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Epidemiology

Poster Session 3

(891) Maternal risk factor clusters and risk of infant congenital heart disease and maternal morbidity

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Clustering of cardiovascular disease (CVD) risk factors is associated with greater CVD incidence. In pregnant women, such risk factors are associated with congenital heart disease in the infant. This study aimed to determine the association of maternal clustered CVD risk with infant critical congenital heart disease (CCHD) and associated severe maternal morbidity (SMM).

Study Design: This retrospective cohort study used Centers for Disease Control birth certificate data for all live births from 2014-2018. Maternal CVD risks factors (yes/no) included pregestational diabetes and hypertension, pre-pregnancy smoking status, and history of preterm delivery. SMM was defined as maternal intensive care unit admission, ruptured uterus, unplanned hysterectomy, or maternal transfusion. Cases were grouped as having 0, 1, 2, or 3 maternal CVD risk factors. Incidence and relative risk (RR) of infant CCHD and SMM were calculated for each cluster group and compared to a group with no risk factors.

Results: The cohort included 11,638 infants with CCHD (0.06%) and 19,329,552 without. CCHD incidence increased with a greater number of maternal CVD risk factors (Figure). When compared to the group with no risk factors, the RR for infant CCHD in groups with 1, 2, or 3 risk factors were RR 1.63 (1.56-1.71), RR 3.37 (3.04-3.75), and RR 9.22 (7.15-11.91) respectively. SMM was more common in mothers with infant CCHD (1.30% vs 0.51%, p< 0.001) and incidence increased with additional maternal risk factors (Figure). In mothers with infant CCHD, the RR for SMM in groups with 1, 2, or 3 risk factors were RR 1.52 (1.05-2.20), RR 2.54 (1.33-4.82), and RR 7.74 (3.27-18.31) respectively when compared to the group with no risk factors.

Conclusion:

CVD risk clustering in mothers of CCHD infants suggests that biological mechanisms underlying CVD may also disturb fetal cardiac development and contribute to poor maternal outcomes. These findings could inform CHD screening and delivery planning. Prevention strategies targeting these risks may benefit both mother and child.