The effect of maternal pre-/early-pregnancy BMI and pregnancy smoking and alcohol on congenital heart diseases: a parental negative control study

AbstractBackgroundCongenital heart diseases (CHDs) are the most common congenital anomaly. The causes of CHDs are largely unknown. Higher prenatal body mass index (BMI), smoking and alcohol consumption are associated with increased risk of CHDs. Whether these are causal is unclear.Methods and ResultsSeven European birth cohorts including 232,390 offspring (2,469 CHD cases [1.1%]) were included. We applied negative exposure paternal control analyses to explore the intrauterine effects of maternal BMI, smoking and alcohol consumption during pregnancy, on offspring CHDs and CHD severity. We used logistic regression and combined estimates using a fixed-effects meta-analysis. Analyses of BMI categories resulted in similar increased odds of CHD in overweight (mothers OR: 1.15 (1.01, 1.31) and fathers 1.10 (0.96, 1.27)) and obesity (mothers OR: 1.12 (0.93, 1.36) and fathers 1.16 (0.90, 1.50)). The association of mean BMI with CHD was null. Maternal smoking was associated with increased odds of CHD (OR: 1.11 (0.97, 1.25)) but paternal smoking was not (OR: 0.96 (0.85, 1.07)). The difference increased when removing offspring with genetic/chromosomal defects (mothers OR: 1.15 (1.01, 1.32) and fathers 0.93 (0.83, 1.05)). The positive association with maternal pregnancy smoking appeared to be driven by non-severe CHD cases (OR: 1.22 (1.04, 1.44)). Associations with maternal (OR: 1.16 (0.52, 2.58)) and paternal (OR: 1.23 (0.74, 2.06)) moderate/heavy pregnancy alcohol consumption were similar.ConclusionsWe found evidence of an intrauterine effect for maternal smoking on offspring CHDs, but no evidence for higher maternal BMI or alcohol consumption. Our findings provide further support for why smoking cessation is important during pregnancy.

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Effect of Maternal Prepregnancy/Early‐Pregnancy Body Mass Index and Pregnancy Smoking and Alcohol on Congenital Heart Diseases: A Parental Negative Control Study

Journal of the American Heart Association ◽

10.1161/jaha.120.020051 ◽

2021 ◽

Author(s):

Kurt Taylor ◽

Ahmed Elhakeem ◽

Johanna Lucia Thorbjørnsrud Nader ◽

Tiffany C. Yang ◽

Elena Isaevska ◽

...

Keyword(s):

Body Mass Index ◽

Alcohol Consumption ◽

Body Mass ◽

Maternal Smoking ◽

Congenital Heart ◽

Heart Diseases ◽

Congenital Heart Diseases ◽

Pregnancy Smoking ◽

Maternal Overweight ◽

Maternal Bmi

Background Congenital heart diseases (CHDs) are the most common congenital anomaly. The causes of CHDs are largely unknown. Higher prenatal body mass index (BMI), smoking, and alcohol consumption are associated with increased risk of CHDs. Whether these are causal is unclear. Methods and Results Seven European birth cohorts, including 232 390 offspring (2469 CHD cases [1.1%]), were included. We applied negative exposure paternal control analyses to explore the intrauterine effects of maternal BMI, smoking, and alcohol consumption during pregnancy, on offspring CHDs and CHD severity. We used logistic regression, adjusting for confounders and the other parent's exposure and combined estimates using a fixed‐effects meta‐analysis. In adjusted analyses, maternal overweight (odds ratio [OR], 1.15 [95% CI, 1.01–1.31]) and obesity (OR, 1.12 [95% CI, 0.93–1.36]), compared with normal weight, were associated with higher odds of CHD, but there was no clear evidence of a linear increase in odds across the whole BMI distribution. Associations of paternal overweight, obesity, and mean BMI were similar to the maternal associations. Maternal pregnancy smoking was associated with higher odds of CHD (OR, 1.11 [95% CI, 0.97–1.25]) but paternal smoking was not (OR, 0.96 [95% CI, 0.85–1.07]). The positive association with maternal smoking appeared to be driven by nonsevere CHD cases (OR, 1.22 [95% CI, 1.04–1.44]). Associations with maternal moderate/heavy pregnancy alcohol consumption were imprecisely estimated (OR, 1.16 [95% CI, 0.52–2.58]) and similar to those for paternal consumption. Conclusions We found evidence of an intrauterine effect for maternal smoking on offspring CHDs, but no evidence for higher maternal BMI or alcohol consumption. Our findings provide further support for the importance of smoking cessation during pregnancy.

