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Results: A total of 42,552 (81.8%) pregnant women were followed up until confirmation of the diagnosis of CHDs in the 43470 infants born to them. High right UtA-PI was associated with an increased risk of fetal CHDs (HR 2.52, 95%CI 1.14-5.56). However, no significant associations were found for subtypes of CHDs. Fetal CHDs was strongly associated with maternal severe pre-eclampsia, but were not associated with mild pre-eclampsia. High right UtA-PI was associated with fetal CHDs in multiple births in path analyses models (HR 6.17,. Totally 96% of the risk of fetal CHDs was mediated by maternal pre-eclampsia in singleton births, while 93.8% related to high right UtA-PI in multiple births. Conclusions: Abnormal UtA-PI was associated with an increased risk of fetal CHD, especially for multiple pregnancies. Different mechanisms for CHD were found between singleton and multiple pregnancies.