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.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