title: Recent decrease in the prevalence of congenital heart defects in Europe.
abstract: OBJECTIVE
  To examine trends in the prevalence of congenital heart defects (CHDs) in Europe and to compare these trends with the recent decrease in the prevalence of CHDs in Canada (Quebec) that was attributed to the policy of mandatory folic acid fortification.
  
  
  METHODS
  We used data for the period 1990-2007 for 47 508 cases of CHD not associated with a chromosomal anomaly from 29 population-based European Surveillance of Congenital Anomalies registries in 16 countries covering 7.3 million births. We estimated trends for all CHDs combined and separately for 3 severity groups using random-effects Poisson regression models with splines.
  
  
  RESULTS
  We found that the total prevalence of CHDs increased during the 1990s and the early 2000s until 2004 and decreased thereafter. We found essentially no trend in total prevalence of the most severe group (group I), whereas the prevalence of severity group II increased until about 2000 and decreased thereafter. Trends for severity group III (the most prevalent group) paralleled those for all CHDs combined.
  
  
  CONCLUSIONS
  The prevalence of CHDs decreased in recent years in Europe in the absence of a policy for mandatory folic acid fortification. One possible explanation for this decrease may be an as-yet-undocumented increase in folic acid intake of women in Europe following recommendations for folic acid supplementation and/or voluntary fortification. However, alternative hypotheses, including reductions in risk factors of CHDs (eg, maternal smoking) and improved management of maternal chronic health conditions (eg, diabetes), must also be considered for explaining the observed decrease in the prevalence of CHDs in Europe or elsewhere.
authors: INSERM, UMR S953, Epidemiological Research on Perinatal Health and Women's and Children's Health, Hôpital Saint Vincent de Paul, Paris, France. babak.khoshnood@inserm.fr
authors: Babak
authors: B
authors: Khoshnood
authors: Maria
authors: M
authors: Loane
authors: Ester
authors: E
authors: Garne
authors: Marie-Claude
authors: MC
authors: Addor
authors: Larraitz
authors: L
authors: Arriola
authors: Marian
authors: M
authors: Bakker
authors: Ingeborg
authors: I
authors: Barisic
authors: Sebastiano
authors: S
authors: Bianca
authors: Patricia
authors: P
authors: Boyd
authors: Elisa
authors: E
authors: Calzolari
authors: Berenice
authors: B
authors: Doray
authors: Elizabeth
authors: E
authors: Draper
authors: Miriam
authors: M
authors: Gatt
authors: Martin
authors: M
authors: Haeusler
authors: Kari Klungsoyr
authors: KK
authors: Melve
authors: Anna
authors: A
authors: Latos-Bielenska
authors: Bob
authors: B
authors: McDonnell
authors: Carmel
authors: C
authors: Mullaney
authors: Vera
authors: V
authors: Nelen
authors: Mary
authors: M
authors: O'Mahony
authors: Anna
authors: A
authors: Pierini
authors: Annette
authors: A
authors: Queisser-Luft
authors: Hanitra
authors: H
authors: Randrianaivo
authors: Judith
authors: J
authors: Rankin
authors: Anke
authors: A
authors: Rissmann
authors: Joaquin
authors: J
authors: Salvador
authors: David
authors: D
authors: Tucker
authors: Christine
authors: C
authors: Verellen-Dumoulin
authors: Diana
authors: D
authors: Wellesley
authors: Natalya
authors: N
authors: Zymak-Zakutnya
authors: Helen
authors: H
authors: Dolk
mesh_terms: D005060:Europe / Q000453:epidemiology; D006330:Heart Defects, Congenital / Q000453:epidemiology*; D006801:Humans; D007231:Infant, Newborn; D015995:Prevalence; D011792:Quebec / Q000453:epidemiology; D013997:Time Factors