title: Dietary vitamin A intake below the recommended daily intake during pregnancy and the risk of congenital diaphragmatic hernia in the offspring.
abstract: BACKGROUND
  Vitamin A has been related to the etiology of congenital diaphragmatic hernia (CDH). We performed a case-control study to investigate whether maternal dietary vitamin A intake is related to CDH in the offspring.
  
  
  METHODS
  Thirty-one pregnancies diagnosed with CDH and 46 control pregnancies were included during the study. After CDH diagnosis and inclusion of controls by risk set sampling, maternal vitamin A intake was investigated with a food frequency questionnaire. Serum retinol and retinol-binding protein were determined. Univariable and multivariable logistic regression models were used to calculate risk estimates with adjustment for potential confounders.
  
  
  RESULTS
  We found no significant differences in the overall nutrient and vitamin A intake between case and control mothers. After stratification in body mass index (BMI) categories, case mothers with normal weight showed a lower energy adjusted vitamin A intake (685 vs. 843 μg retinol activity equivalents [RAEs] / day; p = 0.04) and a slightly lower serum retinol (1.58 vs. 1.67 μmol/L; p = 0.08) than control mothers. Vitamin A intake <800 μg retinol activity equivalents (recommended daily intake) in normal weight mothers was associated with a significantly increased CDH risk (odds ratio [OR], 7.2; 95% confidence interval [CI], 1.5-34.4; p = 0.01). Associations were not significantly different in underweight and overweight mothers.
  
  
  CONCLUSIONS
  In normal-weight mothers, dietary vitamin A intake during pregnancy below the recommended daily intake is significantly associated with an increased risk of a child with CDH. This finding supports the retinoid hypothesis in human CDH, but warrants further investigation in larger study populations. Birth Defects Research (Part A), 2013. © 2013 Wiley Periodicals, Inc.
authors.affiliation: Department of Pediatric Surgery, Sophia Children's Hospital, The Netherlands.
authors.forename: Leonardus W J E
authors.initials: LW
authors.lastname: Beurskens
authors.forename: Lieske H
authors.initials: LH
authors.lastname: Schrijver
authors.forename: Dick
authors.initials: D
authors.lastname: Tibboel
authors.forename: Mark F
authors.initials: MF
authors.lastname: Wildhagen
authors.forename: Maarten F C M
authors.initials: MF
authors.lastname: Knapen
authors.forename: Jan
authors.initials: J
authors.lastname: Lindemans
authors.forename: Jeanne
authors.initials: J
authors.lastname: de Vries
authors.forename: Régine P M
authors.initials: RP
authors.lastname: Steegers-Theunissen
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D019587:Dietary Supplements; D004305:Dose-Response Relationship, Drug; D005260:Female; D005865:Gestational Age; D006548:Hernia, Diaphragmatic / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D008423:Maternal Age; D009426:Netherlands / Q000453:epidemiology; D018673:Nutrition Policy; D011247:Pregnancy; D011296:Prenatal Diagnosis; D018570:Risk Assessment; D014801:Vitamin A / Q000008:administration & dosage*; D014802:Vitamin A Deficiency / Q000196:embryology*
chemical_list: D014801:Vitamin A