Volume 1, Issue 3 (Summer 2020)
J Vessel Circ 2020, 1(3): 13-17 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Arjmandnia M H, Vahedian M, Yyosefi M, Amouei M, Rezvan S, Assi M H, et al . Relationship between vitamin D consumption during pregnancy and neonatal congenital heart disease. J Vessel Circ 2020; 1 (3) :13-17
URL: http://jvessels.muq.ac.ir/article-1-47-en.html
URL: http://jvessels.muq.ac.ir/article-1-47-en.html
Mohammad Hosein Arjmandnia1 
, Mostafa Vahedian1 , Maryam Yyosefi1 , Mehrnam Amouei2 , Sajad Rezvan2 , Mohammad Hossein Assi1 , Millad Siamaki1 , Akram Barati1 , Amir Hossein Naderi * 1, Alireza Sharifi1
, Mostafa Vahedian1 , Maryam Yyosefi1 , Mehrnam Amouei2 , Sajad Rezvan2 , Mohammad Hossein Assi1 , Millad Siamaki1 , Akram Barati1 , Amir Hossein Naderi * 1, Alireza Sharifi1
1- Qom University of Medical Sciences, Qom, Iran
2- Rafsanjan University of Medical Sciences, Rafsanjan, Iran
2- Rafsanjan University of Medical Sciences, Rafsanjan, Iran
Full-Text [PDF 736 kb]
(611 Downloads)
| Abstract (HTML) (1947 Views)
Table 2. Relationship between variables in both case and control groups
Table 3. Independent t-test results of maternal age in the two groups
Discussion
The interaction between genetics and environmental factors, including changing variables in maternal nutrition and lifestyle, plays an important role in the pathogenesis of CHD. Given the fact that females in Iranian society often struggle with vitamin D deficiency, the effects of this deficiency in various conditions on women in society, particularly during pregnancy, were investigated in this study. The results of the present study showed a significant relationship between maternal vitamin D intake and heart defects in neonates. Regarding this, vitamin D intake could reduce the risk of heart abnormality development. No significant relationship was observed between neonatal gender and heart abnormalities.
It was revealed that neonates born in families with higher education than diploma were more likely to develop heart defects. Moreover, the likelihood of developing heart abnormality was higher among newborns with a positive family history of heart disease. In the current study, there was no significant difference between the two groups in terms of maternal age. Several studies examined the relationship between maternal vitamin and other micronutrient intake and neonatal CHD development (26, 32, 33).
The present study merely investigated the effect of vitamin D consumption. In research conducted by Koster et al. (2018), the amount of maternal vitamin D consumption was estimated using gathered data from the maternal body mass index, multivitamin supplementation, and race, as well as the season that mothers' blood samples were collected. Subsequently, vitamin D level in the mother's body was classified into three categories, namely adequate, moderate, and inadequate. According to the results of this study, insufficient or moderate levels of vitamin D in the mother's body were associated with an increased risk of CHD (29). In our study, the levels of maternal vitamin D intake were not measured; rather, the consumption or non-consumption of vitamin D was checked by a checklist. Accordingly, it was revealed that vitamin D intake decreased the incidence of CHD in neonates, which was in agreement with the results of the research conducted by Koster et al. (2018).
Due to the low prevalence of CHD manifestation during infancy, default studies at the birth time are not sufficient to determine the true risk of CHD development. Consequently, this case-control study was carried out with the standardized time determined as after neonatal birth. Dilli et al. reported that serum vitamin D levels in both mothers and neonates were relatively low, indicating that these ratios were effective in the pathogenesis of CHD (30).
The increased level of some nutrients can have a teratogenic effect, whereas vitamin D is beneficial for the development of the fetal heart. Vitamin is involved in the process of binding the active form of vitamin D to its receptor. This receptor is involved in gene regulation (31). Vitamin D receptor is present in all cells and affects many processes if activated. Embryogenesis and cardiogenesis occur between 2 and 7 weeks of gestation which require the regulation of a group of genes (32). The results of recent studies have shown that components of the vitamin D pathway are involved in cardiogenesis (33). The reduction level of 25-hydroxyvitamin D will lead to a reduction in its active type, which consequently affects gene regulation. This finding is supported by evidence demonstrating that the probability of CHD and other diseases development increases with the reduction in vitamin D levels (34).
