Folik Asit ve Konjenital Kalp Hastalıkları Arasındaki İlişki

Year 2024, Volume: 7 Issue: 2, 123 - 129, 30.05.2024

Ferda Koç Hatice Aybüke Çalışkan Tuğba Küçükkasap Cömert

https://doi.org/10.53493/avrasyasbd.1313869

Abstract

Konjenital kalp hastalıkları (KKH), doğum öncesi, doğumda veya yaşamın ilerleyen dönemlerinde saptanabilen yapısal kalp kusurları olarak tanımlanmaktadır. KKH etiyolojisinin karmaşık olduğu, muhtemelen çevresel etmenler ve kalıtsal faktörlerin etkileşimi ile ortaya çıktığı kabul edilmektedir. Maternal mikro besin ögesi durumu, bebeklerde KKH riski ile ilişkili olarak gözlenmektedir. Folik asit (FA), folatın sentetik şeklidir. Literatürü incelediğimizde, yapılan çalışmalarda gebelerde FA desteğinin bebeklerde doğumsal hastalıkların ortaya çıkmasında koruyucu bir etken olduğu görülmektedir. Yapılan çalışmalara göre gebelerde ve yenidoğanlardaki FA takviyesinin KKH insidansı üzerine de faydası olduğu düşünülmektedir.
Amaç: Bu derlemede folik asit takviyesinin gebelik öncesi ve gebelik sürecinde alımının yenidoğandaki konjenital kalp hastalıkları görülme riski ile ilgili yapılan bilimsel çalışmaları bildirmek amaçlanmaktadır.
Sonuç: Gebelik öncesinden itibaren ve gebelik süresince alınan folik asit takviyesinin yenidoğanda konjenital kalp hastalıkları riskini önemli derecede azalttığı, bunun yanısıra etkinlik düzeyi de birçok bilimsel çalışmayla bildirilmiş olup, kesinliği üzerinde daha fazla çalışmaya ihtiyaç duyulmaktadır.

Keywords

folik asit, konjenital kalp hastalıkları, gebelik, gebelik öncesi

THE RELATIONSHIP BETWEEN FOLIC ACID AND CONGENITAL HEART DISEASES

Abstract

Congenital heart diseases (CHD) are defined as structural heart defects that can be detected before birth, at birth, or later in life. It is accepted that the etiology of CHD is complex, possibly resulting from the interaction of environmental factors and hereditary factors. Maternal micronutrient status is observed to be associated with the risk of CHD in infants. Folic acid (FA) is the synthetic form of folate. When we examine the literature, it is seen that FA supplementation in pregnant women is a protective factor in the emergence of congenital diseases in infants. According to studies, FA supplementation in pregnant women and newborns is also thought to be beneficial to the incidence of CHD.
Literature has been examined for this review article, and it is seen that FA supplementation in pregnant women is a protective factor in the emergence of many birth defects in babies. This review, it is aimed to report the scientific studies on the risk of congenital heart diseases in newborns when folic acid supplementation is taken before and during pregnancy.
In conclusion, folic acid supplementation is taken before and during pregnancy significantly reduces the risk of congenital heart diseases in the newborn, as well as its effectiveness has been reported by many scientific studies. Congenital heart diseases are one of the biggest issues in newborn infants, as the common cause of death, but uneasy to diagnose, and it is important to raise awareness among expectant mothers who are considering pregnancy.

