Higher folate levels during pregnancy may lower risk of congenital heart disease

1. Higher folate levels during pregnancy may lower risk of congenital heart disease

Abstract: https://www.acpjournals.org/doi/10.7326/M22-0741

FREE Summary: https://www.acpjournals.org/doi/10.7326/P22-0014   

URLs go live when the embargo lifts

A case-control study has found that higher folate levels before or during early pregnancy are associated with a lower risk for congenital heart disease (CHD) in children.  Folate supplementation may help, and levels of red blood cell (RBC) folate higher than those currently recommended may be warranted. The findings are published in Annals of Internal Medicine.

It is recommended that to-be-pregnant people take folate supplements to prevent birth defects, such as congenital neural tube defects, but their role in preventing CHD is unclear. Prior studies on the association between pregnancy folate levels and the risk for CHD have been conflicting. Many of these studies measured serum folate levels, which can vary, rather than RCB folate, which may be a better measure.

Researchers from Children's Hospital of Fudan University, Shanghai, measured RCB folate levels in 197 women who gave birth to offspring with CHD and 788 who gave birth to those without CHD to quantify the association between periconception RBC folate and offspring CHD risk. Participant data came from the Shanghai Preconception Cohort Study. Participants had their RBC folate levels measured either before conception or during early pregnancy. Offspring were screened by pulse oximetry plus cardiac murmur at early neonatal stage and those screened positive would be conformed by echocardiography for CHD. The women were also screened for MTHFR C677T, a genetic variant that is associated with folate metabolism and a 10 to 35 percent reduction in folate levels. The authors found that women with offspring with CHD had lower median RBC folate levels than those without CHD. According to the authors, to achieve primary CHD prevention, higher target RBC folate levels than currently recommended for neural tube defect prevention may be needed and warrant further study.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with an author, please email Weili Yan, PhD, at yanwl@fudan.edu.cn.

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2. No association found between mRNA vaccines and severe cardiovascular events

Adenoviral-based vaccines may increase risk for myocardial infarction and pulmonary embolism

Abstract: https://www.acpjournals.org/doi/10.7326/M22-0988    

URL goes live when the embargo lifts

A case-series study has found that adenoviral-based vaccines may be associated with increased risk for myocardial infarction (MI) and pulmonary embolism (PE). No association between mRNA vaccines and severe cardiovascular incidence was found in the short term. Myocarditis and pericarditis were not included in the study. Risk for The findings are published in Annals of Internal Medicine.

Incidence of hypertension and cardiovascular, thromboembolic, and hemorrhagic events have been reported for some recipients of both mRNA and adenoviral COVID-19 vaccines. Previous research has not found an association between mRNA vaccines and increased risk of cardiovascular events. However, some studies have reported increased risk for venous thromboembolism after receipt of adenoviral vaccines and arterial thromboembolism or hemorrhagic stroke after receipt of some mRNA vaccines.

Researchers from EPI-PHARE studied 46 million people aged 18 to 74 using data from the French National Health Data System, which provides comprehensive health care claims and hospitalization data for 99% of the French population, to assess short-term risk for severe cardiovascular events (excluding myocarditis and pericarditis) after COVID-19 vaccination. The authors identified persons who received up to two doses of a COVID-19 vaccine during a nonconsecutive three-week exposure period and experienced a subsequent cardiovascular event. Participants received the Pfizer–BioNTech, Moderna, Oxford–AstraZeneca, or Janssen (Johnson & Johnson) vaccine. The authors found that the relative incidence of MI was highest in persons who received a Janssen vaccine during the second week after their dose, with 43 percent of MI events being attributable to the vaccine. They also report that the relative incidence of MI and PE in the second week after receiving a first dose of the Oxford-AstraZeneca vaccine was 22 percent and 29 percent, respectively. There was no evidence of a positive association between the mRNA-based vaccines and acute MI, stroke, or PE in the 3 weeks after each of the first 2 doses. However, the authors note that vaccination, including with adenoviral-based vaccines, could decrease risk for a cardiovascular event by limiting the consequences of a potential SARS-CoV-2 infection.

Media contacts: For an embargoed PDF or author contact information, please contact Angela Collom at acollom@acponline.org.

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