Conclusion
Our study showed that the non-consumption of vitamin D can cause an increase in neonatal CHD incidence. However, further studies are required to be performed in this domain since the adequate and safe intake of nutritional and industrial vitamin D for this group has not been determined yet.
Acknowledgments
The authors would like to thank the Research and Technology Deputy of Qom University of Medical Sciences, as well as all participants cooperating in this study.
Conflicts of interest
The authors declare that there is no conflict of interest.
Full-Text: (516 Views)
Introduction
The neonates with heart defects can cause major problems; for example, children with congenital heart disease (CHD) are at risk for stunted growth (1-3). Moreover, CHDs are major causes of infant and child mortality(4). On the other hand it should be noted that CHD is one of the most common birth defects (5, 6), highlighting the necessity of performing more research in this domain. The literature review indicated that the prevalence of CHD showed an increasing trend by more than 50% from 2000-2010 (7). About two-thirds of such patients are diagnosed at an older age; however, this late diagnosis can increase complications.
Although extensive research has been conducted on known risk factors for the prevalence of CHD, this issue is still of interest to many researchers and students (8). For instance, the prevalence of CHD has been shown to increase sharply with maternal obesity. Nonetheless, this research is not merely devoted to proven risk factors. Another study showed beneficial effects of maternal residential greenness on CHDs (9). The prevalence of CHD is not limited to environmental factors. Regarding this, the findings of a study were indicative of an increased level of high-density lipoprotein 3 cholesterol with a reduced incidence of heart disease (11-13).
The other issue that has been addressed in studies is psychological problems. The results of a study suggested that maternal stress during heart formation may be a risk factor for the development of CHD in neonates (14). In addition, maternal age, even without causing chromosomal problems in the fetus, such as Down Syndrome, can be considered a risk factor for CHD as aging increases the chances of developing this disease (15-21). One of the other factors being studied includes alcohol consumption during pregnancy. According to the results of a study, even low alcohol consumption can have a negative effect on heart development and lead to heart cell defects and CHD incidence (22, 23). Maternal smoking during pregnancy is also a known risk factor for the development of CHD (26-24). In this regard, although a large percentage of CHD have an unknown origin (27), smoking during pregnancy alone accounts for 1.4% of CHD cases. The findings of recent studies have shown that smoking dose can also play a role in the development of this disease.
The effect of consuming multivitamins and folic acid in early pregnancy and even before pregnancy was demonstrated in preventing CHD incidence in recent studies. In this respect, in another study, the researchers were suggested to take this finding into consideration for performing further studies (27, 28). In another recent study, it was found that vitamin D intake was directly related to a reduction in the incidence of cardiovascular disease among neonates (29). Considering these results, it can be concluded that CHD is an issue that cannot be simply ignored, since not only does it pose problems to families but also it will impose huge costs on society. Furthermore, given that women in Iranian society often struggle with vitamin D deficiency, it seems necessary to study the effects of this issue in various conditions on females, especially during pregnancy. Consequently, this study was conducted to examine the consumption of vitamin D and its relationship with congenital cardiovascular disease, as well as several other factors as sub-objectives.
Materials and Methods
Study sample
This case-control study was performed on patients, born from March 2016 onwards, referring to the heart clinic of Hazrat Masoumeh Hospital, Qom, Iran. The subjects with congenital cardiovascular disease those with healthy hearts were categorized as the case and control groups. The population of this study (n=660) was studied in two groups (n=330 each) of CHD positive (case group) and CHD negative (control group). The mean scores of maternal age in the case and control groups were obtained as 30±7.12 and approximately 30±7.25 years, respectively.
