Abstract 1944: Associations of Maternal Fever and Influenza With Congenital Heart Defects
Background: Maternal fever and influenza have been associated with non-cardiac birth defects. Whether such associations are evident for congenital heart defects (CHD) is unclear. We evaluated the possible association of maternal reports of prenatal fever or influenza with CHD.
Methods: We analyzed data on singletons from the Baltimore-Washington Infant Study, a population-based case-control study of CHD among liveborn infants recruited between 1981 and 1989. For the period of three months before pregnancy through the end of the third month of pregnancy, participating mothers were asked whether they experienced a “fever of 101°F or higher,” had “influenza (flu),” or used antipyretics (acetaminophen, salicylates, or non-steroidal anti-inflammatory drugs). We computed odds ratios (OR) and 95% confidence intervals (CI) for associations between CHD and maternal fever or flu and examined whether those associations varied with use of antipyretics (AP).
Results: Among 2575 CHD cases and 3458 controls, there was no association between maternal fever or flu and CHD in aggregate. However, we did find associations for specific heart defects, namely right-sided obstructive defects with fever (OR 1.92, CI 1.22–3.03) and flu (OR 1.54, CI 1.04 –2.29). These associations were most notable for tricuspid atresia (fever: OR 4.78, CI 1.79 –12.79; flu: OR 4.25, CI 1.78 –10.15) and pulmonary atresia with intact ventricular septum (flu: OR 2.50, CI 1.10 –5.70). In addition, atrioventricular septal defects (AVSD) in patients with Down syndrome were associated with fever (OR 1.93, CI 1.13–3.31) and flu (OR 1.76, CI 1.12–2.74). Maternal antipyretic use attenuated the associations of fever with CHD, particularly for any AVSD (no AP: OR 4.31, CI 2.15– 8.62; AP: OR 0.90, CI 0.43–1.87), and in AVSD in patients with Down syndrome (no AP: OR 5.17, CI 2.50 –10.70; AP OR 0.88, CI 0.38 –2.05).
Conclusion: Our findings support a previously reported association of fever or flu with right-sided obstructive lesions and identify a possible new association of fever or flu with AVSD in patients with Down syndrome. They also suggest that antipyretic use may attenuate the associations of fever with CHD. Further work is warranted to replicate these findings.