Advertisement

Maternal Use of Vitamins and Infant Congenital Malformation

  • Bengt Källén
Chapter

Abstract

It is a generally held belief that maternal use of folic acid can drastically reduce the risk of a neural tube defect in the offspring. The data presented here do not support this idea: women who reported the use of folic acid in early pregnancy (most of them starting before the last menstrual period) did not have a lower rate of neural tube defect infants than expected. In contrast to this, there was a nearly significantly low rate of such defects after maternal use of multivitamins. The explanation to this is unclear. No beneficial effect on malformation rate was seen from use of vitamin B12 and other B, C, or D vitamins. Two specific vitamins have been associated with a teratogenic effect: high doses of vitamin A and use of vitamin E. Only few women had used high doses of vitamin A and the literature on the subject reports different results. Such treatment during pregnancy should be avoided. An association between use of vitamin E and congenital malformations in the offspring is probably due to confounding by indication: subfertility and repeated previous miscarriages.

References

  1. Berry RJ, Ericson JD, Li S, Moore CA, Mulinare J, Zhao P, Wong L-YC, Gindleer J, Hong S-X, Correa A. Prevention of neural-tube defects with folic acid in China. N Engl J Med. 1999;341:1485–90.CrossRefGoogle Scholar
  2. Czeizel A, Dudás I. Prevention of first occurrence of neural tube defects by periconceptional vitamin supplementation. N Engl J Med. 1992;327:1832–5.CrossRefGoogle Scholar
  3. Gilboa SM, Lee KA, Cogswell ME, Traven FK, Botto LD, Riehle-Colarusso T, Correa A, Boyle CA, the National Birth Defects Prevention Study. Maternal intake of vitamin E and birth defects. National Birth Defects Prevention Study, 1997-2005. Birth Defects Res A Clin Mol Teratol. 2014;100:647–57.CrossRefGoogle Scholar
  4. Johansen AM, Lie RT, Wilcox AJ, Andersen LF, Drevon VA. Maternal dietary intake of vitamin A and risk of orofacial clefts: a population-based case-control study in Norway. Am J Epidemiol. 2008;167:1164–70.CrossRefGoogle Scholar
  5. Källén B. Folic acid and neural tube defects: effective primary prevention or wishful thinking? Avid science monograph series; 2017.Google Scholar
  6. Källén B, Lundberg G, Åberg A. Relationship between vitamin use, smoking and nausea and vomiting of pregnancy. Acta Obstet Gynecol Scand. 2003;82:916–20.CrossRefGoogle Scholar
  7. Kirke PN, Daly LE, Elwood JH, for the Irish Vitamin Study Group. A randomized trial of low dose folic acid to prevent neural tube defects. Arch Dis Child. 1992;67:1442–6.CrossRefGoogle Scholar
  8. Lammer EJ, Chen DT, Hoar RM, Agnish ND, Benke PJ, Braun JT, Curry CJ, Fernhoff PM, Grix AW, Lott IT, Richard JM, Sun SC. Retinoic acid embryopathy. N Engl J Med. 1985;313:837–41.CrossRefGoogle Scholar
  9. Martinez-Frías ML, Salvador J. Epidemiological aspects of prenatal exposure to high doses of vitamin A in Spain. Eur J Epidemiol. 1990;6:118–23.CrossRefGoogle Scholar
  10. Mastroiacovo P, Mazzone T, Addis A, Elephant E, Carlier P, Vial T, Garbis H, Robert E, Bonati M, Ornoy A, Finardi A, Schaffer C, Caramelli L, Rodriguez-Pinilla E, Clemanti M. High vitamin A intake in early pregnancy and major malformations: a multicenter prospective controlled study. Teratology. 1999;59:7–11.CrossRefGoogle Scholar
  11. Mills JL, Simpson JL, Cunningham GC, Conley MR, Rhoads GG. Vitamin A and birth defects. Am J Obstet Gynecol. 1997;177:31–6.CrossRefGoogle Scholar
  12. Molloy AM. Should vitamin B12 status be considered in assessing risk of neural tube defects? Ann N Y Acad Sci. 2018;14:109–25.CrossRefGoogle Scholar
  13. MRC Vitamin Study Research Group. Prevention of neural tube defects: results of the Medical Research Council Vitamin Study. Lancet. 1991;338:131–7.CrossRefGoogle Scholar
  14. Rothman KJ, Moore LL, Singer MR, Nouyen U-SDT, Mannino S, Milunsky A. Teratogenicity of high vitamin A intake. N Engl J Med. 1995;333:1369–73.CrossRefGoogle Scholar
  15. Smedts HPM, de Vries JH, Rakshandehroo M, Wildhage MF, Verkleij-Hagoort AC. High maternal vitamin E intake by diet or supplements in associated with congenital heart defects in the offspring. BJOG. 2009;116:416–23.CrossRefGoogle Scholar
  16. Smithells RW, Sheppard S, Schorah CJ, Seiler MJ, Nevin NC, Harris R, Read AF, Fielding DW. Possible prevention of neural tube defects by periconceptional vitamin supplementation. Lancet 1980; i: 339–340.CrossRefGoogle Scholar
  17. Szilasi M, Bártfai L, Bartfai Z, Bánhidy F, Czeizel A. No association of maternal E vitamin intake with higher risk of cardiovascular malformations in children: a population-based case-control study. Ther Adv Drug Saf. 2011;2:77–86.CrossRefGoogle Scholar
  18. Vobecky JS, Vobecky J, Shapcott D, Blanchard R, Lafond R, Cloutier D, Munan L. Serum alpha-tocopherol in pregnancies with normal or pathological outcome. Can J Physiol Pharmacol. 1974;52:384–8.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Bengt Källén
    • 1
  1. 1.Tornblad Institute for Comparative EmbryologyLund UniversityLundSweden

Personalised recommendations