Study phases
To control the confounding variables, the groups were matched in terms of the homogeneity of a number of identified risk factors, such as a history of gestational diabetes and maternal smoking and alcohol consumption. The only inclusion criterion was having any congenital cardiovascular disease. The instrument used to collect the necessary data was a researcher-made checklist that assessed the variables of CHD and vitamin D with calcium consumption. Moreover, confounding factors, such as maternal age at delivery, infant gender, parental financial status, parental education level, history of CHD in first-degree relatives (i.e., father, mother, sister, and brother) was also examined using the checklist. The necessary data were collected, followed by the evaluation of qualitative variables, using frequency and percentage, and quantitative variables, using mean and standard deviation.
Statistical analyzes
The sample size was calculated using the volume formula of the logistic regression model for the qualitative response variable and considering the probability of type I error of 5%, power of 0.8, and odds ratio of 0.76 based on the study performed by Botto et al. (28). Accordingly, the minimum sample size was estimated at 660 cases, which were divided into two groups of 330 patients and 330 healthy subjects. An independent sample t-test was used to analyze the quantitative variables of the studied groups. In this study, a p-value of less than 0.05 was considered significant.
Results
Regarding the use of vitamin D during pregnancy, it was revealed that 94 (28.5%) and 159 (48.2%) cases had vitamin D in the case and control groups, respectively.
Initially, the case and control groups were compared in terms of vitamin D intake and its relationship with CHD . In general, 94 and 159 mothers in the case and control groups had vitamin D intake, respectively, indicating a relatively significant difference between the two groups in this regard (Table 1).
In this study, 49.4% and 50.6% of the subjects in the case group and 50.6% and 49.4% of the cases in the control group were males and females,
Although extensive research has been conducted on known risk factors for the prevalence of CHD, this issue is still of interest to many researchers and students (8). For instance, the prevalence of CHD has been shown to increase sharply with maternal obesity. Nonetheless, this research is not merely devoted to proven risk factors. Another study showed beneficial effects of maternal residential greenness on CHDs (9). The prevalence of CHD is not limited to environmental factors. Regarding this, the findings of a study were indicative of an increased level of high-density lipoprotein 3 cholesterol with a reduced incidence of heart disease (11-13).
The other issue that has been addressed in studies is psychological problems. The results of a study suggested that maternal stress during heart formation may be a risk factor for the development of CHD in neonates (14). In addition, maternal age, even without causing chromosomal problems in the fetus, such as Down Syndrome, can be considered a risk factor for CHD as aging increases the chances of developing this disease (15-21). One of the other factors being studied includes alcohol consumption during pregnancy. According to the results of a study, even low alcohol consumption can have a negative effect on heart development and lead to heart cell defects and CHD incidence (22, 23). Maternal smoking during pregnancy is also a known risk factor for the development of CHD (26-24). In this regard, although a large percentage of CHD have an unknown origin (27), smoking during pregnancy alone accounts for 1.4% of CHD cases. The findings of recent studies have shown that smoking dose can also play a role in the development of this disease.
The effect of consuming multivitamins and folic acid in early pregnancy and even before pregnancy was demonstrated in preventing CHD incidence in recent studies. In this respect, in another study, the researchers were suggested to take this finding into consideration for performing further studies (27, 28). In another recent study, it was found that vitamin D intake was directly related to a reduction in the incidence of cardiovascular disease among neonates (29). Considering these results, it can be concluded that CHD is an issue that cannot be simply ignored, since not only does it pose problems to families but also it will impose huge costs on society. Furthermore, given that women in Iranian society often struggle with vitamin D deficiency, it seems necessary to study the effects of this issue in various conditions on females, especially during pregnancy. Consequently, this study was conducted to examine the consumption of vitamin D and its relationship with congenital cardiovascular disease, as well as several other factors as sub-objectives.
Materials and Methods
Study sample
This case-control study was performed on patients, born from March 2016 onwards, referring to the heart clinic of Hazrat Masoumeh Hospital, Qom, Iran. The subjects with congenital cardiovascular disease those with healthy hearts were categorized as the case and control groups. The population of this study (n=660) was studied in two groups (n=330 each) of CHD positive (case group) and CHD negative (control group). The mean scores of maternal age in the case and control groups were obtained as 30±7.12 and approximately 30±7.25 years, respectively.
