Maternal exposure to folate antagonists and susceptibility to congenital heart disease in offspring: A systematic review and meta-analysis

• Published in: British journal of clinical pharmacology Vol. 90; no. 4; pp. 933 - 941
• Main Authors: Luitel, Prajjwol, Yadav, Rukesh, Mandal, Prince, Adhikari, Niranjan, Paudel, Sujan, Mudvari, Anish
• Format: Journal Article
• Language: English
• Published: England 01-04-2024
• Subjects: congenital heart disease; antiepileptic drugs; dihydrofolate reductase inhibitors; folate antagonists; meta‐analysis; pregnancy
• ISSN: 0306-5251; 1365-2125; 1365-2125
• DOI: 10.1111/bcp.16021

The objective of this meta-analysis was to determine whether maternal exposure to folate antagonists is associated with increased rates of congenital heart disease in offspring.
A comprehensive search for articles in the MEDLINE (PubMed) and EMBASE databases published up to 21 August 2023 was performed. The search strategy was not limited by study design but only for articles in the English language.
Analysis of 6 cohort studies and 5 cross-sectional studies, published between 1976 and 2020, showed significant increase in rate of congenital heart disease (odds ratio 1.55, 95% confidence interval, 1.28-1.87) when exposed to folate antagonists compared with the control. Further subgroup analysis showed the increased rate for exposure to both dihydrofolate reductase inhibitors and antiepileptic drugs separately. No differences were observed when analyses were stratified by timing of study.
Administration of folate antagonists within the 12-week period preceding conception and throughout the second and third months of gestation exhibited a statistically significant elevation in the susceptibility to congenital heart diseases. Notably, the protective effect of folic acid supplementation was reported in cases of congenital heart disease linked to dihydrofolate reductase inhibitors but not that associated with antiepileptic drugs.