Abstract 16803: Increasing Burden of Environmental Risk Factors for Congenital Heart Disease in the Current Era
Congenital heart defects (CHD) are prevalent in up to 1.3 million Americans and occur in approximately 36,000 babies each year. We assessed the impact of maternal exposure to environmental risk factors and medications during pregnancy on CHD development and risk factor trends by era (1990-1999 vs. 2000-2010).
Methods: CHD patients (pts) <18 years old were prospectively enrolled in a population-based registry. Prenatal exposure to environmental risk factors and medications was assessed by intake questionnaires and compared to National Birth Defects Prevention Study (NBDPS) and Baltimore-Washington Infant Study (BWIS) controls. Associations were measured by odds ratios (OR).
Results: 1860 CHD pts were enrolled: conotruncal defects (CTD) 31.2%, left-to-right shunts (LRS) 28.6%, LV outflow tract obstructions (LVOTO) 15.0%, RV outflow tract obstructions (RVOTO) 11.0%, valvular defects (VD) 5.1%, and others 9.1%. There was a higher frequency in the current era of advanced maternal age (OR=1.98, p<0.001), advanced paternal age (OR=2.13, p<0.001), insulin-dependent diabetes mellitus (OR=3.69, p=0.008), and urinary tract infections (OR=2.22, p=0.002). Case-control comparisons revealed association of CHD with advanced maternal age (OR=1.33, p=0.001) and gestational diabetes (OR=1.49, p=0.012). Smoking was associated with VD (OR=3.44, p<0.001). Positive family history of CHD in 1st degree relatives was higher in overall CHD (3.14%, OR=2.66, p<0.001), and in specific lesion subtypes i.e. LRS (OR=4.50, p<0.001), LVOTO (OR=2.80, p=0.030), and RVOTO (OR=4.56, p=0.004). Pts with associated extra-cardiac anomalies had higher maternal exposure rates to alcohol (OR=1.60, p=0.049), recreational drugs (OR=2.97, p=0.045) and other medications (OR=2.66, p<0.001). 17.3% of mothers were exposed to medications during pregnancy. Of the drug exposures, 16.1% were known teratogens, 53.1% were deemed safe, and safety profile was unknown in 30.9%.
Conclusion: Higher incidence of maternal risk factors and exposure to medications in the modern era indicates an increasing environmental risk burden for CHD. Understanding the mechanisms by which these factors predispose to CHD will be pivotal in minimizing CHD burden.
- © 2010 by American Heart Association, Inc.