Study phases
To control the confounding variables, the groups were matched in terms of the homogeneity of a number of identified risk factors, such as a history of gestational diabetes and maternal smoking and alcohol consumption. The only inclusion criterion was having any congenital cardiovascular disease. The instrument used to collect the necessary data was a researcher-made checklist that assessed the variables of CHD and vitamin D with calcium consumption. Moreover, confounding factors, such as maternal age at delivery, infant gender, parental financial status, parental education level, history of CHD in first-degree relatives (i.e., father, mother, sister, and brother) was also examined using the checklist. The necessary data were collected, followed by the evaluation of qualitative variables, using frequency and percentage, and quantitative variables, using mean and standard deviation.
Statistical analyzes
The sample size was calculated using the volume formula of the logistic regression model for the qualitative response variable and considering the probability of type I error of 5%, power of 0.8, and odds ratio of 0.76 based on the study performed by Botto et al. (28). Accordingly, the minimum sample size was estimated at 660 cases, which were divided into two groups of 330 patients and 330 healthy subjects. An independent sample t-test was used to analyze the quantitative variables of the studied groups. In this study, a p-value of less than 0.05 was considered significant.
Results
Regarding the use of vitamin D during pregnancy, it was revealed that 94 (28.5%) and 159 (48.2%) cases had vitamin D in the case and control groups, respectively.
Initially, the case and control groups were compared in terms of vitamin D intake and its relationship with CHD . In general, 94 and 159 mothers in the case and control groups had vitamin D intake, respectively, indicating a relatively significant difference between the two groups in this regard (Table 1).
In this study, 49.4% and 50.6% of the subjects in the case group and 50.6% and 49.4% of the cases in the control group were males and females,
Table 1. Contingency table of the relationship between previous abnormalities and vitamin D intake
| P-value | Total | Vitamin D uptake | Congenital heart disease | ||
| No | Yes | ||||
| 0.000 | 330 | 236 | 94 | Number | Positive |
| 100.0% | 71.5% | 28.5% | Percentage | ||
| 330 | 171 | 159 | Number | Negetive | |
| 100.0% | 51.8% | 48.2% | Percentage | ||
| 660 | 407 | 253 | Number | Total | |
| 100.0% | 61.7% | 38.3% | Percentage | ||
respectively. Considering the economic status of the families, 53.3% and 43.6% of the patients in the case and control groups suffered from poor economic status, respectively. According to the results, 29.4% and 37.3% of the parents in the case and control groups had under diploma degree, respectively, and the rest of the parents in both groups held higher degrees.
The results of the Chi-square test (x2=4.61, P-value=0.03) showed that 22.7% of the relatives in the case group had a history of heart abnormalities, while in the healthy group 11.8% of The relatives of the healthy group had a history of heart abnormalities and 88.2% of the rest had no history of heart abnormalities (Table 2).
The mean age scores of mothers in the case and control groups were estimated at approximately 30±7.12 and 30±7.25 years, respectively (Table 3).
The results of the Chi-square test (x2=4.61, P-value=0.03) showed that 22.7% of the relatives in the case group had a history of heart abnormalities, while in the healthy group 11.8% of The relatives of the healthy group had a history of heart abnormalities and 88.2% of the rest had no history of heart abnormalities (Table 2).
The mean age scores of mothers in the case and control groups were estimated at approximately 30±7.12 and 30±7.25 years, respectively (Table 3).
