Maternal Risk Factors Predisposing to Congenital Heart Disease

Background: Congenital Heart Diseases (CHD) are defined as malformations of the heart and great vessels that develop in utero which may manifest at birth or later in childhood. They can be caused by numerous genetic and environmental factors.  Genetic factors are nonmodifiable.  However, identification  of  modifiable  environmental  risk  factors  is  important  to  develop  population  based prevention strategies to reduce the incidence of CHD.

Objectives: The primary objective of the study was to find an association of the maternal lifestyles with CHD in new-borns. The secondary outcome of the study was to identify maternal factors that can be modified for the primary prevention of CHD.

Materials  and  Methods: This  prospective  study  involved  cardiovascular  system  examination  of newborns after delivery in term gestations in 1394 singleton pregnancies. The maternal risk factors considered were age, prepregnancy Body Mass Index  (BMI),  consanguineous  marriage,  caffeine intake, diabetes, stress and intake of periconceptional Folic acid tablets.

Results: In  this  study,  22  (1.58%)  out  of  1394  pregnancies  resulted  in  Congenital  Heart  Defects. Teenage pregnancy (p value= 0.0002), consanguineous marriage (p value=0.0004), overt diabetes mellitus (p value=0.0001), caffeine intake (p value=0.0031), prepregnancy BMI>24(p value=0.0001), maternal stress (p value<0.0001, history of previous congenital malformations (p value=0.004) and non intake of folic acid tablets in the first trimester (p value=0.0023 were found to be the most likely risk factor associated with CHD.

Conclusion: Community  education  programmes  should  be  initiated  in  the  high-risk  population  to prevent teenage pregnancies and consanguineous marriages.   Maternal counseling for periconceptional control of blood glucose, adequate weight maintenance, intake of folic acid tablets, avoidance of stress and caffeine is needed to prevent CHD. The results of numerous studies suggest that in reducing the incidence of CHD, public health strategy needs to focus on avoidance of teenage pregnancy and consanguineous marriages. Pregnancy associated with stress should be monitored more closely.  Prepregnancy  maternal  BMI,  coffee  intake  and  folic  acid  deficiency  have  to  be corrected. Maternal overt diabetes and hyperglycemia during pregnancy needs to be screened and managed timely to reduce the incidence of CHD.

Read full article: