Maternal Prepregnancy Weight and Congenital Heart Defects in the Offspring.
ABSTRACT To determine the relation between having an infant with a major heart defect and a mother's prepregnancy weight, we compared 1,049 Atlanta-area women who gave birth to liveborn or stillborn infants, each with a major heart defect, with 3,029 Atlanta-area women who gave birth to infants without birth defects. The infants of control women were randomly selected from birth certificates and were frequency-matched to the case group by race, birth hospital, and birth period from 1968 through 1980. After excluding diabetic mothers and adjusting for potential confounders, compared with average-weight women (body mass index 19.9-22.7), we found that underweight women (body mass index <16.5) were less likely to have a child with a major isolated heart defect [odds ratio (OR) = 0.64; 95% confidence interval (CI) = 0.43-0.97], whereas the OR was elevated among overweight or obese women (body mass index >26) (OR = 1.36; 95% CI = 0.95-1.93). Using average-weight women who did not take periconceptional multivitamins as the reference group, periconceptional multivitamin use was associated with a reduced OR for isolated heart defects among average-weight women (OR = 0.61, 95% CI = 0.36-0.99) and underweight women but not among overweight or obese women (OR = 1.69, 95% CI = 0.69-3.84).
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ABSTRACT: This study quantifies the association between maternal medical conditions/illnesses and congenital heart defects (CHD) among infants. We carried out a population-based study of all mother-infant pairs (N=2,278,838) in Canada (excluding Quebec) from 2002-2010 using data from the Canadian Institute for Health Information. CHDs among infants were classified phenotypically through a hierarchical grouping of ICD-10 codes. Maternal conditions such as multi-fetal pregnancy, diabetes, hypertension, and congenital heart disease were defined using diagnosis codes. The association between maternal conditions and CHD and its subtypes was modeled using logistic regression, adjusting for maternal age, parity, residence and other factors. There were 26,488 infants diagnosed with CHD at birth or at rehospitalisation in infancy; the overall CHD prevalence was 116.2 per 10,000 live births, of which the severe CHD rate was 22.3 per 10,000. Risk factors for CHD included maternal age ≥40 years (adjusted odds ratio [aOR] 1.48, 95% confidence interval [CI] 1.39-1.58), multi-fetal pregnancy (aOR 4.53, 95% CI 4.28-4.80), diabetes (type 1 aOR 4.65, 95% CI 4.13-5.24; type 2 aOR 4.12, 95% CI 3.69-4.60), hypertension (aOR 1.81, 95% CI 1.61-2.03), thyroid disorders (aOR 1.45, 95% CI 1.26-1.67), congenital heart disease (aOR 9.92, 95% CI 8.36-11.8), systemic connective tissue disorders (aOR 3.01, 95% CI 2.23-4.06) and epilepsy and mood disorders (aOR 1.41, 95% CI 1.16-1.72). Specific CHD subtypes were associated with different maternal risk factors. Several chronic maternal medical conditions including diabetes, hypertension, connective tissue disorders and congenital heart disease confer an increased risk of CHD in the offspring.Circulation 06/2013; 128(6). DOI:10.1161/CIRCULATIONAHA.112.001054 · 14.95 Impact Factor
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ABSTRACT: High postpartum weight retention is a strong independent risk factor for lifetime obesity, cardiovascular disease, and type 2 diabetes in women. Interventions to promote postpartum weight loss have met with some success but have been limited by high attrition. Internet-based treatment has the potential to overcome this barrier and reduce postpartum weight retention, but no study has evaluated the effects of an internet-based program to prevent high postpartum weight retention in women. Fit Moms/Mamás Activas targets recruitment of 12 Women, Infants and Children (WIC) Supplemental Nutrition Program clinics with a total of 408 adult (>18 years), postpartum (<1 year) women with 14.5 kg or more weight retention or a body mass index of 25.0 kg/m(2) or higher. Clinics are matched on size and randomly assigned within county to either a 12-month standard WIC intervention or to a 12-month WIC enhanced plus internet-based weight loss intervention. The intervention includes: monthly face-to-face group sessions; access to a website with weekly lessons, a web diary, instructional videos, and computer-tailored feedback; four weekly text messages; and brief reinforcement from WIC counselors. Participants are assessed at baseline, six months, and 12 months. The primary outcome is weight loss over six and 12 months; secondary outcomes include diet and physical activity behaviors, and psychosocial measures. Fit Moms/Mamás Activas is the first study to empirically examine the effects of an internet-based treatment program, coupled with monthly group contact at the WIC program, designed to prevent sustained postpartum weight retention in low-income women at high risk for weight gain, obesity, and related comorbidities. This trial was registered with Clinicaltrials.gov (identifier: NCT01408147 ) on 29 July 2011.Trials 12/2015; 16(1):573. DOI:10.1186/s13063-015-0573-9 · 2.12 Impact Factor
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ABSTRACT: The aim of this study was to investigate the relationship between maternal body mass index (BMI) and all congenital heart defects (CHDs) combined and 11 individual defects. Pubmed, ELSEVIER ScienceDirect and Springer Link (up to Feb. 2013) were searched, and the reference list of retrieved articles was reviewed. Three authors independently extracted the data. The systematic review included 24 studies, 14 of which were included in a meta-analysis. RevMan 5.2 and Stata 11.0 were used to perform all statistical analyses. Fixed-effects or random-effects model was used to pool the results of individual study (expressed as odds ratios [ORs] accompanying 95 % confidence intervals [CIs]). A dose-response effect was observed between overweight, moderate obesity and severe obesity and a pregnancy with any CHD (the pooled OR was 1.08 [1.02-1.15], 1.15 [1.11-1.20] and 1.39 [1.31-1.47], respectively) as well as some individual defects such as hypoplastic left heart syndrome (HLHS), pulmonary valve stenosis (PVS) and outflow tract defects (OTD). When we excluded mothers with diabetes, the pooled OR for all CHDs combined was 1.12 [1.04-1.20] and 1.38 [1.20-1.59] for moderately obese and severely obese, respectively. The highest increased risk was severely obese mothers for Tetralogy of Fallot (TOF) (OR 1.94 [1.49-2.51]). Being underweight did not increase the risk of any of the aforementioned CHDs but aortic valve stenosis (AVS) (OR 1.47 [1.01-2.15]). The results of our study showed that increasing maternal BMI was associated with an increasing risk of CHDs; severe obesity was an even greater risk factor for developing CHDs.American journal of obstetrics and gynecology 08/2014; 211(2). DOI:10.1016/j.ajog.2014.03.028 · 3.97 Impact Factor