title: Folic acid fortification and the birth prevalence of congenital heart defect cases in Alberta, Canada.
abstract: BACKGROUND
  Congenital heart defects (CHDs) are the most common type of congenital anomaly. The precise etiology is unknown and the development of successful primary prevention strategies is challenging. Folic acid may have a protective role; however published results have been inconsistent. This study examines the impact of mandatory folic acid fortification (FAF) on the prevalence of CHDs.
  
  
  METHODS
  CHD cases were ascertained using the Alberta Congenital Anomalies Surveillance System, Pediatric Cardiology Clinics, Pathology, and hospital records. The birth prevalence and odds ratios (OR) of isolated CHD cases (i.e., without noncardiac anomalies) were calculated comparing pre-FAF (1995-1997) with post-FAF (1999-2002).
  
  
  RESULTS
  The prevalence of isolated CHD cases remained relatively unchanged when pre-FAF (9.34, 95% confidence interval [CI] 8.79-9.92) was compared with post-FAF (9.41, 95% CI, 8.93-9.91). Left ventricular outflow tract obstruction (LVOTO) decreased post-FAF (OR, 0.76; 95% CI, 0.61-0.94). Coarctation of the aorta contributed to this decline (OR, 0.55; 95% CI, 0.32-0.92). Atrial septal defect (ASD) (OR, 1.42; 95% CI, 1.13-1.80) and ASD with ventricular septal defect (OR, 1.52; 95% CI, 1.10-2.10) increased post-FAF. The remaining types of CHDs were unchanged.
  
  
  CONCLUSIONS
  FAF alone does not have an impact on the prevalence of CHDs as a group and the majority of selected types of CHDs in Alberta. The decrease in LVOTO, particularly coarctation of the aorta, may be due to FAF or other environmental factors. The increase in ASD and ASD with ventricular septal defect may reflect an increase in diagnosis and ascertainment.
authors.affiliation: Alberta Congenital Anomalies Surveillance System, Alberta Health and Wellness, Calgary, Alberta, Canada. tanya.bedard@albertahealthservices.ca
authors.forename: Tanya
authors.initials: T
authors.lastname: Bedard
authors.forename: R Brian
authors.initials: RB
authors.lastname: Lowry
authors.forename: Barbara
authors.initials: B
authors.lastname: Sibbald
authors.forename: Joyce R
authors.initials: JR
authors.lastname: Harder
authors.forename: Cynthia
authors.initials: C
authors.lastname: Trevenen
authors.forename: Vera
authors.initials: V
authors.lastname: Horobec
authors.forename: John D
authors.initials: JD
authors.lastname: Dyck
mesh_terms: D000416:Alberta / Q000453:epidemiology; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage*; D006330:Heart Defects, Congenital / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D018811:Maternal Exposure / Q000009:adverse effects*; D015995:Prevalence
chemical_list: D005492:Folic Acid
keywords: Alberta; congenital heart defect; folic acid fortification; prevention; public health