Perspective:

The authors suggest that having a child with a congenital heart defect may be a novel risk factor for the future development of maternal cardiovascular disease. The mechanism by which this association occurs is unclear. Women with congenital heart disease themselves are known to have an increased risk of having a child with congenital heart defects. For this reason, pregnant women with congenital heart disease are recommended to have a fetal echocardiogram during the second trimester. Whether some of the increased risk of future cardiovascular hospitalizations is related to pre-existing maternal cardiac disease is unknown. Other possible explanations of future cardiovascular risk relate to psychosocial stressors. High levels of stress and anxiety are involved in raising a child with complex congenital heart disease, which may accelerate the development of atherosclerotic disease. The authors were able to control for depression, but the cumulative effect of stress over the long-term is difficult to quantify. Information about body mass index and smoking status was not available, but would be important to explore in future studies. More research is needed to determine whether targeted primary prevention aimed at this population could be effective and beneficial.