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Reduction of urinary tract and cardiovascular defects by periconceptional multivitamin supplementation
1Department of Human Genetics and Teratology, National Institute of Hygiene--WHO Collaborating Centre for the Community Control of Hereditary Diseases, Budapest, Hungary.
Insights
Periconceptional multivitamin supplementation significantly reduced major congenital abnormalities, including neural tube defects. This finding suggests a preventive role for multivitamins in early pregnancy.
Area of Science:
- Obstetrics and Gynecology
- Public Health
- Developmental Biology
Background:
- Congenital abnormalities pose a significant global health burden.
- Periconceptional nutritional status is crucial for fetal development.
- Folic acid is known to prevent neural tube defects.
Purpose of the Study:
- To investigate the preventive efficacy of periconceptional multivitamin supplementation.
- To assess the impact on neural tube defects and other congenital abnormalities.
- To evaluate the role of folic acid in preventing birth defects.
Main Methods:
- A Hungarian randomized, double-blind, controlled trial.
- Involved 2,471 (multivitamin) and 2,391 (trace element) offspring.
- Supplementation included 0.8 mg folic acid daily before conception and until the second missed period.
Main Results:
- The multivitamin group showed a significantly lower rate of major congenital abnormalities (20.6/1,000 vs. 40.6/1,000).
- A highly significant reduction in neural tube defects was observed (relative risk 0.54).
- Significant reductions were noted in urinary tract and cardiovascular malformations.
Conclusions:
- Periconceptional multivitamin supplementation, particularly with folic acid, appears to reduce major congenital abnormalities.
- The findings support the use of multivitamins for preventing birth defects.
- Further research is encouraged to replicate these hypothesis-generating results.
Abstract:
The objective in the Hungarian randomised double-blind controlled trial was to study the preventive effect of periconceptional multivitamin supplementation on neural tube-defects and other congenital abnormalities. There were 2,471 and 2,391 informative offspring (prenatally diagnosed and terminated malformed fetuses, stillborn fetuses, and liveborn infants) in the multivitamin and placebo-like trace element groups, respectively. A single tablet either of a multivitamin containing 0.8 mg of folic acid or trace element supplement was given daily for at least one month before conception and at least until the date of the second missed menstrual period. The total rate of major congenital abnormalities was 20.6/1,000 in the multivitamin and 40.6/1,000 in the trace element group. After the exclusion of six cases of neural-tube defects in the trace element group the difference was very highly significant [P = 0.0003; relative risk of 0.54 (95% CI 0.39, 0.76)]. Multivitamin supplementation appeared to result in a significant reduction in the rate of urinary tract abnormalities, mainly obstructive defects, and in the rate of sporadic cardiovascular malformations, mainly ventricular septal defects. This report is regarded as a hypothesis-generating study encouraging others to see if the result can be repeated.