Mediation analysis of gestational age, congenital heart defects, and infant birth-weight

Children with congenital heart defects (CHD) have impaired cognitive development. The objective was to determine if children with CHDs differed in academic performance during elementary and middle school years from children without CHDs. Data from the state birth defects registry, Arkansas Reproductive Health Monitoring System (ARHMS), birth certificate records, and achievement test-scores (grades 3-8) from the Arkansas Department of Education were linked using unique identifiers for children born between 2000-2011 in Arkansas. Cases were identified using 6-digit British Paediatric Association codes and matched controls were assigned from birth certificate data. Proficiency (yes/no) on achievement tests was determined using standard thresholds per grade. Data were stratified based on sex, gestational age, and birth weight. Odds ratios (OR) and 95% confidence intervals (CI) were calculated from multivariate logistic regression adjusting for maternal education level and age, race/ethnicity, and infant sex. A total of 3,730 children with CHDs and 7,385 children without CHDs were evaluated. Children with CHD were less likely to be proficient in early elementary school grades for mathematics (3rd: OR=0.72, 95% CI: 0.59, 0.87; 4th: OR=0.77, 95% CI: 0.62, 0.95) and literacy (3rd: OR=0.75, 95% CI: 0.63, 0.89; 4th: OR=0.72, 95% CI: 0.58, 0.90). The trend of being less proficient associated with CHD remained mostly consistent with sex, gestational age, and birth weight. In multivariate analysis, CHD was negatively associated with being proficient in mathematics and literacy. Maternal education (1-3 years beyond high school) was positively associated with test proficiency. Additionally, non-Hispanic (NH) black children had lower odds of being proficient compared to NH white children. Educational performance was negatively associated with CHD in early elementary grades; there was no difference in later grades. However, larger sample sizes in later grades are necessary for reliable estimates. Maternal education and race/ethnicity were significant factors associated with childhood educational performance.

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Survival, Morbidities, and Developmental Outcomes among Low Birth Weight Infants with Congenital Heart Defects

American Journal of Perinatology ◽

10.1055/s-0040-1712964 ◽

2020 ◽

Author(s):

Mihai Puia-Dumitrescu ◽

Laura N. Sullivan ◽

David Tanaka ◽

Kimberley Fisher ◽

Rick Pittman ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Congenital Heart Defects ◽

Gestational Age ◽

Congenital Heart ◽

Heart Defects ◽

Ductus Arteriosus ◽

Developmental Outcomes ◽

Low Birth Weight Infants ◽

Common Diagnosis

Objective Prematurity and low birth weight (LBW) are risk factors for increased morbidity and mortality in infants with congenital heart defects (CHDs). We sought to describe survival, inhospital morbidities, and 2-year neurodevelopmental follow-up in LBW infants with CHD. Study Design We included infants with birth weight (BW) <2,500 g diagnosed with CHD (except isolated patent ductus arteriosus) admitted January 2013 to March 2016 to a single level-IV academic neonatal intensive care unit. We reported CHD prevalence by BW and gestational age; selected in-hospital morbidities and mortality by infant BW, CHD type, and surgical intervention; and developmental outcomes by Bayley's scales of infant and toddler development, third edition (BSID-III) scores at age 2 years. Results Among 420 infants with CHD, 28 (7%) underwent cardiac surgery. Median (25th and 75th percentiles) gestational age was 30 (range: 27–33) weeks and BW was 1,258 (range: 870–1,853) g. There were 134 of 420 (32%) extremely LBW (<1,000 g) infants, 82 of 420 (20%) were small for gestational age, and 51 of 420 (12%) multiples. Most common diagnosis: atrial septal defect (260/420, 62%), followed by congenital anomaly of the pulmonary valve (75/420, 18%). Most common surgical procedure: pulmonary artery banding (5/28, 18%), followed by the tetralogy of Fallot corrective repair (4/28, 14%). Survival to discharge was 88% overall and lower among extremely LBW (<1,000 g, 81%) infants and infants undergoing surgery (79%). Comorbidities were common (35%); retinopathy of prematurity and bronchopulmonary dysplasia were most prevalent. BSID-III scores were available on 148 of 176 (84%); any scores <85 were noted in 73 of 148 (49%), with language being most commonly affected. Conclusion Among LBW infants with congenital heart disease, hospital mortality varied by BW and cardiac diagnosis. Key Points