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Maternal tobacco consumption during pregnancy and risk of congenital heart diseases in offspring

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20181534 ◽

2018 ◽

Vol 5 (3) ◽

pp. 1023 ◽

Cited By ~ 1

Author(s):

Deveshwar Dev ◽

Rambabu Sharma ◽

Meenakshi Sharma

Keyword(s):

Congenital Heart ◽

Heart Diseases ◽

Smoking Habit ◽

Tobacco Consumption ◽

P Value ◽

Congenital Heart Diseases ◽

Cross Sectional ◽

Increased Risk ◽

History Of ◽

Age And Sex

Background: Maternal tobacco consumption (both active and passive) during pregnancy as a risk factor for congenital heart diseases in off-springs has been studied by some workers with a small number of subjects hence requires to be evaluated through a study with a significant size of cohort. The objective of the study was to find out the association between maternal tobacco consumption and the risk of CHDs among their off springs.Methods: This is a hospital based, comparative, cross sectional, observational study. 518 children with CHDs, confirmed by echocardiography were included as cases and 240 children without any obvious congenital anomaly matched for age and sex were taken as controls. The following clinical observations were collected through questionnaires in a predesigned Performa: maternal and paternal tobacco consumption during pregnancy; maternal medical, gestational and obstetric history; and other birth defects.Results: Children from case and control groups were comparable with respect to age and sex at the inclusion in the study. Out of the total 758 study participants, 73 children (14.01%) with CHDs had history of maternal tobacco consumption (active consumption) during pregnancy and 86 children (16.6%) with CHDs had history of paternal smoking habit (P value was highly significant).Conclusions: Tobacco consumption during pregnancy (both active and passive) confer an increased risk of CHDs in their off springs (p value <0.001).

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Congenital Heart Disease in non-Diabetic Large-for-Gestational-Age (LGA) Neonates

Cardiovascular & Haematological Disorders - Drug Targets ◽

10.2174/1871529x20666201216170012 ◽

2020 ◽

Vol 20 ◽

Author(s):

Majid Firouzi ◽

Hamidreza Sherkatolabbasieh ◽

Alireza Nezami ◽

Shiva Shafizadeh

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Birth Weight ◽

Gestational Age ◽

Congenital Heart ◽

Heart Diseases ◽

Large For Gestational Age ◽

Congenital Heart Diseases ◽

Increased Risk ◽

Heart Abnormalities

Background: Congenital heart diseases are the most prevalent congenital abnormalities in the neonates, caused by the environmental and genetic factors and contribute to the leading cause of death. The aim of this study is to evaluate the relationship between neonates with large for gestational age and increased risk of congenital heart diseases among nondiabetic mothers. Methods: In this study, 179 neonates with large for gestational age in Khorramabad were enrolled where heart abnormalities were evaluated using echocardiography. Results: 87 neonates had more than 4000 g of the birth weight with no heart abnormalities and 92 (51%) macrosomic neonates had congenital heart diseases. Statistical analysis revealed that there was a significant relationship between birth weight and increased risk of acquiring congenital heart disease between the two groups. There was no significant relationship between birth weight, maternal age, gender, labor type and blood group between the two groups. The highest incidence of congenital heart anomalies was related to 38% of arterial septal defect (ASD) and 15.2% of ASD and VSD, respectively Conclusion: The most prevalent abnormality was arterial septal ASD. None of these abnormalities were associated with maternal age, birth weight and neonate gender. Future studies for congenital heart disease and neonatal birth weight are therefore, recommended.

