Association Between Preeclampsia and Congenital Heart Defects

Sarah Vo, Mercer University College of Pharmacy

Congenital heart defects (CHD) are suggested to be the most common anomalies in infants.  It is said that it affects every eight births per 1,000. [1]

According to Mayo Clinic, CHD is when the structure of a child’s heart has problems.  These problems are said to include a small hole between heart chambers that closes on its own, obstructed blood flow, or abnormal blood vessels.  Environmental and genetic risk factors are considered to play a role in CHD, including diabetes, medications, or drinking alcohol during pregnancy.  [2]

Preeclampsia is a pregnancy complication associated with high blood pressure per Mayo Clinic.  Preeclampsia is suggested to occur after 20 weeks of pregnancy in a woman whose blood pressure had been normal and can cause serious complications for the mother and baby. [3]

Title: Association Between Preeclampsia and Congenital Heart Defects [4]
Design Prospective, cohort, population-based; N = 1,941,072
Objective To determine the prevalence of congenital heart defects in offspring of women with preeclampsia
Study Groups Women who delivered infants with or without heart defects at 20 weeks of gestation or more
Methods Extracted discharge abstracts for women paired with infants delivered at 20 weeks of gestation or more between 1989 and 2012

Absolute prevalence of congenital heart defects per 1,000 infants for women with and without preeclampsia

Duration 1989 – 2012
Primary Outcome Measure Presence of any critical or noncritical congenital heart defect detected in infants at birth
Baseline Characteristics Total Number (No.) of Infants No. of Infants with Congenital Heart Defects Prevalence per 1,000 Infants (95% Confidence Interval (CI))
Preeclampsia
Yes 72,782 1,219 16.7 (15.8 – 17.7)
No 1,869,290 16,077 8.6 (8.5 – 8.7)
Age (years)
< 25 420,416 3,746 8.9 (8.6 – 9.2)
25 – 34 1,271,564 10,972 8.6 (8.5 – 8.8)
>/= 35 250,092 2,578 10.3 (10.1 – 10.5)
Comorbidity (preexisting hypertension or diabetes, obesity, thyroid disorders, etc.)
Yes 169,913 3,037 17.9 (17.2 – 18.5)
No 1,772,159 14,259 8.0 (7.9 – 8.2)
Period
1989 – 1996 706,069 5,242 7.4 (7.2 – 7.6)
1997 – 2004 573,650 5,890 10.3 (10.0 – 10.5)
2005 – 2012 662,353 6,164 9.3 (9.1 – 9.5)
Results Preeclampsia

(n = 72,782)

No preeclampsia

(n = 1,869,290)

Prevalence Ratio

(95% CI)

Prevalence Difference (95% CI)
Congenital heart defects
No. 1,219 16,077
Prevalence 16.7 / 1,000 8.6 / 1,000 1.57 (1.48 to 1.67) 577.1 (483.0 to 671.1)
Critical heart defects
No. 90 1,414
Prevalence 123.7 / 100,000 75.6 / 100,000 1.25 (1.00 to 1.57) 23.6 / 100,000 (-1.0 to 48.2)
Noncritical heart defects
No. 1,120 14,752
Prevalence 1,538.8 / 100,000 789.2 / 100,000 1.56 (1.47 to 1.67) 521.1 / 100,000 (431.1 to 611.0)
Adverse Events Common Adverse Events: not applicable
Serious Adverse Events: not applicable
Percentage that Discontinued due to Adverse Events: not applicable
Study Author Conclusions In this population-based study, preeclampsia was significantly associated with noncritical heart defects in offspring, and preeclampsia with onset before 34 weeks was associated with critical heart defects. However, the absolute risk of congenital heart defects was low.

The absolute prevalence of congenital heart defects was suggested to be higher for infants of women with preeclampsia than those without it.  Infants of women with preeclampsia were considered to have no increased prevalence of critical heart defects but did have an increased prevalence of noncritical heart defects compared with infants of non-preeclamptic women.  The study does not have information on heart defects diagnosed later in childhood or adulthood.  Therefore, long-term follow-up studies assessing maternal history of preeclampsia and lifelong risk of heart defects are merited.

References

  1. Van der linde D, Konings EE, Slager MA, et al. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol. 2011;58(21):2241-7.
  2. Mayo Clinic Staff. Congenital heart defects in children.  The Mayo Clinic.  http://www.mayoclinic.org/diseases-conditions/congenital-heart-defects/basics/risk-factors/con-20034017.  Accessed October 28, 2015.
  3. Mayo Clinic Staff.   The Mayo Clinic.  http://www.mayoclinic.org/diseases-conditions/preeclampsia/basics/definition/con-20031644.  Accessed October 28, 2015.
  4. Auger N, Fraser WD, Healy-profitós J, Arbour L. Association Between Preeclampsia and Congenital Heart Defects. JAMA. 2015;314(15):1588-98.
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