Table 2. Relationship between variables in both case and control groups
| P-value | Total | Neonatal gender | Congenital heart disease | ||
| Female | Male | ||||
| 0.76 | 330 | 167 | 163 | Number | Positive |
| 100.0% | 50.6% | 49.4% | Percentage | ||
| 330 | 163 | 167 | Number | Negative | |
| 100.0% | 49.4% | 50.6% | Percentage | ||
| 660 | 330 | 330 | Number | Total | |
| 100.0% | 50.0% | 50.0% | Percentage | ||
| 0.01 | Total | Economic status | Congenital heart disease | ||
| Low | Good | ||||
| 330 | 176 | 154 | Number | Positive | |
| 100.0% | 53.3% | 46.7% | Percentage | ||
| 330 | 144 | 186 | Number | Negative | |
| 100.0% | 43.6% | 56.4% | Percentage | ||
| 660 | 320 | 340 | Number | Total | |
| 100.0% | 48.5% | 51.5% | Percentage | ||
| P-value | Total | Parental education | Congenital heart disease | ||
| Higher than diploma | Under diploma | ||||
| 0.03 | 330 | 233 | 97 | Number | Positive |
| 100.0% | 70.6% | 29.4% | Percentage | ||
| 330 | 207 | 123 | Number | Negative | |
| 100.0% | 62.7% | 37.3% | Percentage | ||
| 660 | 440 | 220 | Number | Total | |
| 100.0% | 66.7% | 33.3% | Percentage | ||
| P-value | Total | History of congenital heart disease in family | Congenital heart disease | ||
| No | Yes | ||||
| 0.000 | 330 | 255 | 75 | Number | Positive |
| 100.0% | 77.3% | 22.7% | Percentage | ||
| 330 | 291 | 39 | Number | Negative | |
| 100.0% | 88.2% | 11.8% | Percentage | ||
| 660 | 546 | 114 | Number | Total | |
| 100.0% | 82.7% | 17.3% | Percentage | ||
Table 3. Independent t-test results of maternal age in the two groups
| Congenital heart disease | n | Mean | SD | P-value | |
| Maternal age | Yes | 330 | 29.96 | 7.12 | 0.75 |
| No | 330 | 30.13 | 7.25 |
Discussion
The interaction between genetics and environmental factors, including changing variables in maternal nutrition and lifestyle, plays an important role in the pathogenesis of CHD. Given the fact that females in Iranian society often struggle with vitamin D deficiency, the effects of this deficiency in various conditions on women in society, particularly during pregnancy, were investigated in this study. The results of the present study showed a significant relationship between maternal vitamin D intake and heart defects in neonates. Regarding this, vitamin D intake could reduce the risk of heart abnormality development. No significant relationship was observed between neonatal gender and heart abnormalities.
It was revealed that neonates born in families with higher education than diploma were more likely to develop heart defects. Moreover, the likelihood of developing heart abnormality was higher among newborns with a positive family history of heart disease. In the current study, there was no significant difference between the two groups in terms of maternal age. Several studies examined the relationship between maternal vitamin and other micronutrient intake and neonatal CHD development (26, 32, 33).
The present study merely investigated the effect of vitamin D consumption. In research conducted by Koster et al. (2018), the amount of maternal vitamin D consumption was estimated using gathered data from the maternal body mass index, multivitamin supplementation, and race, as well as the season that mothers' blood samples were collected. Subsequently, vitamin D level in the mother's body was classified into three categories, namely adequate, moderate, and inadequate. According to the results of this study, insufficient or moderate levels of vitamin D in the mother's body were associated with an increased risk of CHD (29). In our study, the levels of maternal vitamin D intake were not measured; rather, the consumption or non-consumption of vitamin D was checked by a checklist. Accordingly, it was revealed that vitamin D intake decreased the incidence of CHD in neonates, which was in agreement with the results of the research conducted by Koster et al. (2018).
Due to the low prevalence of CHD manifestation during infancy, default studies at the birth time are not sufficient to determine the true risk of CHD development. Consequently, this case-control study was carried out with the standardized time determined as after neonatal birth. Dilli et al. reported that serum vitamin D levels in both mothers and neonates were relatively low, indicating that these ratios were effective in the pathogenesis of CHD (30).
The increased level of some nutrients can have a teratogenic effect, whereas vitamin D is beneficial for the development of the fetal heart. Vitamin is involved in the process of binding the active form of vitamin D to its receptor. This receptor is involved in gene regulation (31). Vitamin D receptor is present in all cells and affects many processes if activated. Embryogenesis and cardiogenesis occur between 2 and 7 weeks of gestation which require the regulation of a group of genes (32). The results of recent studies have shown that components of the vitamin D pathway are involved in cardiogenesis (33). The reduction level of 25-hydroxyvitamin D will lead to a reduction in its active type, which consequently affects gene regulation. This finding is supported by evidence demonstrating that the probability of CHD and other diseases development increases with the reduction in vitamin D levels (34).
