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Congenital heart defects, maternal febrile illness, and multivitamin use: a population-based study
L D Botto1, M C Lynberg, J D Erickson
1National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341, USA.
Insights
Maternal febrile illness during early pregnancy is linked to an increased risk of congenital heart defects in infants. This association was observed across various heart defect types, though potentially reduced by multivitamin use.
Area of Science:
- Epidemiology
- Reproductive Health
- Pediatrics
Background:
- Congenital heart defects are a significant cause of infant mortality and morbidity.
- Understanding environmental risk factors during pregnancy is crucial for prevention.
- Febrile illnesses are common during pregnancy, but their teratogenic potential requires further investigation.
Purpose of the Study:
- To investigate the association between maternal febrile illness in early pregnancy and the risk of cardiac defects in offspring.
- To identify specific types of congenital heart defects associated with maternal febrile illness.
- To explore the potential modifying effect of periconceptional multivitamin use.
Main Methods:
- Population-based case-control study conducted in metropolitan Atlanta.
- Case infants (n=905) with cardiac defects were identified from multiple sources.
- Control infants (n=3,029) without birth defects were selected via stratified random sampling from birth certificates.
- Mothers reported febrile illness occurring from one month before pregnancy through the first three months of gestation.
Main Results:
- Maternal febrile illness during early pregnancy was significantly associated with an increased risk of congenital heart defects (Odds Ratio [OR] = 1.8; 95% Confidence Interval [CI] = 1.4-2.4).
- Influenza-like illness showed a similar association (OR = 2.1; 95% CI = 0.8-5.5).
- Strongest associations were observed for tricuspid atresia (OR = 5.2), left obstructive defects (OR = 2.7), transposition of the great arteries (OR = 1.9), and ventricular septal defects (OR = 1.8).
- The observed associations were generally weaker among mothers who reported using multivitamins during the periconceptional period.
Conclusions:
- Febrile illness during the first trimester of pregnancy is a potential risk factor for congenital heart defects.
- Specific cardiac malformations demonstrate a stronger association with maternal febrile illness.
- Periconceptional multivitamin use may mitigate the risk of heart defects associated with maternal febrile illness.
Abstract:
We assessed the relation between febrile illness during pregnancy and cardiac defects in the offspring in a population-based case-control study in metropolitan Atlanta. Case infants (905) with cardiac defects were actively ascertained from multiple sources. Control infants (3,029) were infants without birth defects who were selected from birth certificates by stratified random sampling. We compared those whose mothers reported febrile illness from 1 month before pregnancy through the third month of pregnancy with those whose mothers reported no illness during the same period. Febrile illness was positively associated with the occurrence of heart defects in the offspring (odds ratio [OR] = 1.8; 95% confidence interval = 1.4-2.4). When influenzalike illness was the reported febrile illness, the OR was 2.1 (95% confidence interval = 0.8-5.5). The association with febrile illness was strongest for tricuspid atresia (OR = 5.2), left obstructive defects (OR = 2.7), transposition of the great arteries (OR = 1.9), and ventricular septal defects (OR = 1.8). These ORs were generally lower among mothers who used multivitamins during the periconceptional period.