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Risk assessment of congenital heart defects based on maternal factors in early pregnancy-a systematic review and
Zihan Suo1, Anett Rancz1, Árpád Ágoston Jankó1,2
1Centre for Translational Medicine, Semmelweis University, Budapest, 1085, Hungary.
Insights
Maternal health factors like diabetes, obesity, smoking, and hypertension significantly increase congenital heart defect (CHD) risk. Optimizing maternal well-being before and during pregnancy is crucial for preventing CHD in newborns.
Area of Science:
- Cardiology
- Public Health
- Maternal-Fetal Medicine
Background:
- Congenital heart defect (CHD) is a primary cause of neonatal mortality.
- Early maternal risk factors significantly influence CHD development.
Purpose of the Study:
- To systematically review and analyze the association between first-trimester maternal factors and the risk of CHD.
- To provide evidence for public health strategies aimed at CHD prevention.
Main Methods:
- Systematic review and meta-analysis of cohort and case-control studies.
- Searched MEDLINE, Embase, and Cochrane TRIALS.
- Analyzed 78 studies involving 393,534 cases and 29,493,495 controls.
Main Results:
- Maternal pre-pregnancy diabetes (OR 2.91), obesity (OR 1.23), active smoking (OR 1.28), passive smoking (OR 2.67), and chronic hypertension (OR 1.39) significantly elevated overall CHD risk.
- Underweight showed a slight association with ventricular septal defect (OR 1.10).
Conclusions:
- Maternal pre-pregnancy conditions and lifestyle choices are critical determinants of offspring CHD risk.
- Interventions focusing on maternal health optimization before and during pregnancy are essential for reducing CHD incidence.
Abstract:
Congenital heart defect (CHD) is a leading cause of neonatal mortality, with early maternal risk factors playing a significant role in its development. This systematic review and meta-analysis investigated the relationship between maternal factors during the first trimester and CHD. The study protocol was registered on PROSPERO (CRD42023476855). MEDLINE, Embase, and Cochrane TRIALS were systematically searched for eligible cohort and case-control studies. The primary outcome was the risk of the fetus developing CHD under the effects of maternal factors. The outcome was estimated by odds ratios (ORs) and 95% confidence interval (CI) using the random-effects model. Seventy-eight studies with 393 534 cases and 29 493 495 controls were included. Maternal pre-pregnancy diabetes (OR 2.91, 95% CI 2.10-4.03), obesity (OR 1.23, 95% CI 1.13-1.33), active (OR 1.28, 95% CI 1.03-1.57) and passive smoking (OR 2.67, 95% CI 1.30-5.46), and chronic hypertension (OR1.39, 95% CI 1.02-1.90) significantly increased the risk of overall CHD in offspring. While underweight was not associated with overall CHD, it showed a slight association with ventricular septal defect (OR 1.10, 95% CI 1.02-1.18). These findings emphasize the importance of optimizing maternal health and lifestyle before and during pregnancy and provide evidence for public health strategies to reduce the risk of CHD.
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