Conclusion
Our study showed that the non-consumption of vitamin D can cause an increase in neonatal CHD incidence. However, further studies are required to be performed in this domain since the adequate and safe intake of nutritional and industrial vitamin D for this group has not been determined yet.
Acknowledgments
The authors would like to thank the Research and Technology Deputy of Qom University of Medical Sciences, as well as all participants cooperating in this study.
Conflicts of interest
The authors declare that there is no conflict of interest.
Type of Study: Research |
Subject:
cardiovascular diseases
Received: 2020/08/23 | Accepted: 2020/12/25 | Published: 2020/08/31
Received: 2020/08/23 | Accepted: 2020/12/25 | Published: 2020/08/31
References
1. Arjmandnia MH, Yousefi M, Rezvan S, Vahedian M, Noori E, Mohammadi A, et al. Evaluation of congenital heart diseases in neonates with diabetic mothers who referred to teaching hospitals in Qom, Iran. J Vessel Circ 2020;1(1):33-6. DOI: 10.29252/jvesselcirc.1.1.33 [DOI:10.29252/jvesselcirc.1.1.33]
2. Vahedian M, Yosefi M, Mohammadi A, Rezvan S, Noori E, Rezaei G, et al. Evaluation of referral indications for fetal echocardiography in pregnant women referred to Echocardiography unit of Masoumeh Hospital in the winter of 2018. Jundishapur Sci Med J 2019;18(4):369-77. DOI: 10.22118/JSMJ.2019.196900.1784
3. Snookes SH, Gunn JK, Eldridge BJ, Donath SM, Hunt RW, Galea MP, et al. A systematic review of motor and cognitive outcomes after early surgery for congenital heart disease. Pediatrics 2010;125(4):e818-27. DOI: 10.1542/peds.2009-1959 [DOI:10.1542/peds.2009-1959]
4. NIE, Zhiqiang, et al. Maternal residential greenness and congenital heart defects in infants: A large case-control study in Southern China. Environment International, 2020, 142: 105859. [DOI:10.1016/j.envint.2020.105859]
5. Stothard KJ, Tennant PW, Bell R, Rankin J. Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis. JAMA 2009;301(6):636-50. DOI: 10.1001/jama.2009.113 [DOI:10.1001/jama.2009.113]
6. EUROCAT Guide. 1.2 instructions for the registration of Congenital Anomales. UK EUROCAT Central Registry, January 2002. Available at: URL: https://scholar.google.com/scholar?hl=fa&as_sdt=0%2C5&q=EUROCAT+G.+1.2+Instructions+for+the+registration+of+CongenitalAnomales.+UK+EUROCAT+Central+Registry%2C+January+2002.+2005&btnG=; 2005. Link
7. Reller MD, Strickland MJ, Riehle-Colarusso T, Mahle WT, Correa A. Prevalence of congenital heart defects in metropolitan Atlanta, 1998-2005. J Pediatr 2008;153(6):807-13. DOI: 10.1016/j.jpeds.2008.05.059 [DOI:10.1016/j.jpeds.2008.05.059]
8. American Academy of Pediatrics. Noninherited risk factors and congenital cardiovascular defects: current knowledge. Pediatrics 2007;120(2):445-6. DOI: 10.1542/peds.2007-1541 [DOI:10.1542/peds.2007-1541]
9. NIE, Zhiqiang, et al. Maternal residential greenness and congenital heart defects in infants: A large case-control study in Southern China. Environment International, 2020, 142: 105859.link [DOI:10.1016/j.envint.2020.105859]