Keywords

folic acid, congenital heart diseases, pregnancy, pre-pregnancy

References

• Bayraktar, NA. (2020). Biventriküler ve Univentriküler Konjenital Kalp Hastalarının Bazı Biyokimyasal Bulguları ile Beslenme Durumlarının Değerlendirilmesi. Başkent Üniversitesi Sağlık Bilimleri Enstitüsü, Diyetetik Programı Doktora Tezi, Ankara.
• Botto, LD, Mulinare, J, & Erickson, JD. (2003). Do multivitamin or folic acid supplements reduce the risk for congenital heart defects? Evidence and gaps. Am. J. Med. Genet. A, 121(2):95-101. https://doi.org/10.1002/ajmg.a.20132
• Chen, H., Zhang, Y., Wang, D., Chen, X., Li, M., Huang, X., ... & SPCC (Shanghai Preconception Cohort) Group. (2022). Periconception Red Blood Cell Folate and Offspring Congenital Heart Disease: Nested Case–Control and Mendelian Randomization Studies. Ann. Intern. Med., 175(9), 1212-1220. https://doi.org/10.7326/m22-0741
• Cheng, Z., Gu, R., Lian, Z., & Gu, H. F. (2022). Evaluation of the association between maternal folic acid supplementation and the risk of congenital heart disease: a systematic review and meta-analysis. Nutr. J., 21(1), 20. https://doi. org/10.1186/s12937-022-00772-2
• Czeizel, A. E., Dudás, I., Vereczkey, A., & Bánhidy, F. (2013). Folate deficiency and folic acid supplementation: the prevention of neural-tube defects and congenital heart defects. Nutrients, 5(11), 4760-4775. https://doi. org/10.3390/nu5114760
• Çeltik, C. (2021). Nutrition in children with congenital heart disease. Umraniye Pediatri Dergisi, 1(3).
• De Wit, B., Meyer, R., Desai, A., Macrae, D., & Pathan, N. (2010). Challenge of predicting resting energy expenditure in children undergoing surgery for congenital heart disease. Pediatr. Crit. Care Med., 11(4), 496-501. https://doi. org/10.1097/pcc.0b013e3181ce7465
• EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies). (2014). Scientific Opinion on Dietary Reference Values for Folate. EFSA J., 12(11), 1-59. https:// doi.org/10.2903/j.efsa.2014.3893
• Feng, Y., Wang, S., Chen, R., Tong, X., Wu, Z., & Mo, X. (2015). Maternal folic acid supplementation and the risk of congenital heart defects in offspring: a meta-analysis of epidemiological observational studies. Sci. Rep., 5(1), 8506. https://doi.org/10.1038/srep08506
• Green, N. S. (2002). Folic acid supplementation and prevention of birth defects. J. Nutr., 132(8), 2356S-2360S. https://doi. org/10.1093/jn/132.8.2356s
• Gropper, S. S., & Smith, J. L. (2012). Advanced nutrition and human metabolism. Cengage Learning. Köksal G. (2003). Doğumsal Kalp Hastalıklarında Beslenme. Sürekli Tıp Eğitimi Dergisi, 12(2): 57-60.
• Li, X., Li, S., Mu, D., Liu, Z., Li, Y., Lin, Y., ... & Zhu, J. (2013). The association between periconceptional folic acid supplementation and congenital heart defects: a case– control study in China. Prev. Med., 56(6), 385-389. https:// doi.org/10.1016/j.ypmed.2013.02.019
• Liu, S., Joseph, K. S., Luo, W., León, J. A., Lisonkova, S., Van den Hof, M., ... & Kramer, M. S. (2016). Effect of folic acid food fortification in Canada on congenital heart disease subtypes. Circ., 134(9), 647-655. https://doi.org/10.1161/ circulationaha.116.022126
• Mao, B., Qiu, J., Zhao, N., Shao, Y., Dai, W., He, X., ... & Zhang, Y. (2017). Maternal folic acid supplementation and dietary folate intake and congenital heart defects. PLoS One, 12(11), e0187996. https://doi.org/10.1371/journal.pone.0187996
