Author + information
- Received September 17, 2018
- Accepted October 2, 2018
- Published online January 7, 2019.
- Martina Persson, MD, PhDa,b,c,∗ (, )
- Neda Razaz, MPH, PhDa,
- Anna-Karin Edstedt Bonamy, MD, PhDa,
- Eduardo Villamor, MD, DrPHd and
- Sven Cnattingius, MD, PhDa
- aDepartment of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
- bDepartment of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- cDepartment of Diabetes and Endocrinology, Sachsska Children's Hospital, Södersjukhuset, Stockholm, Sweden
- dDepartment of Epidemiology, School of Public Health and Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan
- ↵∗Address for correspondence:
Dr. Martina Persson, Clinical Epidemiology Unit (T2), Department of Medicine Solna, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
Background Congenital heart defects are more frequent in offspring of mothers with overweight or obesity. However, associations between maternal overweight and obesity, and risks of complex and specific heart defects are not clear.
Objectives This study sought to analyze associations between maternal overweight and obesity severity and rates of complex and specific heart defects.
Methods This was a population-based cohort study in Sweden, including 2,050,491 live singleton infants born between 1992 and 2012. Data on maternal and infant characteristics, and diagnoses of congenital heart defects were retrieved from nationwide registries. Maternal body mass index (BMI) was categorized as underweight (BMI <18.5 kg/m2), normal weight (BMI 18.5 to <25 kg/m2), overweight (BMI 25 to <30 kg/m2), obesity class I (BMI 30 to <35 kg/m2), class II (BMI 35 to <40 kg/m2), and class III (BMI ≥40 kg/m2). Outcomes included complex heart defects (tetralogy of Fallot, transposition of the great arteries, atrial septal defects [ASD], aortic arch defects, and single-ventricle heart) and subgroups of specific heart defects diagnosed up to 5 years of age. The authors calculated adjusted prevalence rate ratios (PRRs) with 95% confidence intervals.
Results A total of 28,628 (1.40%, N = 2,050,491) children had at least 1 congenital heart defect. PRRs of aortic arch defects increased with maternal obesity severity. Compared with offspring of normal weight mothers, PRRs of aortic arch defects and transposition of the great arteries were doubled in offspring of mothers with severe obesity. PRRs of ASD and persistent ductus arteriosus in term infants increased with maternal BMI.
Conclusions PRRs of aortic branch defects, ASD, and persistent ductus arteriosus increase with maternal obesity severity.
This study was funded by the Swedish Research Council for Health, Working Life and Welfare (grants No 2014-0073 and 2017-00134), the Stockholm County Council (ALF project 20150118 and a clinical postdoctoral position to Dr. Persson), and by an unrestricted grant from Karolinska Institutet (No. 2368/10-221, Distinguished Professor Award to Dr. Cnattingius). Dr. Razaz is supported by a postdoctoral fellowship award from the Canadian Institutes of Health Research (CIHR). The study was approved by the Regional Ethic Review Board at Karolinska Institutet, Stockholm, Sweden (No. 2012/1813-31/4). No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received September 17, 2018.
- Accepted October 2, 2018.
- 2019 American College of Cardiology Foundation
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