An underlying mechanism for congenital heart defects includes abnormal vascular development, a phenomenon also linked with preeclampsia. This study by Boyd et al. (Circulation, 2017) sought to determine if having a fetus or newborn with a heart defect was similarly associated with a higher risk of hypertensive disorders during pregnancy.
Retrospective Cohort Study
Data from 1,972,857 singleton pregnancies without chromosomal abnormalities ≥20 weeks gestation born in Denmark between 1978-2011, complicated by offspring with congenital heart defects and preeclampsia were analyzed. Congenital heart defects in offspring was most strongly associated with early preterm preeclampsia (odds ratio 7.00, 95% CI 6.11-8.03). Congenital heart defects were also associated with late term preterm preeclampsia (odds ratio 2.82, 95% CI 2.38-3.34) and less so with term preeclampsia (odds ratio 1.16, 95% CI 1.06-1.27)
However, congenital heart defects were not associated with gestational hypertension (odds ratio 1.07, 95% CI 0.92-1.25). These results held regardless of type of congenital heart disease. The investigators also looked at congenital heart defects in offspring in a previous pregnancy as a predictor of preeclampsia in subsequent pregnancies and found similar associations: there was a risk for early preterm preeclampsia (odds ratio 2.37, 95% CI 1.68-3.34) and late preterm preeclampsia (odds ratio 2.04, 95% CI 1.52-2.75), minimal association with term preeclampsia, and no association with gestational hypertension. When assessing preeclampsia in a previous pregnancy as a risk for congenital heart disease in subsequent pregnancies, preterm preeclampsia but not term preeclampsia or gestational hypertension was strongly associated with congenital heart defects in the offspring of later pregnancies (odds ratio 7.91, 95% CI 6.06-10.3). Late preterm preeclampsia was also associated with subsequent offspring with congenital heart disease (odds ratio 2.83, 95% CI 2.11-3.79) but term preeclampsia and gestational hypertension were not. Because these associations appear to be present across multiple pregnancies, the authors suggest that the underlying pathophysiology is maternal and not fetal in origin.
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
