Maternal Zinc, Copper, and Selenium Intakes during Pregnancy and Congenital Heart Defects

Nutrients
Q1
Mar 2022
Citations:22
Influential Citations:1
Observational Studies (Human)
81
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Enhanced Details

Methods
Case-control study (Aug 2014–Aug 2016) in six tertiary comprehensive hospitals in Xi'an, Northwest China. Pregnant women waiting for delivery; cases: fetuses diagnosed with isolated congenital heart defects (CHDs) by echocardiography/cardiac catheterization/surgery; controls: fetuses with no congenital malformations; exclusion: gestational diabetes or multiple gestations; sample sizes: 474 cases and 948 controls; dietary intake assessed with a validated 111-item FFQ covering the entire pregnancy; supplement use recorded; CHD diagnoses confirmed; analyses used mixed logistic regression adjusting for covariates; total intakes = dietary + supplemental intakes; CHD subtypes included.
Results
Higher total intakes of zinc and selenium during pregnancy were associated with lower risk of total CHDs. Highest vs lowest quartiles showed ORs of 0.22 (0.12–0.42) for zinc and 0.29 (0.15–0.54) for selenium. Zinc-to-copper and selenium-to-copper ratios were inversely associated with total CHDs, VSD, and ASD. Dietary intakes showed similar patterns; meeting RNIs for zinc (9.5 mg/d) and selenium (65 mg/d) associated with lower CHD risk. Zinc and selenium supplement use during pregnancy (and in the first trimester) linked to reduced CHD risk (zinc supplements OR 0.53; selenium supplements OR 0.45; first-trimester zinc OR 0.58; first-trimester selenium OR 0.52). Some additive protective effects observed when both zinc and selenium intakes were high (e.g., OR 0.51 for high zinc + high selenium vs low zinc + low selenium; OR 0.55 for high zinc + low copper + high selenium; OR 0.53 for high zinc + high copper + high selenium). Copper intake alone showed no significant associations. Implications: promoting adequate zinc and selenium intake during pregnancy may reduce CHD incidence, especially in selenium-deficient Northwest China; further studies warranted to confirm and understand mechanisms.
Limitations
Selection bias from hospital-based sampling and potential exclusion of fetal CHD deaths; recall bias due to retrospective dietary data; exposure misclassification from assessing intake across the entire pregnancy rather than the 3rd–8th week; limited power to analyze CHD subtypes; residual confounding; observational design cannot establish causality.

Abstract

The effects of zinc, copper, and selenium on human congenital heart defects (CHDs) remain unclear. This study aimed to investigate the associations of the maternal total, dietary, and supplemental intakes of zinc, copper, and selenium during pregnanc...