Congenital Heart Defects, Maternal Febrile Illness, and Multivitamin Use: A Population-Based Study

Abstract

We assessed the relation between febrile illness during pregnancy and cardiac defects in the offspring in a population-based case-control study in metropolitan Atlanta. Case infants (905) with cardiac defects were actively ascertained from multiple sources. Control infants (3,029) were infants without birth defects who were selected from birth certificates by stratified random sampling. We compared those whose mothers reported febrile illness from 1 month before pregnancy through the third month of pregnancy with those whose mothers reported no illness during the same period. Febrile illness was positively associated with the occurrence of heart defects in the offspring (odds ratio [OR] = 1.8; 95% confidence interval = 1.4-2.4). When influenzalike illness was the reported febrile illness, the OR was 2.1 (95% confidence interval = 0.8-5.5). The association with febrile illness was strongest for tricuspid atresia (OR = 5.2), left obstructive defects (OR = 2.7), transposition of the great arteries (OR = 1.9), and ventricular septal defects (OR = 1.8). These ORs were generally lower among mothers who used multivitamins during the periconceptional period.

Noninherited Risk Factors and Congenital Cardiovascular Defects: Current Knowledge

“…61 More recent studies suggest that other maternal febrile illnesses during the first trimester of pregnancy also may be associated with an increased risk for certain heart defects. 6,15,62,63 Mothers reporting any febrile illnesses during the first trimester of pregnancy have a 2-fold-higher risk of offspring with any heart defect in these studies. 6,15 Specific groups of defects that have been shown to be associated with maternal febrile illness include pulmonic stenosis, 6 all right-sided obstructive defects, 15 tricuspid atresia, 6,15 coarctation of the aorta, 15 all left-sided obstructive defects, 15 conotruncal defects, and VSDs.…”

“…6,15,62,63 Mothers reporting any febrile illnesses during the first trimester of pregnancy have a 2-fold-higher risk of offspring with any heart defect in these studies. 6,15 Specific groups of defects that have been shown to be associated with maternal febrile illness include pulmonic stenosis, 6 all right-sided obstructive defects, 15 tricuspid atresia, 6,15 coarctation of the aorta, 15 all left-sided obstructive defects, 15 conotruncal defects, and VSDs. 15 A case-control study in California found an association of maternal fever with conotruncal defects among offspring born to mothers who did not use multivitamins.…”

“…For example, 2 studies have shown that women who used medications that are folic acid antagonists had an increased risk of having babies with heart defects but that this risk was reduced for women who also took multivitamin supplements containing folic acid. 13,14 In a third study, 15 an increased risk for heart defects associated with maternal febrile illness (see below) appeared to be reduced among women using multivitamin supplements around the time of conception and during early pregnancy. Similar findings have been reported for other birth defects.…”

Is the Prevalence of Specific Types of Congenital Heart Defects Different for Non-Hispanic White, Non-Hispanic Black and Hispanic Infants?

“…Few studies provide race-specific prevalence estimates for types of CHD and results are inconclusive [3,[6][7][8][9][10][11]. Some studies report excess risk of specific types of CHDs for Whites compared to Blacks and very few studies have reported risk of specific types of CHD for Hispanics.…”

Congenital Heart Diseases in Children: Incidence, Risk Factors, Mortality

“…Среди ВПС у детей, рожденных от матерей, перенес-ших острый инфекционный процесс во время беременно-сти, в большей степени распространены пороки клапана легочной артерии, синдромы с обструкцией правых или левых камер сердца, пороки развития трикуспидально-го клапана, коарктация аорты, ДМЖП [36]. Инфекции мочевыводящих путей у беременной женщины чаще были связаны с ВПС, приводящими к обструкции правых камер сердца; и, наоборот, респираторные инфекции в большинстве случаев протекали без формирования ВПС [37].…”