title: Dietary intake of B-vitamins in mothers born a child with a congenital heart defect.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  We investigated the association between the maternal dietary intake of B-vitamins and having a child with a CHD.
  
  
  METHODS
  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.
  
  
  RESULTS
  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 microg, controls 175 microg) than the Dutch recommended dietary allowance of 300 microg. Within the case-group, the intake of proteins and vitamin B(6) and the concentrations of serum vitamin B(12) and folate were significantly lower in hyperhomocysteinemics (tHcy > or = 14.5 micromol/l) than in normohomocysteinemics. The maternal educational level was positively associated with B-vitamin intake, except for vitamin B(12) in controls. Low educated case-mothers showed a significantly lower median vitamin B(12) intake than controls (2.8 microg and 3.8 microg, P = 0.01). The CHD risk doubled if vitamin B(12) intake in these mothers reduced by 50% (OR 2.0; 95% CI: 1.1-3.5).
  
  
  CONCLUSIONS
  A diet low in vitamin B(12) 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.
authors.affiliation: Dept. of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
authors.forename: Anna C
authors.initials: AC
authors.lastname: Verkleij-Hagoort
authors.forename: Jeanne H M
authors.initials: JH
authors.lastname: de Vries
authors.forename: Nicolette T C
authors.initials: NT
authors.lastname: Ursem
authors.forename: Robert
authors.initials: R
authors.lastname: de Jonge
authors.forename: Wim C J
authors.initials: WC
authors.lastname: Hop
authors.forename: Régine P M
authors.initials: RP
authors.lastname: Steegers-Theunissen
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D004044:Dietary Proteins; D004522:Educational Status; D005260:Female; D005492:Folic Acid; D006330:Heart Defects, Congenital / Q000453:epidemiology / Q000209:etiology*; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D020138:Hyperhomocysteinemia / Q000097:blood / Q000150:complications*; D007231:Infant, Newborn; D016015:Logistic Models; D039382:Maternal Nutritional Physiological Phenomena / Q000502:physiology*; D009751:Nutritional Requirements; D009752:Nutritional Status; D011247:Pregnancy; D011248:Pregnancy Complications; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014805:Vitamin B 12 / Q000008:administration & dosage / Q000097:blood; D014803:Vitamin B Complex / Q000008:administration & dosage* / Q000097:blood
chemical_list: D004044:Dietary Proteins; D006710:Homocysteine; D014803:Vitamin B Complex; D005492:Folic Acid; D014805:Vitamin B 12