Proportion of selected congenital heart defects attributable to recognized risk factors

Simeone, Regina M.; Tinker, Sarah C.; Gilboa, Suzanne M.; Agopian, A. J.; Oster, Matthew E.; Devine, Owen; Honein, Margaret A.

doi:10.1016/j.annepidem.2016.10.003

Cited by 29 publications

(26 citation statements)

References 73 publications

(86 reference statements)

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“…The effect is independent of whether the mother is affected by type 1 or type 2 diabetes, and studies of the NOD (non-obese diabetic) mouse show that CHD in offspring correlates with elevated glucose during embryogenesis 127 . Especially in view of the increasing rates of type 2 diabetes in the younger population, this represents an important contributor to CHD; for example, maternal diabetes is thought to contribute to 6–8% of HLHS and TOF 128 . The potential for gene-environment interactions highlight the continued need to catalogue environmental exposures within a cohort which also has corresponding DNA sequencing data.…”

Section: Future Efforts In Chd Genomicsmentioning

confidence: 99%

Genetics and Genomics of Congenital Heart Disease

Zaidi

Brueckner

2017

Circulation Research

371

432

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Congenital heart disease is the most common birth defect, and due to major advances in medical and surgical management, there are now more adults living with CHD than children. Until recently, the cause of the majority of CHD was unknown. Advances in genomic technologies have discovered the genetic etiology of a significant fraction of CHD, while at the same time pointing to remarkable complexity in CHD genetics. This review will focus on the evidence for genetic causes underlying CHD and discuss data supporting both monogenic and complex genetic mechanisms underlying CHD. The discoveries from CHD genetic studies draw attention to biological pathways that simultaneously open the door to a better understanding of cardiac development, and impact clinical care of CHD patients. Finally, we address clinical genetic evaluation of patients and families affected by CHD.

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Section: Future Efforts In Chd Genomicsmentioning

confidence: 99%

Genetics and Genomics of Congenital Heart Disease

Zaidi

Brueckner

2017

Circulation Research

371

432

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“… Data not shown for rare fetal cardiac anomaly classifications in our cohort: heterotaxy, complex defects, and atrioventricular septal defects (n = 11). LVOTO , left ventricular outflow tract obstruction; NA , not available; NICU , neonatal intensive care unit; RVOTO , right ventricular outflow tract obstruction. a Data extrapolated from previous studies 7,8 ; b Column denominator is number of patients with NICU admission or 5-min Apgar score documentation available; c N corresponds to number of neonates with respective category of anomaly. …”

Section: Figurementioning

confidence: 99%

“…3,4 The increasing prevalence of diabetes and obesity, both associated with fetal cardiac defects, including a population-attributable risk of 4.2% for pregestational diabetes and 8% for prepregnancy obesity, has also contributed to a rise in fetal cardiac anomalies. 5–7 …”

Section: Introductionmentioning

confidence: 99%

Neonatal outcomes in fetuses with cardiac anomalies and the impact of delivery route

Parikh

Grantz

Iqbal

et al. 2017

American Journal of Obstetrics and Gynecology

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BACKGROUND Congenital fetal cardiac anomalies compromise the most common group of fetal structural anomalies. Several previous reports analyzed all types of fetal cardiac anomalies together without individualized neonatal morbidity outcomes based on cardiac defect. Mode of delivery in cases of fetal cardiac anomalies varies greatly as optimal mode of delivery in these complex cases is unknown. OBJECTIVE We sought to determine rates of neonatal outcomes for fetal cardiac anomalies and examine the role of attempted route of delivery on neonatal morbidity. STUDY DESIGN Gravidas with fetal cardiac anomalies and delivery >34 weeks, excluding stillbirths and aneuploidies (n = 2166 neonates, n = 2701 cardiac anomalies), were analyzed from the Consortium on Safe Labor, a retrospective cohort study of electronic medical records. Cardiac anomalies were determined using International Classification of Diseases, Ninth Revision codes and organized based on morphology. Neonates were assigned to each cardiac anomaly classification based on the most severe cardiac defect present. Neonatal outcomes were determined for each fetal cardiac anomaly. Composite neonatal morbidity (serious respiratory morbidity, sepsis, birth trauma, hypoxic ischemic encephalopathy, and neonatal death) was compared between attempted vaginal delivery and planned cesarean delivery for prenatal and postnatal diagnosis. We used multivariate logistic regression to calculate adjusted odds ratio for composite neonatal morbidity controlling for race, parity, body mass index, insurance, gestational age, maternal disease, single or multiple anomalies, and maternal drug use. RESULTS Most cardiac anomalies were diagnosed postnatally except hypoplastic left heart syndrome, which had a higher prenatal than postnatal detection rate. Neonatal death occurred in 8.4% of 107 neonates with conotruncal defects. Serious respiratory morbidity occurred in 54.2% of 83 neonates with left ventricular outflow tract defects. Overall, 76.3% of pregnancies with fetal cardiac anomalies underwent attempted vaginal delivery. Among patients who underwent attempted vaginal delivery, 66.1% had a successful vaginal delivery. Women with a fetal cardiac anomaly diagnosed prenatally were more likely to have a planned cesarean delivery than women with a postnatal diagnosis (31.7 vs 22.8%; P < .001). Planned cesarean delivery compared to attempted vaginal delivery was not associated with decreased composite neonatal morbidity for all prenatally diagnosed (adjusted odds ratio, 1.67; 95% confidence interval, 0.85–3.30) or postnatally diagnosed (adjusted odds ratio, 0.99; 95% confidence interval, 0.77–1.27) cardiac anomalies. CONCLUSION Most fetal cardiac anomalies were diagnosed postnatally and associated with increased rates of neonatal morbidity. Planned cesarean delivery for prenatally diagnosed cardiac anomalies was not associated with less neonatal morbidity.

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“…Lastly, maternal factors that might explain some of the variation in risk of CHD across US census regions and divisions, such as age, obesity status, and presence of pregestational diabetes, were not available in the NIS and therefore could not be included in our multivariable binomial regression models (Simeone et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…The reasons for geographic variation in phenotypes are largely unknown. Prior work has suggested epigenetic, environmental, and familial risk factors may all play a role (Bernier, Stefanescu, Samoukovic, & Tchervenkov, ; Simeone et al, ; Tang et al, ; van der Linde et al, ).…”

Section: Introductionmentioning

confidence: 99%