Abstract 1666: Urinary Tract Infection in Pregnancy as a Risk Factor for Congenital Heart Defects
OBJECTIVE: In a population-based case-control study, we investigated the association between congenital heart defects and maternal urinary tract infections.
METHODS: The National Birth Defects Prevention Study enrolled 3,690 women who had infants with nonsyndromic congenital heart defects, and 4,760 women who had infants without birth defects. Women with preexisting diabetes were excluded from analyses. Affected infants had one or more of the following defects: conotruncal, septal, anomalous pulmonary venous return, atrioventricular septal defects and left- or right-sided obstructive heart defects. Mothers were considered to have a urinary tract infection (UTI) if they had at least one infection from one month prior to conception through the first trimester of pregnancy. Exposure to sulfonamides and other medications were also limited to this exposure period. Adjusted odds ratios and 95% confidence intervals were computed to determine the association between CHDs and maternal UTIs. To investigate if maternal use of sulfonamides and/or fever modified the effect between CHDs and UTIs, stratified analyses were conducted.
RESULTS: Case infants were more likely to be male than controls. Case mothers were more likely to have gestational diabetes and be older than control mothers. Women who had infants with hypoplastic left heart syndrome (HLHS) were 1.7 times more likely than control mothers to report having a UTI at some time during the exposure period (p<0.01). This association was independent of potential confounding factors, including periconceptional vitamin use, folic acid intake, alcohol intake, mother’s race or ethnicity, and maternal age. There was no evidence in support of an association between CHD subtypes and sulphonamide exposure.
CONCLUSION: Maternal UTIs from one month prior to conception through the first trimester of pregnancy increased the estimated risk of having an infant with hypoplastic left heart syndrome. Periconceptional detection and treatment of asymptomatic bacteriuria and UTI in women of reproductive age may decrease the risk of having an infant with a left-sided obstructive cardiac defect.