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Children Born with Congenital Heart Defects and Growth Restriction at Birth: A Systematic Review and Meta-Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17093056 ◽

2020 ◽

Vol 17 (9) ◽

pp. 3056 ◽

Cited By ~ 1

Author(s):

Ali Ghanchi ◽

Neil Derridj ◽

Damien Bonnet ◽

Nathalie Bertille ◽

Laurent J. Salomon ◽

...

Keyword(s):

Systematic Review ◽

Congenital Heart Defects ◽

Gestational Age ◽

Small For Gestational Age ◽

Congenital Heart ◽

Heart Defects ◽

Data Extraction ◽

Meta Analysis ◽

Adverse Outcomes ◽

Growth Restriction

Newborns with congenital heart defects tend to have a higher risk of growth restriction, which can be an independent risk factor for adverse outcomes. To date, a systematic review of the relation between congenital heart defects (CHD) and growth restriction at birth, most commonly estimated by its imperfect proxy small for gestational age (SGA), has not been conducted. Objective: To conduct a systematic review and meta-analysis to estimate the proportion of children born with CHD that are small for gestational age (SGA). Methods: The search was carried out from inception until 31 March 2019 on Pubmed and Embase databases. Studies were screened and selected by two independent reviewers who used a predetermined data extraction form to obtain data from studies. Bias was assessed using the Critical Appraisal Skills Programme (CASP) checklist. The database search identified 1783 potentially relevant publications, of which 38 studies were found to be relevant to the study question. A total of 18 studies contained sufficient data for a meta-analysis, which was done using a random effects model. Results: The pooled proportion of SGA in all CHD was 20% (95% CI 16%–24%) and 14% (95% CI 13%–16%) for isolated CHD. Proportion of SGA varied across different CHD ranging from 30% (95% CI 24%–37%) for Tetralogy of Fallot to 12% (95% CI 7%–18%) for isolated atrial septal defect. The majority of studies included in the meta-analysis were population-based studies published after 2010. Conclusion: The overall proportion of SGA in all CHD was 2-fold higher whereas for isolated CHD, 1.4-fold higher than the expected proportion in the general population. Although few studies have looked at SGA for different subtypes of CHD, the observed variability of SGA by subtypes suggests that growth restriction at birth in CHD may be due to different pathophysiological mechanisms.

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Folate supplementation for prevention of congenital heart defects and low birth weight: an update

Cardiovascular Diagnosis and Therapy ◽

10.21037/cdt.2019.02.03 ◽

2019 ◽

Vol 9 (S2) ◽

pp. S424-S433 ◽

Cited By ~ 7

Author(s):

Rima Obeid ◽

Wolfgang Holzgreve ◽

Klaus Pietrzik

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Heart Defects ◽

Folate Supplementation

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Clinical outcomes in very low birth weight infants with major congenital heart defects

Early Human Development ◽

10.1016/j.earlhumdev.2014.09.006 ◽

2014 ◽

Vol 90 (12) ◽

pp. 791-795 ◽

Cited By ~ 11

Author(s):

Anna W. Anderson ◽

P. Brian Smith ◽

Kristin M. Corey ◽

Kevin D. Hill ◽

Kanecia O. Zimmerman ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Clinical Outcomes ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Very Low Birth Weight ◽

Heart Defects ◽

Low Birth Weight Infants

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The incidence and diagnostics of congenital heart defects in Kaunas infant population during 1999–2005

Medicina ◽

10.3390/medicina44020018 ◽

2008 ◽

Vol 44 (2) ◽

pp. 139

Author(s):

