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Heart defects and other malformations in the Inuit in Canada: a baseline study
L Arbour1, C Gilpin, V Millor-Roy
1Children and Women's Health Centre of BC, University of British Columbia, Vancouver British Columbia, Canada. larbour@cw.bc.ca
Insights
Birth defects, particularly heart defects, were significantly higher in Inuit infants compared to the general population. Further research is needed to identify contributing factors and potential interventions like optimizing vitamin intake.
Area of Science:
- Public Health
- Pediatrics
- Genetics
Background:
- Birth defects are a significant global cause of infant morbidity and healthcare costs.
- Disparities in birth defect rates may exist among different ethnic and geographical groups.
Purpose of the Study:
- To compare the prevalence of birth defects in Inuit populations residing in Arctic Quebec and Nunavut with a general Canadian population.
- To identify specific types of birth defects that are disproportionately higher in the Inuit sample.
Main Methods:
- A chart review of 2567 live births of Inuit children (1989-1994) was conducted.
- Data was compared against the Alberta Congenital Anomalies Surveillance System (ACASS) rates.
Main Results:
- Inuit infants had nearly double the rate of total birth defects (99.7/1000 vs. 51.5/1000).
- Congenital heart defects were significantly increased in Inuit infants (22.9/1000 vs. 5.6/1000), especially ventricular septal defects (VSDs) and atrial septal defects (ASDs).
Conclusions:
- High rates of congenital heart defects contribute significantly to the elevated overall birth defect rate in the Inuit population.
- Potential contributing factors include genetic predisposition, low folate and vitamin A intake, and alcohol consumption.
- Optimizing periconceptional vitamin status may be a strategy to reduce birth defect rates.
Objectives:
Birth defects occur in all ethnic groups, remaining an important world-wide cause of perinatal and infant morbidity. This contributes greatly to an excess of health care dollars allocated to the care and repair of those affected. This is especially true when those affected live in remote geographical locations.
Study Design:
A chart review of 2567 live births of children of Inuit parents residing in Arctic Quebec (Nunavik) and on Baffin Island (Nunavut) between 1989 and 1994 (five years) was carried out compared to rates of anomalies of the Alberta Congenital Anomalies Surveillance System (ACASS).
Results:
Birth defects were higher in the Inuit sample in nearly every major ICD-9 category with the exception of neural tube defects, eye anomalies and chromosome abnormalities. (Total: 99.7/1000 Vs 51.5/1000; OR 1.93 95% CI 1.7-2.3). Congenital heart defects were significantly increased 22.9/1000 Vs 5.6/1000, with an OR of 4.18 (95% CI 3.2-5.4) in the ICD-9 category 745. In particular, ventricular septal defects (VSDs) and atrial septal defects (ASDs) (OR 4.9 CI 3.5-6.9 and 4.6 CI 2.9-7.2) were frequent.
Conclusions:
A high rate of heart defects was an important contributor to the nearly two times rate of total birth defects in the Inuit compared to the ACASS. Further study should be carried out to determine the contributing factors. Genetic predisposition to specific heart defects, and a diet low in folate and vitamin A are considerations. The use of alcohol may exacerbate vitamin status in pregnancy. Optimizing vitamin status in the periconceptional period may reduce the rate of birth defects.