10. Ewers L, Clark CS, Peng H, Roda SM, Menrath B, Lind C, et al. Lead levels in new residential enamel paints in Taipei, Taiwan and comparison with those in mainland China. Environ Res 2011;111(6):757-60. DOI: 10.1016/j.envres.2011.05.011 [DOI:10.1016/j.envres.2011.05.011]
11. Gofman JW, Young W, Tandy R. Ischemic heart disease, atherosclerosis, and longevity. Circulation 1966;34(4):679-97. DOI: 10.1161/01.cir.34.4.679 [DOI:10.1161/01.CIR.34.4.679]
12. Gordon DJ, Probstfield JL, Garrison RJ, Neaton JD, Castelli WP, Knoke JD, et al. High-density lipoprotein cholesterol and cardiovascular disease. Four prospective American studies. Circulation 1989;79(1):8-15. DOI: 10.1161/01.cir.79.1.8 [DOI:10.1161/01.CIR.79.1.8]
13. Hu G, Cui Y, Jousilahti P, Sundvall J, Girman CJ, Antikainen R, et al. Joint effect of high-density lipoprotein cholesterol and low-density lipoprotein cholesterol on the risk of coronary heart disease. Eur J Prev Cardiol 2013;20(1):89-97. DOI: 10.1177/1741826711428242 [DOI:10.1177/1741826711428242]
14. Adams MM, Mulinare J, Dooley K. Risk factors for conotruncal cardiac defects in Atlanta. J Am Coll Cardiol 1989;14(2):432-42. DOI: 10.1016/0735-1097(89)90199-x [DOI:10.1016/0735-1097(89)90199-X]
15. Forrester MB, Merz RD. Descriptive epidemiology of selected congenital heart defects, Hawaii, 1986-1999. Paediatr Perinatal Epidemiol 2004;18(6):415-24. DOI: 10.1111/j.1365-3016.2004.00594.x [DOI:10.1111/j.1365-3016.2004.00594.x]
16. Hollier LM, Leveno KJ, Kelly MA, MCIntire DD, Cunningham FG. Maternal age and malformations in singleton births. Obstet Gynecol 2000;96(5):701-6. DOI: 10.1016/s0029-7844(00)01019-x [DOI:10.1016/S0029-7844(00)01019-X]
17. Kidd S, Lancaster P, McCredie R. The incidence of congenital heart defects in the first year of life. J Paediatr Child Health 1993;29(5):344-9. DOI: 10.1111/j.1440-1754.1993.tb00531.x [DOI:10.1111/j.1440-1754.1993.tb00531.x]
18. Materna‐Kiryluk A, Wiśniewska K, Badura‐Stronka M, Mejnartowicz J, Wiȩckowska B, Balcar‐Boroń A, et al. Parental age as a risk factor for isolated congenital malformations in a Polish population. Paediatric Perinat Epidemiol 2009;23(1):29-40. DOI: 10.1111/j.1365-3016.2008.00979.x [DOI:10.1111/j.1365-3016.2008.00979.x]
19. Miller A, Riehle‐Colarusso T, Siffel C, Frías JL, Correa A. Maternal age and prevalence of isolated congenital heart defects in an urban area of the United States. Am J Med Genet Part A 2011;155A(9):2137-45. DOI: 10.1002/ajmg.a.34130 [DOI:10.1002/ajmg.a.34130]
20. Pradat P, Francannet C, Harris J, Robert E. The epidemiology of cardiovascular defects, part I: a study based on data from three large registries of congenital malformations. Pediatr Cardiol 2003;24(3):195-221. DOI: 10.1007/s00246-002-9401-6 [DOI:10.1007/s00246-002-9401-6]
21. Reefhuis J, Honein MA. Maternal age and non‐chromosomal birth defects, Atlanta--1968-2000: teenager or thirty‐something, who is at risk? Birth Defects Res Part A Clin Mol Teratol 2004;70(9):572-9. DOI: 10.1002/bdra.20065 [DOI:10.1002/bdra.20065]
22. Goh JM, Bensley JG, Kenna K, Sozo F, Bocking AD, Brien J, et al. Alcohol exposure during late gestation adversely affects myocardial development with implications for postnatal cardiac function. Am J Physiol Heart Circ Physiol 2011;300(2):H645-51. DOI: 10.1152/ajpheart.00689.2010 [DOI:10.1152/ajpheart.00689.2010]
