Maternal intake of fat, riboflavin and nicotinamide and the risk of having offspring with congenital heart defects.
BACKGROUND
With the exception of studies on folic acid, little evidence is available concerning other nutrients in the pathogenesis of congenital heart defects (CHDs). Fatty acids play a central role in embryonic development, and the B-vitamins riboflavin and nicotinamide are co-enzymes in lipid metabolism.


OBJECTIVE
To investigate associations between the maternal dietary intake of fats, riboflavin and nicotinamide, and CHD risk in the offspring.


METHODS
A case-control family study was conducted in 276 mothers of a child with a CHD comprising of 190 outflow tract defects (OTD) and 86 non-outflow tract defects (non-OTD) and 324 control mothers of a non-malformed child. Mothers filled out general and food frequency questionnaires at 16 months after the index-pregnancy, as a proxy of the habitual food intake in the preconception period. Nutrient intakes (medians) were compared between cases and controls by Mann-Whitney U test. Odds ratios (OR) for the association between CHDs and nutrient intakes were estimated in a logistic regression model.


RESULTS
Case mothers, in particular mothers of a child with OTD, had higher dietary intakes of saturated fat, 30.9 vs. 29.8 g/d; P < 0.05. Dietary intakes of riboflavin and nicotinamide were lower in mothers of a child with an OTD than in controls (1.32 vs. 1.41 mg/d; P < 0.05 and 14.6 vs. 15.1 mg/d; P < 0.05, respectively). Energy, unsaturated fat, cholesterol and folate intakes were comparable between the groups. Low dietary intakes of both riboflavin (<1.20 mg/d) and nicotinamide (<13.5 mg/d) increased more than two-fold the risk of a child with an OTD, especially in mothers who did not use vitamin supplements in the periconceptional period (OR 2.4, 95%CI 1.4-4.0). Increasing intakes of nicotinamide (OR 0.8, 95%CI 0.7-1.001, per unit standard deviation increase) decreased CHD risk independent of dietary folate intake.


CONCLUSIONS
A maternal diet high in saturated fats and low in riboflavin and nicotinamide seems to contribute to CHD risk, in particular OTDs.
Smedts
Huberdina P M
HP
Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
Rakhshandehroo
Maryam
M
Verkleij-Hagoort
Anna C
AC
de Vries
Jeanne H M
JH
Ottenkamp
Jaap
J
Steegers
Eric A P
EA
Steegers-Theunissen
Régine P M
RP
D000328:Adult; D016022:Case-Control Studies; D004041:Dietary Fats / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006330:Heart Defects, Congenital / Q000453:epidemiology*; D006801:Humans; D007231:Infant, Newborn; D050356:Lipid Metabolism / Q000502:physiology; D016015:Logistic Models; D008297:Male; D039382:Maternal Nutritional Physiological Phenomena / Q000502:physiology*; D009536:Niacinamide / Q000008:administration & dosage* / Q000172:deficiency; D009751:Nutritional Requirements; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011297:Prenatal Exposure Delayed Effects; D039401:Prenatal Nutritional Physiological Phenomena / Q000502:physiology; D012256:Riboflavin / Q000008:administration & dosage*; D012257:Riboflavin Deficiency / Q000097:blood / Q000150:complications; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014803:Vitamin B Complex / Q000008:administration & dosage*; D014804:Vitamin B Deficiency / Q000097:blood / Q000150:complications / Q000453:epidemiology; D055815:Young Adult
D004041:Dietary Fats; D014803:Vitamin B Complex; D009536:Niacinamide; D012256:Riboflavin
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