• Moore, J. P., & Aboulhosn, J. A. (2017). Introduction to the congenital heart defects: anatomy of the conduction system. Card. Electrophysiol. Clin., 9(2), 167-175. https:// doi.org/10.1016/j.ccep.2017.02.001
• Nydegger, A., Walsh, A., Penny, D. J., Henning, R., & Bines, J. E. (2009). Changes in resting energy expenditure in children with congenital heart disease. Eur. J. Clin. Nutr., 63(3), 392-397. https://doi.org/10.1038/sj.ejcn.1602956
• Park, I. S. (Ed.). (2019). An Illustrated Guide to Congenital Heart Disease: From Diagnosis to Treatment–From Fetus to Adult. Springer. https://doi.org/10.1007/978-981-13-6978-0
• Pierpont, M. E., Basson, C. T., Benson Jr, D. W., Gelb, B. D., Giglia, T. M., Goldmuntz, E., ... & Webb, C. L. (2007). Genetic basis for congenital heart defects: current knowledge: a scientific statement from the American Heart Association Congenital Cardiac Defects Committee, Council on Cardiovascular Disease in the Young: endorsed by the American Academy of Pediatrics. Circ., 115(23), 3015-3038. https://doi.org/10.1161/circulationaha.106.183056
• TÜRKİYE BESLENME REHBERİ (TÜBER) (2022). Sağlık Bakanlığı, Halk Sağlığı Genel Müdürlüğü, Sağlık Bakanlığı Yayın No:1031, Ankara.
• van Beynum, I. M., Kapusta, L., Bakker, M. K., den Heijer, M., Blom, H. J., & de Walle, H. E. (2010). Protective effect of periconceptional folic acid supplements on the risk of congenital heart defects: a registry-based case–control study in the northern Netherlands. Eur. Heart J., 31(4), 464- 471. https://doi.org/10.1093/eurheartj/ehp479
• Van Der Bom, T., Zomer, A. C., Zwinderman, A. H., Meijboom, F. J., Bouma, B. J., & Mulder, B. J. (2011). The changing epidemiology of congenital heart disease. Nat. Rev. Cardiol., 8(1), 50-60. https://doi.org/10.1038/nrcardio.2010.166
• Wang, D., Jin, L., Zhang, J., Meng, W., & Ren, A. (2022). Maternal periconceptional folic acid supplementation and risk for fetal congenital heart defects. J. Pediatr., 240, 72-78. https://doi.org/10.1016/j.jpeds.2021.09.004
• Wang, H., De Steur, H., Chen, G., Zhang, X., Pei, L., Gellynck, X., Zheng, X. (2016). Effectiveness of folic acid fortified flour for prevention of neurol tube defects in high risk region. Nutrients, 8(3), 1-11. https://doi.org/10.3390/nu8030152
• World Health Organization. (2012). Guideline: daily iron and folic acid supplementation in pregnant women. World Health Organization.
• Yan, J., Liu, Y., Cao, L., Zheng, Y., Li, W., & Huang, G. (2017). Association between duration of folic acid supplementation during pregnancy and risk of postpartum depression. Nutrients, 9(11), 1206. https://doi.org/10.3390/nu9111206
• Yan, M. X., Zhao, Y., Zhao, D. D., Dang, S. N., Zhang, R., Duan, X. Y., ... & Qu, P. F. (2022). The Association of Folic Acid, Iron Nutrition during Pregnancy and Congenital Heart Disease in Northwestern China: A Matched Case-Control Study. Nutrients, 14(21), 4541. https://doi.org/10.3390/nu14214541
• Yurdakul Ertürk, E., Küçüködük, Ş., Baysal, K., Ayyıldız, P., Yılmaz, A. & Oğur, G. (2016). Yenidoğan Yoğun Bakım Ünitesinde Konjenital Kalp Hastalığı Tanısı Alan Olguların Retrospektif Değerlendirilmesi. Güncel Pediatri, 14 (2) , 67- 73. https://doi.org/10.4274/jcp.02486
• Zan, S., Yapıcıoğlu, H., Erdem, S., Özlü, F., Satar, M., Özbarlas, N., ... & Poyrazoğlu, H. (2015). Çukurova Üniversitesi Tıp Fakültesi Hastanesi Yenidoğan Yoğun Bakım Ünitelerinde son beş yılda izlenen konjenital kalp hastalarının retrospektif incelenmesi. Cocuk Sagligi ve Hastaliklari Derg., 58(1), 7-16.