Virginija Dulskienë ◽

Vilija Malinauskienë ◽

Ada Azaravièienë ◽

Renata Kuèienë

Keyword(s):

Birth Weight ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Heart Defects ◽

Epidemiological Methods ◽

Normal Birth ◽

Congenital Heart Malformations ◽

Increased Risk ◽

Heart Malformation ◽

Heart Malformations

The objective of this study was to determinate the incidence and diagnostics of congenital heart defects in Kaunas infant population in 1999–2005 and to compare the data obtained with the data of years 1995–1998. Subject and methods. The study population comprised all newborns born in Kaunas city during 1999– 2005. Congenital heart defects were registered based on clinical diagnosis after its verification using the data from consulting centers and pediatric outpatient departments. To assess the incidence of congenital heart malformations in newborn population, we conducted a validated newborn register based on maternal residential district. Modern epidemiological methods were used for data analysis. Results. In 1999–2005, there were 24 069 live births in Kaunas: 2231 newborns were born with congenital anomalies, 198 had congenital heart malformations. The incidence of congenital heart defects was 8.2 per 1000 live newborns. The majority of congenital heart malformations were diagnosed in delivery units (93.94%). We have analyzed the relationship between birth weight and gestational age of newborns with congenital heart malformations. Newborns with low birth weight were at significantly higher risk of congenital heart malformation than newborns with normal birth weight (OR=3.52, 95% CI, 2.25–5.47). Our data also showed that newborns born before 32 weeks of gestation had a 5-fold increased risk of congenital heart malformation (OR=5.20; 95% CI, 2.50–10.84) and infants born before 37 weeks of gestation had a 4-fold increased risk (OR=4.08; 95% CI, 2.68–6.19) compared with newborns born after 37 weeks of gestation. Conclusions. This study shows that incidence of congenital heart anomalies in Kaunas newborn population was 8.2 cases per 1000 live newborns in 1999–2005. It was determined that during 1999–2005, the number of above-mentioned anomalies diagnosed in delivery units increased by 23%.

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Clinical course and prognosis of hemodynamically significant congenital heart defects in very low birth weight infants

Korean Journal of Pediatrics ◽

10.3345/kjp.2009.52.4.481 ◽

2009 ◽

Vol 52 (4) ◽

pp. 481

Author(s):

Hye Soo Yoo ◽

Ji Eun Kim ◽

Soo Kyoung Park ◽

Hyun Ju Seo ◽

Yoo Jin Jeong ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Very Low Birth Weight ◽

Clinical Course ◽

Heart Defects ◽

Low Birth Weight Infants

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Maternal sociodemographic characteristics, early pregnancy behaviours, and livebirth outcomes as congenital heart defects risk factors - Northern Ireland 2010-2014

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04223-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hafi Saad ◽

Marlene Sinclair ◽

Brendan Bunting

Keyword(s):

