title: Maternal intake of fat, riboflavin and nicotinamide and the risk of having offspring with congenital heart defects.
abstract: 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.
authors.affiliation: Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
authors.forename: Huberdina P M
authors.initials: HP
authors.lastname: Smedts
authors.forename: Maryam
authors.initials: M
authors.lastname: Rakhshandehroo
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: Jaap
authors.initials: J
authors.lastname: Ottenkamp
authors.forename: Eric A P
authors.initials: EA
authors.lastname: Steegers
authors.forename: Régine P M
authors.initials: RP
authors.lastname: Steegers-Theunissen
mesh_terms: 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
chemical_list: D004041:Dietary Fats; D014803:Vitamin B Complex; D009536:Niacinamide; D012256:Riboflavin
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