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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Factors associated with an increased risk of congenital heart disease

Factors associated with an increased risk of congenital heart disease
  Estimated risk* Associated CHD lesions
Prematurity (gestational age <37 weeks)[1] OR 2.4 (95% CI 2.2-2.7) Various
Multifetal pregnancy[2] OR 4.53 (95% CI 4.28-4.8) RVOTO lesions, VSD, ASD
In utero infection
Rubella[3] Cardiac defects occur in 10 to 20% of infants with congenital rubella PDA and peripheral pulmonary artery stenosis
Maternal influenza or flu-like illness[4] OR 2.04 (95% CI 1.27-3.27) RVOTO lesions
Maternal factors[2]
Preeclampsia[5] RR 1.57 (95% CI 1.48-1.67) Septal defects
PKU[6] Cardiac defects occur in 15% of infants with poorly controlled maternal PKU CoA and HLHS
Diabetes mellitus OR 4.65 (95% CI 4.13-5.24) Heterotaxy syndrome, conotruncal defects, AVSD, LVOTO and RVOTO lesions
Hypertension OR 1.81 (95% CI 1.61-2.03) RVOTO, VSD, ASD
Obesity OR 1.48 (95% CI 1.32-1.65) Various
Thyroid disorders OR 1.45 (95% CI 1.26-1.67) Various
Systemic connective tissue disorders OR 3.01 (95% CI 2.23-4.06) Heterotaxy syndrome
Epilepsy and mood disorders OR 1.41 (95% CI 1.16-1.72) Various
Age ≥40 years OR 1.48 (95% CI 1.39-1.58) AVSD
Alcohol or substance use OR 1.88 (95% CI 1.74-2.04) RVOTO, VSD, ASD
First-trimester cigarette smoking[7]

OR 1.9 (95% CI 1.04-3.45)

OR 1.32 (95% CI 1.06-1.65)

OR 1.36 (95% CI 1.04-1.78)

Truncus arteriosus

RVOTO

Secundum ASD

Maternal medications during pregnancy[6,8]:

Increased risk of CHD has been reported with thalidomide, ACE inhibitor, retinoic acid, NSAIDs, phenytoin, and lithium

Estimates vary

Various

NSAIDs are associated with D-TGA, AVSD, VSD, bicuspid aortic valve

Lithium has been reported to be associated with Ebstein anomalyΔ
Assisted reproductive technology[9] RR 1.64 (95% CI 1.30-2.07) Various
Family history of CHD[10]
First-degree relative with any CHD RR 3.21 (95% CI 2.96-3.49) Various
Second-degree relative with any CHD RR 1.78 (95% CI 1.09-2.91) Various
First-degree relative with heterotaxy RR 79.1 (95% CI 32.9-190.0) Heterotaxy
First-degree relative with RVOTO RR 48.6 (95% CI 27.5-85.6) RVOTO
First-degree relative with AVSD RR 24.3 (95% CI 12.2-48.7) AVSD
First-degree relative with LVOTO RR 12.9 (95% CI 7.48-22.20) LVOTO
First-degree relative with conotruncal defect RR 11.7 (95% CI 8.01-17.00) Conotruncal defect
First-degree relative with isolated ASD RR 7.07 (95% CI 4.51-11.10) ASD
First-degree relative with isolated VSD RR 3.41 (95% CI 2.20-5.29) VSD

CHD: congenital heart disease; OR: odds ratio; RVOTO: right ventricular outflow tract obstruction; VSD: ventricular septal defect; ASD: atrial septal defect; PDA: patent ductus arteriosus; RR: relative risk; PKU: phenylketonuria; CoA: coarctation of the aorta; HLHS: hypoplastic left heart syndrome; AVSD: atrioventricular septal defect; LVOTO: left ventricular outflow tract obstruction; ACE: angiotensin-converting enzyme; NSAID: nonsteroidal antiinflammatory drug; D-TGA: D-transposition of the great arteries.

* These estimates are for relative risk. The absolute risk depends on the baseline prevalence of the CHD defect. The overall prevalence of CHD in the general population is approximately 1%.

¶ The association of CHD with mood disorders is most likely reflective of the medications used in the treatment of these disorders.

Δ The association of lithium with Ebstein anomaly is controversial; however, screening for CHD is generally recommended for infants exposed to lithium during the first or second trimester of pregnancy. Refer to the UpToDate topics on teratogenic and postnatal risks of lithium and prenatal screening for fetal cardiac abnormalities for more details.
References:
  1. Tanner K, Sabrine N, Wren C. Cardiovascular malformations among preterm infants. Pediatrics 2005; 116:e833.
  2. Liu S, Joseph KS, Lisonkova S, et al. Association between maternal chronic conditions and congenital heart defects: A population-based cohort study. Circulation 2013; 128:583.
  3. Reef SE, Plotkin S, Cordero JF, et al. Preparing for elimination of congenital Rubella syndrome (CRS): Summary of a workshop on CRS elimination in the United States. Clin Infect Dis 2000; 31:85.
  4. Oster ME, Riehle-Colarusso T, Alverson CJ, Correa A. Associations between maternal fever and influenza and congenital heart defects. J Pediatr 2011; 158:990.
  5. Auger N, Fraset WD, Healy-Profitos J, Abour L. Association between preeclampsia and congenital heart defects. JAMA 2015; 314:1588.
  6. Jenkins KJ, Correa A, Feinstein JA, et al. Noninherited risk factors and congenital cardiovascular defects: Current knowledge: A scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young: Endorsed by the American Academy of Pediatrics. Circulation 2007; 115:2995.
  7. Alverson CJ, Strickland MJ, Gilboa SM, Correa A. Maternal smoking and congenital heart defects in the Baltimore-Washington Infant Study. Pediatrics 2011; 127:e647.
  8. Diav-Citrin O, Shechtman S, Tahover E, et al. Pregnancy outcome following in utero exposure to lithium: A prospective, comparative, observational study. Am J Psychiatry 2014; 171:785.
  9. Wen J, Jiang J, Ding C, et al. Birth defects in children conceived by in vitro fertilization and intracytoplasmic sperm injection: A meta-analysis. Fertil Steril 2012; 97:1331.
  10. Øyen N, Poulsen G, Boyd HA, et al. Recurrence of congenital heart defects in families. Circulation 2009; 120:295.
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