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Parental alcohol consumption and the risk of congenital heart diseases in offspring: An updated systematic review and meta-analysis

European Journal of Preventive Cardiology ◽

10.1177/2047487319874530 ◽

2019 ◽

Vol 27 (4) ◽

pp. 410-421 ◽

Cited By ~ 6

Author(s):

Senmao Zhang ◽

Lesan Wang ◽

Tubao Yang ◽

Lizhang Chen ◽

Lijuan Zhao ◽

...

Keyword(s):

Alcohol Consumption ◽

Dose Response ◽

Congenital Heart ◽

Heart Diseases ◽

Meta Analysis ◽

Alcohol Exposure ◽

Congenital Heart Diseases ◽

Response Relationship ◽

Dose Response Relationship ◽

Parental Alcohol

Objective The aim of this study was to provide updated evidence to assess the association between parental alcohol consumption and the risk of total congenital heart diseases (CHDs) and specific CHD phenotypes in offspring, and explore the possible dose–response pattern. Methods PubMed, Embase and Chinese databases were searched with an end-date parameter of July 24, 2019 to identify studies meeting pre-stated inclusion criteria. A random-effects model was used to calculate the overall combined risk estimates. A meta-analysis of the dose–response relationship was performed. Subgroup analysis, sensitivity analysis, and Galbraith plot were conducted to explore potential heterogeneity moderators. Results A total of 55 studies involving 41,747 CHD cases and 297,587 controls were identified. Overall, both maternal (odds ratio (OR) = 1.16; 95% confidence interval (CI): 1.05–1.27) and paternal (OR = 1.44; 95% CI: 1.19–1.74) alcohol exposures were significantly associated with risk of total CHDs in offspring. Additionally, a nonlinear dose–response relationship between parental alcohol exposure and risk of total CHDs was observed. With an increase in parental alcohol consumption, the risk of total CHDs in offspring also gradually increases. For specific CHD phenotypes, a statistically significant association was found between maternal alcohol consumption and risk of tetralogy of fallot (OR = 1.20; 95% CI: 1.08–1.33). Relevant heterogeneity moderators have been identified by subgroup analysis, and sensitivity analysis yielded consistent results. Conclusions Although the role of potential bias and evidence of heterogeneity should be carefully evaluated, our review indicates that parental alcohol exposures are significantly associated with the risk of CHDs in offspring, which highlights the necessity of improving health awareness to prevent alcohol exposure during preconception and conception periods.

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Prenatal Detection of Congenital Heart Diseases: One-Year Survey Performing a Screening Protocol in a Single Reference Center in Brazil

Cardiology Research and Practice ◽

10.1155/2014/175635 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Luciane Alves Rocha ◽

Edward Araujo Júnior ◽

Liliam Cristine Rolo ◽

Fernanda Silveira Bello Barros ◽

Karina Peres da Silva ◽

...

Keyword(s):

Congenital Heart ◽

Fetal Heart ◽

Heart Diseases ◽

University Hospital ◽

High Rate ◽

Congenital Heart Diseases ◽

Increased Risk ◽

Tertiary Center ◽

Screening Protocol ◽

Complex Cases

Objective. To describe the experience of a tertiary center in Brazil to which patients are referred whose fetuses are at increased risk for congenital heart diseases (CHDs).Methods. This was a cross-sectional observational study. The data was collected prospectively, during the year 2012, through a screening protocol of the fetal heart adapted from the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guideline. We performed a fetal echocardiogram screening for all pregnant women who were referred to the fetal cardiology outpatient obstetrics clinic of a university hospital. The exams were classified as normal or abnormal. The cases considered abnormal were undergone to a postnatal echocardiogram. We categorized the abnormal fetal heart according to severity in “complex,” “significant,” “minor,” and “others.”Results. We performed 271 fetal heart screening. The incidence of abnormal screenings was 9.96% (27 fetuses). The structural CHD when categorized due to severity showed 48.1% (n=13) of “complex” cases, 18.5% (n=5) “significant” cases, and 7.4% (n=2) “minor” cases. The most common referral reason was by maternal causes (67%) followed by fetal causes (33%). The main referral indication was maternal metabolic disease (30%), but there was just one fetus with CHD in such cases (1.2%). CHDs were found in 19/29 fetuses with suspicion of some cardiac abnormality by obstetrician (65.5%).Conclusion. We observed a high rate of CHD in our population. We also found that there was higher incidence of complex cases.

