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Recent decrease in the prevalence of congenital heart defects in Europe.

Babak Khoshnood1, Maria Loane, Ester Garne

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Congenital heart defect (CHD) prevalence in Europe decreased recently, unlike in Quebec after mandatory folic acid fortification. This European decline may be due to increased folic acid intake or other factors like reduced maternal smoking.

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Area of Science:

  • Public Health
  • Epidemiology
  • Reproductive Health

Background:

  • Congenital heart defects (CHDs) are a significant public health concern.
  • A previous study in Quebec, Canada, linked a decrease in CHD prevalence to mandatory folic acid fortification policies.
  • Understanding CHD trends in Europe is crucial for public health interventions.

Purpose of the Study:

  • To analyze trends in CHD prevalence across Europe from 1990 to 2007.
  • To compare European CHD trends with those observed in Quebec, Canada.
  • To investigate potential factors contributing to observed CHD prevalence changes.

Main Methods:

  • Utilized data from 29 European population-based registries (1990-2007) covering 7.3 million births.
  • Included 47,508 cases of CHDs not associated with chromosomal anomalies.
  • Employed random-effects Poisson regression models with splines to estimate trends for combined and severity-grouped CHDs.

Main Results:

  • Overall CHD prevalence increased until 2004 and subsequently decreased.
  • No significant trend was observed for the most severe CHD group (Group I).
  • Prevalence of moderate severity group (Group II) increased until 2000, then decreased; Group III trends mirrored overall CHD trends.

Conclusions:

  • CHD prevalence has recently declined in Europe without mandatory folic acid fortification.
  • Increased folic acid intake (supplementation or voluntary fortification) is a potential, though undocumented, explanation.
  • Other factors like reduced maternal smoking and improved management of maternal conditions (e.g., diabetes) may also contribute to the observed decrease.