Infant Heart Defects and Maternal Cardiovascular Risk
Are women who have had babies with congenital heart defects at increased cardiovascular risk later in life?
Hospital discharge and procedure codes were used to identify neonates with congenital heart defects and linked to the maternal records, resulting in a cohort of 1,084,251 women who delivered between 1989 and 2013 in Quebec, Canada. Future maternal cardiovascular hospitalizations were analyzed up to 25 years post-pregnancy, and adjusted for age, parity, pre-eclampsia, comorbidity, material deprivation, and time period.
Women who had delivered infants with heart defects had more cardiovascular hospitalizations later in life. There were 3.38 cardiovascular hospitalizations per 1,000 person-years for mothers with infants with critical defects (95% confidence interval [CI], 2.67-4.27), 3.19 for noncritical defects (95% CI, 2.96-3.45), and 2.42 for no heart defects (95% CI, 2.39-2.44). Specific causes of cardiovascular hospitalizations such as myocardial infarction, heart failure, and other atherosclerotic disorders were also higher in women who had delivered infants with congenital heart disease.
Women who delivered infants with congenital heart defects have higher risk of future cardiovascular-related hospitalizations. These women may have a predisposition to later cardiovascular disease.
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.
Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Cardiac Surgery and Arrhythmias, Cardiac Surgery and CHD and Pediatrics, Cardiac Surgery and Heart Failure, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Interventions, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Acute Heart Failure, Interventions and Structural Heart Disease, Stress
Keywords: Atherosclerosis, Anxiety, Cardiac Surgical Procedures, Heart Defects, Congenital, Heart Failure, Infant, Infant, Newborn, Mothers, Myocardial Infarction, Pre-Eclampsia, Pregnancy, Pregnancy Outcome, Primary Prevention, Risk Factors, Stress, Psychological, Women
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