Maternal Fetal Environment and the Prevalence of Atrial Septal Defects in the Neonate
Presented By:
Anna Maria Dehn, Anna Sellmer, Sofie Dannesbo, Ruth Ottilia Birgitta Voegg, Elisabeth Blixenkrone Moeller, Heather Boyd, Helle Zingenberg, Kasper Iversen, Henning Bundgaard, Vibeke Hjortdal
Department of Cardiothoracic Surgery, Copenhagen University Hospital Rigshospitalet Copenhagen, Denmark
anna.maria.dehn@regionh.dkOverview:
Background: Atrial septal defect (ASD) of the secundum type is one of the most common congenital heart defects. ASDs are associated with increased morbidity and mortality, but the etiology and pathophysiology of ASDs remain poorly understood. Maternal morbidity and complications during pregnancy, also known as an impaired maternal-fetal environment (MFE), are known to be associated with congenital heart disease in the child. Particularly preeclampsia is associated with congenital cardiac defects. Most studies on MFE and congenital heart disease focus on the more complex cardiac defects. Less is known about the association between an impaired MFE and simple cardiac defects like ASD.
Methods: Using data from the Copenhagen Baby Heart Study (CBHS) we investigated the MFE and the prevalence of ASDs in a cohort of 11,959 singleton newborns. CBHS is a prospective, population-based cohort-study of children born in the Capital Region of Denmark. We collected information on maternal and infant characteristics. Neonatal echocardiograms were performed for all newborns and assessed for ASD.
Maternal preeclampsia was defined by International Classification of Diseases, 10th revision (ICD-10) codes O14.0-O14.2. The prevalence of ASD in neonates born after pregnancies complicated by maternal preeclampsia was compared to the prevalence of ASD in neonates born after pregnancies without maternal preeclampsia.
Results: Echocardiographic analyses showed, that among women with preeclampsia, 5.9% had newborns with ASDs, compared with 3.7% in women who did not have preeclampsia. The crude risk ratio for ASD in newborns born after pregnancies with maternal preeclampsia was 1.6 (95% CI 1.06-2.31, p=0.04) compared to children born after pregnancies without preeclampsia. There were no differences in maternal age, maternal pre-pregnancy BMI, parity, or maternal ethnicity between newborns with ASD and newborns without ASD. Neither did we find differences in gestational age at birth, birth weight or birth length or percentage of children born small for gestational age and the pH values of umbilical arterial and venous blood measured immediately after birth was not altered in newborns with ASD compared to newborns without ASD. Measurements for placenta and placental function (placental weight, placental weight:birth weight ratio, PAPP-A Multiple of Median) as well as Nuchal Translucency Multiple of Median did not differ between newborns with and without ASD either.
Conclusion: Maternal preeclampsia was associated with an increased prevalence of ASD in the child. The association of maternal preeclampsia and ASD in the newborn found in this study points towards a possible common pathophysiological pathway. There were no differences in maternal or infant characteristics when comparing newborns with and without ASD. Placental characteristics and nuchal translucency did not differ either.
Methods: Using data from the Copenhagen Baby Heart Study (CBHS) we investigated the MFE and the prevalence of ASDs in a cohort of 11,959 singleton newborns. CBHS is a prospective, population-based cohort-study of children born in the Capital Region of Denmark. We collected information on maternal and infant characteristics. Neonatal echocardiograms were performed for all newborns and assessed for ASD.
Maternal preeclampsia was defined by International Classification of Diseases, 10th revision (ICD-10) codes O14.0-O14.2. The prevalence of ASD in neonates born after pregnancies complicated by maternal preeclampsia was compared to the prevalence of ASD in neonates born after pregnancies without maternal preeclampsia.
Results: Echocardiographic analyses showed, that among women with preeclampsia, 5.9% had newborns with ASDs, compared with 3.7% in women who did not have preeclampsia. The crude risk ratio for ASD in newborns born after pregnancies with maternal preeclampsia was 1.6 (95% CI 1.06-2.31, p=0.04) compared to children born after pregnancies without preeclampsia. There were no differences in maternal age, maternal pre-pregnancy BMI, parity, or maternal ethnicity between newborns with ASD and newborns without ASD. Neither did we find differences in gestational age at birth, birth weight or birth length or percentage of children born small for gestational age and the pH values of umbilical arterial and venous blood measured immediately after birth was not altered in newborns with ASD compared to newborns without ASD. Measurements for placenta and placental function (placental weight, placental weight:birth weight ratio, PAPP-A Multiple of Median) as well as Nuchal Translucency Multiple of Median did not differ between newborns with and without ASD either.
Conclusion: Maternal preeclampsia was associated with an increased prevalence of ASD in the child. The association of maternal preeclampsia and ASD in the newborn found in this study points towards a possible common pathophysiological pathway. There were no differences in maternal or infant characteristics when comparing newborns with and without ASD. Placental characteristics and nuchal translucency did not differ either.
