“…28 Additionally, the rate of congenital heart disease in some populations can be affected by maternal comorbidities or environmental exposures including but not limited to obesity, diabetes, infections, smoking, alcohol, hypertension, connective tissue disorders, epilepsy, mood disorders, lead, and lithium. [29][30][31][32][33][34][35][36][37] In some populations, the occurrence of some cardiac malformations may also change over time, independent of improved detection. 4,12 Despite genetic heterogeneity, ethnicity does appear to have an effect on the occurrence of some cardiac malformations.…”