scholarly journals Maternal Obesity and the Risk of Congenital Heart Defects: the Mediation Effect of Pregestational Diabetes

2021 ◽  
Author(s):  
Xiao-Xia Wu ◽  
Ru-Xiu Ge ◽  
Le Huang ◽  
Fu-Ying Tian ◽  
Yi-Xuan Chen ◽  
...  
Keyword(s):  
Risk Factor ◽  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Maternal Education ◽  
Maternal Obesity ◽  
Heart Defects ◽  
Normal Weight ◽  
Mediation Effect ◽  
Pregestational Diabetes ◽  
Increased Risk

Abstract Background Congenital heart defects (CHDs) are the most common birth defects worldwide. Maternal obesity has been proposed as a risk factor for CHDs, but the results are controversial and inconclusive. Pregestational diabetes (PGDM) is well known as a risk factor for CHDs and is closely related to obesity. However, the effect of PGDM on the association between maternal obesity and CHDs has not been investigated.Objectives We aimed to explore the association between maternal obesity and CHDs and to further evaluate the mediation effect of PGDM on this association.Methods We involved 53708 mother-infant pairs with deliveries between 2017 and 2019 from the Birth Cohort in Shenzhen (BiCoS). Mothers were categorized into four groups: the underweight group (BMI < 18.5), normal weight group (18.5 ≤ BMI < 24), overweight group (24 ≤ BMI < 28) and obesity group (BMI ≥ 28). To evaluate the association between BMI and CHDs, we fit multivariable logistic regression models, adjusting for maternal age, maternal education level, mode of conception, parity, GDM and offspring sex. Mediation analysis was used to confirm the mediation effect of PGDM on the association between maternal obesity and CHDs.Results The proportion of obese individuals in the BiCoS was 2.11%. Overall, 372 (0.69%) infants were diagnosed with CHDs. The prevalence of CHDs in underweight, normal weight, overweight and obese individuals was 0.64%, 0.68%, 0.72% and 1.24%, respectively. Maternal obesity was associated with an increased risk of CHDs (OR=1.97, 95% CI 1.14–3.41). The offspring of women with PGDM were 6.88 times (95% CI 4.11–11.53) more likely to have CHDs than the offspring of mothers without PGDM. The mediation effect of PGDM on the association between maternal obesity and CHDs was significant (OR=1.18, 95% CI 1.06–1.32). The estimated mediation proportion was 24.83%.Conclusion Our findings suggested that maternal obesity was associated with CHDs and that PGDM partially mediated the association between maternal obesity and CHDs.

scholarly journals Maternal obesity and metabolic disorders associate with congenital heart defects in the offspring: A systematic review

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0252343
Author(s):  
Gitte Hedermann ◽  
Paula L. Hedley ◽  
Ida N. Thagaard ◽  
Lone Krebs ◽  
Charlotte Kvist Ekelund ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Gestational Diabetes ◽  
Cohort Studies ◽  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Metabolic Disorders ◽  
Maternal Obesity ◽  
Heart Defects ◽  
Increased Risk ◽  
Maternal Overweight