23. Andersen AM, Andersen PK, Olsen J, Grønbæk M, Strandberg-Larsen K. Moderate alcohol intake during pregnancy and risk of fetal death. Int J Epidemiol 2012;41(2):405-13. DOI: 10.1093/ije/dyr189 [DOI:10.1093/ije/dyr189]
24. Karatza AA, Giannakopoulos I, Dassios TG, Belavgenis G, Mantagos SP, Varvarigou AA. Periconceptional tobacco smoking and Xisolated congenital heart defects in the neonatal period. Int J Cardiol 2011;148(3):295-9. DOI: 10.1016/j.ijcard.2009.11.008 [DOI:10.1016/j.ijcard.2009.11.008]
25. Lee LJ, Lupo PJ. Maternal smoking during pregnancy and the risk of congenital heart defects in offspring: a systematic review and metaanalysis. Pediatr Cardiol 2013;34(2):398-407. DOI: 10.1007/s00246-012-0470-x [DOI:10.1007/s00246-012-0470-x]
26. Botto LD, Mulinare J, Erickson JD. Do multivitamin or folic acid supplements reduce the risk for congenital heart defects? Evidence and gaps. Am J Med Genet A 2003;121(2):95-101. DOI: 10.1002/ajmg.a.20132 [DOI:10.1002/ajmg.a.20132]
27. Czeizel AE. Periconceptional folic acid-containing multivitamin supplementation for the prevention of neural tube defects and cardiovascular malformations. Ann Nutr Metab 2011;59(1):38-40. DOI: 10.1159/000332125 [DOI:10.1159/000332125]
28. Botto LD, Mulinare J, Erickson JD. Occurrence of congenital heart defects in relation to maternal multivitamin use. Am J Epidemiol 2000;151(9):878-84. DOI: 10.1093/oxfordjournals.aje.a010291 [DOI:10.1093/oxfordjournals.aje.a010291]
29. Koster M, van Duijn L, Krul-Poel Y, Laven J, Helbing W, Simsek S, et al. A compromised maternal vitamin D status is associated with congenital heart defects in offspring. Early Hum Dev 2018;117:50-6. DOI: 10.1016/j.earlhumdev.2017.12.011 [DOI:10.1016/j.earlhumdev.2017.12.011]
30. Dilli D, Dogan NN, Örün UA, Koç M, Zenciroglu A, Karademir S, et al. Maternal and neonatal micronutrient levels in newborns with CHD. Cardiol Young 2018;28(4):523. DOI: 10.1017/S1047951117002372 [DOI:10.1017/S1047951117002372]
31. Mangelsdorf DJ, Evans RM. The RXR heterodimers and orphan receptors. Cell 1995;83(6):841-50. DOI: 10.1016/0092-8674(95)90200-7 [DOI:10.1016/0092-8674(95)90200-7]
32. Brade T, Pane LS, Moretti A, Chien KR, Laugwitz KL. Embryonic heart progenitors and cardiogenesis. Cold Spring Harb Perspect Med 2013;3(10):a013847. DOI: 10.1101/cshperspect.a013847 [DOI:10.1101/cshperspect.a013847]
33. Kwon HJ. Vitamin D receptor signaling is required for heart development in zebrafish embryo. Biochem Biophys Res Commun 2016;470(3):575-8. DOI: 10.1016/j.bbrc.2016.01.103 [DOI:10.1016/j.bbrc.2016.01.103]
34. Pludowski P, Holick MF, Pilz S, Wagner CL, Hollis BW, Grant WB, et al. Vitamin D effects on musculoskeletal health, immunity, autoimmunity, cardiovascular disease, cancer, fertility, pregnancy, dementia and mortality-a review of recent evidence. Autoimmun Rev 2013;12(10):976-89. DOI: 10.1016/j.autrev.2013.02.004 [DOI:10.1016/j.autrev.2013.02.004]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
Owned by Qom University of Medical Sciences
Published by Qom University of Medical Sciences Press
eISSN: 2717-0357
Email: jvessels[at]muq.ac.ir
j.vessels.circul[at]gmail.com
