Maternal Periconceptional Folic Acid Supplementation and Risk for Fetal Congenital Heart Defects.

OBJECTIVE: To determine the effects of maternal periconceptional supplementation with folic acid or multiple micronutrients containing folic acid on the prevention of fetal congenital heart defects (CHDs). STUDY DESIGN: Data were drawn from a Prenatal Health Care System and a Birth Defects Surveillance System in a district of Beijing, China. A total of 63 969 singleton births, live or stillborn, 308 CHDs among them, during 2013 to 2018 were included. Associations between different patterns of supplementation and risk for total CHDs or main types of CHDs were evaluated with risk ratios (RRs). RESULTS: For folic acid or multiple micronutrients containing folic acid users compared with nonusers, the adjusted RRs (ARRs) for total CHDs, critical CHD, and ventricular septal defect (VSD) were 0.60 (95% CI, 0.44-0.83), 0.41 (95% CI, 0.26-0.67), and 0.47 (95% CI, 0.30-0.74), respectively. When we compared multiple micronutrients containing folic acid users with folic acid users, the ARRs were 0.84 (95% CI, 0.66-1.09), 0.64 (95% CI, 0.41-1.00), and 0.94 (95% CI, 0.63-1.41) for total CHDs, critical CHD, and VSD, respectively. We also found that, compared with supplementation initiated after conception, supplementation initiated before conception was associated with a lower risk for CHDs: the ARRs were 0.68 (95% CI, 0.48-0.95) for total CHDs and 0.26 (95% CI, 0.10-0.71) for critical CHD, but 1.08 (95% CI, 0.63-1.83) for VSD. CONCLUSIONS: Maternal periconceptional supplementation with folic acid or multiple micronutrients containing folic acid seems to decrease the risk for CHDs, especially critical CHD, in offspring. Supplementation confers a greater protective effect when it is initiated before conception. We did not find any difference between folic acid and multiple micronutrients containing folic acid in terms of preventing CHDs.

Adherence to and acceptability of home fortification with vitamins and minerals in children aged 6 to 23 months: a systematic review.

BACKGROUND: Vitamin and mineral deficiencies affect more than two million people worldwide. In 2011, based on recent scientific evidence and the low effectiveness of current strategies, the World Health Organization recommended home fortification of foods with multiple micronutrients in powder (MNP) as a new strategy to prevent and control anaemia during childhood. This systematic review assessed adherence to and acceptability of home fortification with multiple micronutrients in powder (MNP) in complementary feeding. METHODS: Adherence was assessed based on number or percentage of prescribed sachets that were consumed, and acceptability was assessed according to perceptions of caregivers and children about MNP. RESULTS: In summary, the studies indicated that home fortification with MNP has good adherence, ranging from 50% to over 90% of the prescribed sachets and that MNP was well accepted by caregivers. Caregivers reported side effects in 3% to 32% of children taking MNP in many studies; diarrhoea, vomiting, and constipation were the most common. CONCLUSIONS: Home fortification with MNP has good adherence and acceptability in infants, with higher adherence in non-daily or flexible administration regimens. Characteristics of the target population and increased diarrhoea burden should be considered for planning public health programs with long term use of MNP. Acceptability of the MNP is satisfactory, when the use and perceived beneficial effects on children's health are considered.