Background Congenital heart defects (CHDs) are the most common congenital malformations. The aetiology of CHDs is complex. Large cohort studies and systematic reviews and meta-analyses based on these have reported an association between higher risk of CHDs in the offspring and individual maternal metabolic disorders such as obesity, diabetes, hypertension, and preeclampsia, all conditions that can be related to insulin resistance or hyperglycaemia. However, the clinical reality is that these conditions often occur simultaneously. The aim of this review is, in consequence, both to evaluate the existing evidence on the association between maternal metabolic disorders, defined as obesity, diabetes, hypertension, preeclampsia, dyslipidaemia and CHDs in the offspring, as well as the significance of combinations, such as metabolic syndrome, as risk factors. Methods A systematic literature search of papers published between January 1, 1990 and January 14, 2021 was conducted using PubMed and Embase. Studies were eligible if they were published in English and were case-control or cohort studies. The exposures of interest were maternal overweight or obesity, hypertension, preeclampsia, diabetes, dyslipidaemia, and/or metabolic syndrome, and the outcome of interest was CHDs in the offspring. Furthermore, the studies were included according to a quality assessment score. Results Of the 2,250 identified studies, 32 qualified for inclusion. All but one study investigated only the individual metabolic disorders. Some disorders (obesity, gestational diabetes, and hypertension) increased risk of CHDs marginally whereas pre-gestational diabetes and early-onset preeclampsia were strongly associated with CHDs, without consistent differences between CHD subtypes. A single study suggested a possible additive effect of maternal obesity and gestational diabetes. Conclusions Future studies of the role of aberrations of the glucose-insulin homeostasis in the common aetiology and mechanisms of metabolic disorders, present during pregnancy, and their association, both as single conditions and–particularly–in combination, with CHDs are needed.

scholarly journals Association between maternal obesity and metabolic disorders and congenital heart defects in the offspring: a literature review

2020 ◽  
Author(s):  
Gitte Hedermann ◽  
Paula L Hedley ◽  
Ida N Thagaard ◽  
Lone Krebs ◽  
Thorkild IA Sørensen ◽  
...  
Keyword(s):  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Metabolic Disorders ◽  
Maternal Obesity ◽  
Heart Defects ◽  
Chronic Hypertension ◽  
Mortality And Morbidity ◽  
Increased Risk ◽  
Early Onset Preeclampsia ◽  
The Individual

SummaryCongenital heart defects (CHDs) are the most common congenital malformation and will, in severe cases, have a serious impact on neonatal mortality and morbidity. The aetiology of CHDs is complex. Large cohort studies have reported an association between increased risk of CHDs in the offspring and individual maternal metabolic disorders such as diabetes, hypertension, preeclampsia, and obesity. All conditions that can be related to insulin resistance and possibly metabolic syndrome (MetS). The aim of this review is to evaluate the existing evidence on the association between maternal metabolic disorders, defined as obesity, diabetes, hypertension, preeclampsia, dyslipidaemia, and MetS, or combinations thereof and CHDs in the offspring. A literature search was performed using PubMed and Embase databases. Of the 2,076 potentially relevant identified studies, 30 qualified for inclusion. Only one study dealt with the combination of more than one maternal metabolic condition as risk factor for CHDs in the offspring. All other studies investigated the individual metabolic disorders and their association with CHDs. Some disorders (chronic hypertension, gestational diabetes, and obesity) increased risk of CHDs marginally whereas pregestational diabetes and early-onset preeclampsia were highly associated with CHDs. Future studies on the combination of several metabolic disorders in the same pregnancy and their association with CHDs are needed.

scholarly journals Academic Achievement Among Children with Congenital Heart Defects in Arkansas

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Suman Maity ◽  
Nahed El-hassan ◽  
Anthony Goudie ◽  
Jeffrey R Kaiser ◽  
Wendy N Nembhard
Keyword(s):  
Birth Weight ◽  
Congenital Heart Defects ◽  
Gestational Age ◽  
Congenital Heart ◽  
Maternal Education ◽  
Heart Defects ◽  
Birth Certificate ◽  
Educational Performance ◽  
Negatively Associated ◽  
Race Ethnicity

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.

scholarly journals Say NO to ROS: Their Roles in Embryonic Heart Development and Pathogenesis of Congenital Heart Defects in Maternal Diabetes

Antioxidants ◽  
2019 ◽  
Vol 8 (10) ◽  
pp. 436 ◽  
Author(s):  
Engineer ◽  
Saiyin ◽  
Greco ◽  
Feng
Keyword(s):  
Oxidative Stress ◽  
Nitric Oxide ◽  
Congenital Heart Defects ◽  
Heart Development ◽  
Congenital Heart ◽  
Heart Defects ◽  
Maternal Diabetes ◽  
Embryonic Heart ◽  
Pregestational Diabetes ◽  
Enos Uncoupling