Risk Factors ◽

Northern Ireland ◽

Birth Outcomes ◽

Congenital Heart Defects ◽

Early Pregnancy ◽

Gestational Age ◽

Congenital Heart ◽

Heart Defects ◽

Sociodemographic Characteristics ◽

History Of

Abstract Background Congenital Heart Defects (CHD) is the most commonly occurring congenital anomaly in Europe and a major paediatric health care concern. Investigations are needed to enable identification of CHD risk factors as studies have given conflicting results. This study aim was to identify maternal sociodemographic characteristics, behaviours, and birth outcomes as risk factors for CHD. This was a population based, data linkage cohort study using anonymised data from Northern Ireland (NI) covering the period 2010-2014. The study cohort composed of 94,067 live births with an outcome of 1162 cases of CHD using the International Statistical Classification of Diseases and Related Health Problems (ICD)-10 codes and based on the European Surveillance of Congenital Anomalies (EUROCAT) grouping system for CHD. CHD cases were obtained from the HeartSuite database (HSD) at the Royal Belfast Hospital for Sick Children (RBHSC), maternal data were extracted from the Northern Ireland Maternity System (NIMATS), and medication data were extracted from the Enhanced Prescribing Database (EPD). STATA version 14 was used for the statistical analysis in this study, Odds Ratio (OR), 95% Confident intervals (CI), P value, and logistic regression were used in the analysis. Ethical approval was granted from the National Health Service (NHS) Research Ethics Committee. Result In this study, a number of potential risk factors were assessed for statistically significant association with CHD, however only certain risk factors demonstrated a statistically significant association with CHD which included: gestational age at first booking (AOR = 1.21; 95% CI = 1.04-1.41; P < 0.05), family history of CHD or congenital abnormalities and syndromes (AOR = 4.14; 95% CI = 2.47-6.96; P < 0.05), woman’s smoking in pregnancy (AOR = 1.22; 95% CI = 1.04-1.43; P < 0.05), preterm birth (AOR = 3.01; 95% CI = 2.44-3.01; P < 0.05), multiple births (AOR = 1.89; 95% CI = 1.58-2.60; P < 0.05), history of abortion (AOR = 1.12; 95% CI = 1.03-1.28; P < 0.05), small for gestational age (SGA) (AOR = 1.44; 95% CI = 1.22-1.78; P < 0.05), and low birth weight (LBW) (AOR = 3.10; 95% CI = 2.22-3.55; P < 0.05). Prescriptions and redemptions of antidiabetic (AOR = 2.68; 95% CI = 1.85-3.98; P < 0.05), antiepileptic (AOR = 1.77; 95% CI = 1.10-2.81; P < 0.05), and dihydrofolate reductase inhibitors (DHFRI) (AOR = 2.13; 95% CI = 1.17-5.85; P < 0.05) in early pregnancy also showed evidence of statistically significant association with CHD. Conclusion The results of this study suggested that there are certain maternal sociodemographic characteristics, behaviours and birth outcomes that are statistically significantly associated with higher risk of CHD. Appropriate prevention policy to target groups with higher risk for CHD may help to reduce CHD prevalence. These results are important for policy makers, obstetricians, cardiologists, paediatricians, midwives and the public.

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Birth outcomes of cases with different congenital heart defects - a population-based study

International Journal of Health ◽

10.14419/ijh.v3i1.4406 ◽

2015 ◽

Vol 3 (1) ◽

pp. 7

Author(s):

Attila Vereczkey ◽

Balázs Gerencsér ◽

Andrew E Czeizel ◽

István Szabó

Keyword(s):

Birth Weight ◽

Birth Outcomes ◽

Gestational Age ◽

Intrauterine Growth Restriction ◽

Congenital Heart ◽

Low Birthweight ◽

Heart Defects ◽

Population Based ◽

Intrauterine Growth ◽

Gestational Age At Delivery

Background: In general, previous epidemiological studies evaluated congenital heart defects (CHDs) together. The aim of the present study was to identify possible etiological factors of different CHD-entities, because the underlying causes are unclear in the vast majority of patients.Objectives: Different CHD-entities as homogeneously as possible with confirmed diagnoses were analyzed in the population-based large dataset of the Hungarian Case-Control Surveillance of Congenital Abnormalities.Methods: 3,750 live-born singleton CHD-patients were analyzed according to birth outcomes, i.e. gestational age at delivery and birth weight, the rate of preterm birth, low birthweight and small for gestational age.Results: The major findings of the study showed that cases with different CHD-entities had shorter gestational age at delivery and lower mean birth weight, and these variables associated with a higher rate of preterm birth and particularly with a much higher rate of low birthweight and small for gestational age. This study showed the importance of sex in the birth outcomes of some CHD-entities. The question is why several CHD-entities manifested more frequently in newborns with intrauterine growth restriction because fetal heart has a passive role before birth without pulmonary circulation.Conclusions: The birth outcomes of cases indicate the effect of CHDs for fetal development. In addition maternal confounders have to consider. Finally, CHDs and intrauterine growth restriction as two developmental errors may have a common route, thus fetal growth and birthweight associated gene polymorphisms may have a role in the origin of CHDs.

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