamin B12 pyridoxine homocysteine
We are very grateful to all participating families. We thank Prof. W.A. Helbing, Prof. J. Ottenkamp, Dr. F.M.H. Siebel, the nurses at the Paediatric Cardiology outpatient clinic of Erasmus MC, Mrs S. Meyboom, Mr. B. van Zelst and Mr. R. de Nooijer for their significant contributions. This study was funded by the Netherlands Heart Foundation (grant 2002.B027).
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