Congenital heart defects (CHDs) are the most prevalent and serious birth defect, occurring in 1% of all live births. Pregestational maternal diabetes is a known risk factor for the development of CHDs, elevating the risk in the child by more than four-fold. As the prevalence of diabetes rapidly rises among women of childbearing age, there is a need to investigate the mechanisms and potential preventative strategies for these defects. In experimental animal models of pregestational diabetes induced-CHDs, upwards of 50% of offspring display congenital malformations of the heart, including septal, valvular, and outflow tract defects. Specifically, the imbalance of nitric oxide (NO) and reactive oxygen species (ROS) signaling is a major driver of the development of CHDs in offspring of mice with pregestational diabetes. NO from endothelial nitric oxide synthase (eNOS) is crucial to cardiogenesis, regulating various cellular and molecular processes. In fact, deficiency in eNOS results in CHDs and coronary artery malformation. Embryonic hearts from diabetic dams exhibit eNOS uncoupling and oxidative stress. Maternal treatment with sapropterin, a cofactor of eNOS, and antioxidants such as N-acetylcysteine, vitamin E, and glutathione as well as maternal exercise have been shown to improve eNOS function, reduce oxidative stress, and lower the incidence CHDs in the offspring of mice with pregestational diabetes. This review summarizes recent data on pregestational diabetes-induced CHDs, and offers insights into the important roles of NO and ROS in embryonic heart development and pathogenesis of CHDs in maternal diabetes.

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

Medicina ◽  
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%.

scholarly journals Eight-fold increased risk for congenital heart defects in children carrying the nicotinamide N-methyltransferase polymorphism and exposed to medicines and low nicotinamide

2008 ◽  
Vol 29 (11) ◽  
pp. 1424-1431 ◽  
Author(s):  
L. M.J.W. van Driel ◽  
H. P.M. Smedts ◽  
W. A. Helbing ◽  
A. Isaacs ◽  
J. Lindemans ◽  
...  
Keyword(s):  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Heart Defects ◽  
Increased Risk

scholarly journals Maternal socioeconomic and lifestyle factors during pregnancy and the risk of congenital heart defects

Medicina ◽  
2009 ◽  
Vol 45 (11) ◽  
pp. 904 ◽  
Author(s):  
Renata Kučienė ◽  
Virginija Dulskienė
Keyword(s):  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Maternal Education ◽  
Heart Defects ◽  
Multivariate Regression Analysis ◽  
Lifestyle Factors ◽  
Epidemiological Methods ◽  
Smoking During Pregnancy ◽  
Adjusted Risk ◽  
Study Results

The objective of study was to estimate the importance of maternal socioeconomic and lifestyle factors during pregnancy in the risk of congenital heart defects in Kaunas infant population in 1999–2005. Material and methods. An epidemiological case-control study was conducted. The study comprised 187 newborns with congenital heart defects (cases) and 643 randomly selected newborns without any defects (controls), born in Kaunas city during 1999–2005. Modern epidemiological methods were used for data analysis. A multivariate logistic regression was used to determine adjusted risk factors of congenital heart defects. Results. The logistic multivariate regression analysis showed that low and moderate maternal education significantly increased the risk of congenital heart defects (primary or basic [OR=3.43; 95% CI, 1.54–7.64] and secondary [OR=1.56; 95% CI, 1.00–2.45] vs advanced vocational or higher education). The housewives and workers had a higher risk of delivering a newborn with congenital heart defects than the office workers (OR=2.34; 95% CI, 1.34–4.10 and OR=1.28; 95% CI, 0.79–2.07, respectively). Maternal smoking during pregnancy tended to increase the risk of congenital heart defects by 48% (OR=1.48; 95% CI, 0.82–2.67). Conclusions. According to our study results, unfavorable maternal socioeconomic factors and smoking during pregnancy increased the risk of congenital heart defects.

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