title: Lack of maternal folic acid supplementation is associated with heart defects in Down syndrome: a report from the National Down Syndrome Project.
abstract: BACKGROUND
  Maternal folic acid supplementation has been associated with a reduced risk for neural tube defects and may be associated with a reduced risk for congenital heart defects and other birth defects. Individuals with Down syndrome are at high risk for congenital heart defects and have been shown to have abnormal folate metabolism.
  
  
  METHODS
  As part of the population-based case-control National Down Syndrome Project, 1011 mothers of infants with Down syndrome reported their use of supplements containing folic acid. These data were used to determine whether a lack of periconceptional maternal folic acid supplementation is associated with congenital heart defects in Down syndrome. We used logistic regression to test the relationship between maternal folic acid supplementation and the frequency of specific heart defects correcting for maternal race or ethnicity, proband sex, maternal use of alcohol and cigarettes, and maternal age at conception.
  
  
  RESULTS
  Lack of maternal folic acid supplementation was more frequent among infants with Down syndrome and atrioventricular septal defects (odds ratio [OR], 1.69; 95% confidence interval [CI], 1.08-2.63; p = 0.011) or atrial septal defects (OR, 1.69; 95% CI, 1.11-2.58; p = 0.007) than among infants with Down syndrome and no heart defect. Preliminary evidence suggests that the patterns of association differ by race or ethnicity and sex of the proband. There was no statistically significant association with ventricular septal defects (OR, 1.26; 95% CI, 0.85-1.87; p = 0.124).
  
  
  CONCLUSIONS
  Our results suggest that lack of maternal folic acid supplementation is associated with septal defects in infants with Down syndrome. Birth Defects Research (Part A), 2011. © 2011 Wiley-Liss, Inc.
authors: Department of Human Genetics, Emory University, Atlanta, Georgia, USA. ljbean@emory.edu
authors: Lora J H
authors: LJ
authors: Bean
authors: Emily G
authors: EG
authors: Allen
authors: Stuart W
authors: SW
authors: Tinker
authors: Natasha D
authors: ND
authors: Hollis
authors: Adam E
authors: AE
authors: Locke
authors: Charlotte
authors: C
authors: Druschel
authors: Charlotte A
authors: CA
authors: Hobbs
authors: Leslie
authors: L
authors: O'Leary
authors: Paul A
authors: PA
authors: Romitti
authors: Marjorie H
authors: MH
authors: Royle
authors: Claudine P
authors: CP
authors: Torfs
authors: Kenneth J
authors: KJ
authors: Dooley
authors: Sallie B
authors: SB
authors: Freeman
authors: Stephanie L
authors: SL
authors: Sherman
mesh_terms: D019587:Dietary Supplements; D004314:Down Syndrome / Q000150:complications / Q000453:epidemiology*; D005260:Female; D005492:Folic Acid; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000453:epidemiology*; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D008297:Male; D011247:Pregnancy; D014481:United States / Q000453:epidemiology
chemical_list: D005492:Folic Acid