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- Title
Folate related birth defects and future maternal cardiovascular mortality.
- Authors
K., Klungsøyr; L., DeRoo; J., Rich-Edwards; S., Hernandez-Diaz; S., Cnattingius; A. K., Wikstrom; G., Egeland; R., Skjærven
- Abstract
Introduction: Low levels of plasma folate increase homocysteine levels and may be linked to cardiovascular disease (CVD). Maternal periconceptional folic acid supplementation prevents offspring Neural tube defects (NTD), and possibly other birth defects. Aim: We aimed at evaluating premature (40-69 years) CVD mortality in mothers whose first infant had folate-related birth defects, taking account of number of life-time births (1 vs >1). Methods: We used linked data from the Swedish and Norwegian Medical Birth and Cause of Death Registries (Sweden: 1973-2010, Norway: 1967-2014), and linked successive births to their mothers. Major birth defects were defined according to the European network of congenital anomaly registries, folate-related defects were defined as NTDs, oral clefts, cardiac defects, or limb reduction defects. Women were followed to 2010/2014 for pregnancies and mortality, and Cox regression analyses were used to evaluate associations between a birth defect and maternal premature CVD mortality, adjusting for confounders. Results: Among 2,237,648 women (Norway: 42.4%, Sweden: 57.6%) there were 48,903 premature deaths and 5,961 (2.7 per 1000) premature CVD deaths (Norway: 3.9 per 1000, Sweden: 1.8 per 1000). A folate-related defect in first birth was significantly associated with increased premature CVD mortality (adjusted HR (adjHR) 1.3; 95% CI 1.0-1.8), seemingly driven by cardiac defects (adjHR 2.1; 1.3 to 3.2). The relation was, however, limited to one-child mothers: Folate-related and cardiac defects in first and only birth: adjHR 3.3; 2.1 to 5.1 and adjHR 5.0; 2.7 to 9.0, respectively; vs mothers with >1 birth: adjHR 1.0; 0.6 to 1.5 and adjHR 1.4; 0.8 to 2.6. Excluding women with diabetes in first pregnancy and foreign born women only slightly attenuated results. A similar relation for fathers' CVD mortality by offspring birth defects was not found. Conclusion: We found no indication that folate-related defects predict maternal CVD mortality, but factors associated with birth defects, reduced fertility and increased diabetes risk may be important.
- Subjects
HUMAN abnormalities; FOLIC acid deficiency; CARDIOVASCULAR disease related mortality; MATERNAL mortality; NEURAL tube defects
- Publication
Norsk Epidemiologi, 2018, Vol 28, Issue Supplement 1, p38
- ISSN
0803-2491
- Publication type
Article