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Screening of congenital heart disease in the second trimester of pregnancy: current knowledge and new perspectives to the clinical practice

Cardiology in the Young ◽

10.1017/s1047951113001558 ◽

2013 ◽

Vol 24 (3) ◽

pp. 388-396 ◽

Cited By ~ 6

Author(s):

Luciane Alves Rocha ◽

Edward Araujo Júnior ◽

Liliam Cristine Rolo ◽

Fernanda Silveira Bello Barros ◽

Karina Peres Silva ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Clinical Practice ◽

Congenital Heart ◽

Current Knowledge ◽

Heart Diseases ◽

Screening Method ◽

Cardiac Anatomy ◽

Congenital Heart Diseases ◽

Increased Risk

AbstractObjectiveCongenital heart diseases are common in foetuses, with an incidence greater than six times that of chromosomal abnormalities; however, experts in cardiac anatomy have evaluated only the foetuses of pregnant women with increased risk for congenital heart disease. Over the years, it has become clear that congenital heart disease occur in foetuses of low-risk women. In the mid-1980s, a proposal to expand the assessment of cardiac anatomy was presented to obstetricians in order to improve prenatal screening. With the aim to systematise and improve the diagnosis of congenital heart disease in foetuses, the International Society of Ultrasound in Obstetrics and Gynecology established an ultrasound heart examination guideline. In this review, we have described the important features of this guideline and discussed the applications of this tool in clinical practice.MethodsWe performed a literature search of the National Library of Medicine for publications released between 2000 and 2012; we used search terms pertinent to congenital heart disease, such as foetal echocardiography, foetal heart and cardiac screening examination.ResultsThe guidelines serve as a standard and help to systematise the screening for congenital heart diseases, but we think that some topics may be added to design the most appropriate screening method. However, we cannot expand the topics to be evaluated in this examination without good training of sonographers who undergo this screening.ConclusionAlthough the screening standardisation is a good tool to be used in day-to-day practice, the increment of aortic and ductal archs and colour Doppler to heart screening could be useful to detect further cardiac defects.

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Pattern of congenital heart diseases among children with Down syndrome attending a tertiary care medical college hospital

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20172665 ◽

2017 ◽

Vol 4 (4) ◽

pp. 1357

Author(s):

Kumar G. V. ◽

Srinivasa V. ◽

Ananda kumar T. S.

Keyword(s):

Congenital Heart Disease ◽

Down Syndrome ◽

Heart Disease ◽

Chromosomal Abnormality ◽

Trisomy 21 ◽

Congenital Heart ◽

Heart Diseases ◽

Tertiary Care ◽

Congenital Heart Diseases ◽

Increased Risk

Background: Down syndrome (DS) is the most common chromosomal abnormality associated with learning difficulties with reported incidence between1/600 -1/1000 live births. DS (trisomy 21) is the most common chromosomal abnormality seen in clinical practice. Most children with DS have trisomy 21, due to chromosomal non-disjunction during meiosis; however, other abnormalities, such as Robertsonian translocation, mosaic, double or triple aneuploidies have been reported. The association between DS and congenital heart disease (CHD) is well established. Congenital heart disease is the most common cause of death among patients with DS and affected children have an increased risk of mortality.Methods: The present descriptive study was conducted on children who had clinical features suggestive of Down syndrome and who were karyotypically proved as Down syndrome.Results: In 100 cases of down syndrome 60 children were males and 40 children were females. 45 children had congenital heart diseases. The frequency of CHD in down syndrome is 45%. Ventricular septal defect was the most common CHD found 40% children with down syndrome.Conclusions: All children with Down’s syndrome should have a cardiac evaluation at birth. Early referral and screening of all babies born with the clinical phenotype of DS should be encouraged due to the high prevalence of congenital heart defects.

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