Maternal Hypertension with Nifedipine Treatment Associated with a Higher Risk for Right-sided Obstructive Defects of the Heart: a Population-based Case-control Study

Overview

Journal Heart Asia

Date 2016 Jun 22

PMID 27326152

Citations 1

Authors

Melinda Csaky-Szunyogh

Attila Vereczkey

Balazs Gerencser

Andrew E Czeizel

Affiliations

Soon will be listed here.

Abstract

Objective: To establish possible aetiological factors contributing to congenital heart defects (CHD) overall and separately for different types of CHD, as causes are unknown for the vast majority of patients.

Design: To estimate a possible association with maternal diseases and related drug treatments as exposures in the mothers of cases with right-sided obstructive defects of the heart (RSODH).

Setting: A large population-based Hungarian Case-Control Surveillance of Congenital Abnormalities data set.

Patients: Newborn infants with four types of RSODH based on autopsy or surgical records.

Interventions: Comparison of 200 live-born cases with RSODH including 72 (36.0%) with pulmonary valve stenosis, 13 (6.5%) with tricuspid atresia/stenosis, 7 (3.5%) with Ebstein's anomaly and 108 (54.0%) with pulmonary atresia, with 304 matched controls and 38 151 population controls without any defects.

Main Outcome Measures: Risk of any RSODH and risk of each type of RSODH.

Results: High blood pressure, particularly chronic hypertension with nifedipine treatment, was associated with a risk for RSODH (OR 7.03, 95% CI 3.13 to 13.84). High doses of folic acid reduced the birth prevalence of pulmonary atresia (OR 0.29, 95% CI 0.16 to 0.53).

Conclusions: The multifactorial threshold model provides the best explanation for the origins of RSODH. Genetic predisposition may be triggered by maternal hypertension with nifedipine treatment, while the risk for pulmonary atresia is reduced by high doses of folic acid in early pregnancy.

Citing Articles

Association Between Maternal Factors in Early Pregnancy and Congenital Heart Defects in Offspring: The Japan Environment and Children's Study.

Kawai S, Pak K, Iwamoto S, Kawakami C, Inuzuka R, Maeda J J Am Heart Assoc. 2023; 12(17):e029268.

PMID: 37642029 PMC: 10547327. DOI: 10.1161/JAHA.122.029268.

References

Czeizel A . Specified critical period of different congenital abnormalities: a new approach for human teratological studies. Congenit Anom (Kyoto). 2008; 48(3):103-9. DOI: 10.1111/j.1741-4520.2008.00189.x. View

Scott Jr W, Resnick E, Hummler H, Clozel J, Burgin H . Cardiovascular alterations in rat fetuses exposed to calcium channel blockers. Reprod Toxicol. 1997; 11(2-3):207-14. DOI: 10.1016/s0890-6238(97)00008-7. View

NORA J . From generational studies to a multilevel genetic-environmental interaction. J Am Coll Cardiol. 1994; 23(6):1468-71. DOI: 10.1016/0735-1097(94)90393-x. View

Banhidy F, Acs N, Puho E, Czeizel A . The efficacy of antihypertensive treatment in pregnant women with chronic and gestational hypertension: a population-based study. Hypertens Res. 2010; 33(5):460-6. DOI: 10.1038/hr.2010.17. View

Goh Y, Bollano E, Einarson T, Koren G . Prenatal multivitamin supplementation and rates of congenital anomalies: a meta-analysis. J Obstet Gynaecol Can. 2006; 28(8):680-689. DOI: 10.1016/S1701-2163(16)32227-7. View

Czeizel A, Rockenbauer M, Siffel C, Varga E . Description and mission evaluation of the Hungarian case-control surveillance of congenital abnormalities, 1980-1996. Teratology. 2001; 63(5):176-85. DOI: 10.1002/tera.1032. View

Botto L, Lin A, Riehle-Colarusso T, Malik S, Correa A . Seeking causes: Classifying and evaluating congenital heart defects in etiologic studies. Birth Defects Res A Clin Mol Teratol. 2007; 79(10):714-27. DOI: 10.1002/bdra.20403. View

Czeizel A . Reduction of urinary tract and cardiovascular defects by periconceptional multivitamin supplementation. Am J Med Genet. 1996; 62(2):179-83. DOI: 10.1002/(SICI)1096-8628(19960315)62:2<179::AID-AJMG12>3.0.CO;2-L. View

Ionescu-Ittu R, Marelli A, Mackie A, Pilote L . Prevalence of severe congenital heart disease after folic acid fortification of grain products: time trend analysis in Quebec, Canada. BMJ. 2009; 338:b1673. PMC: 2682153. DOI: 10.1136/bmj.b1673. View

10.

Botto L, Khoury M, Mulinare J, Erickson J . Periconceptional multivitamin use and the occurrence of conotruncal heart defects: results from a population-based, case-control study. Pediatrics. 1996; 98(5):911-7. View

11.

Czeizel A, Banhidy F . Chronic hypertension in pregnancy. Curr Opin Obstet Gynecol. 2010; 23(2):76-81. DOI: 10.1097/GCO.0b013e328342b7a9. View

12.

Czeizel A . First 25 years of the Hungarian congenital abnormality registry. Teratology. 1997; 55(5):299-305. DOI: 10.1002/(SICI)1096-9926(199705)55:5<299::AID-TERA1>3.0.CO;2-V. View

13.

Magee L, Schick B, Donnenfeld A, Sage S, Conover B, Cook L . The safety of calcium channel blockers in human pregnancy: a prospective, multicenter cohort study. Am J Obstet Gynecol. 1996; 174(3):823-8. DOI: 10.1016/s0002-9378(96)70307-1. View

14.

van Beynum I, Kapusta L, Bakker M, den Heijer M, Blom H, de Walle H . Protective effect of periconceptional folic acid supplements on the risk of congenital heart defects: a registry-based case-control study in the northern Netherlands. Eur Heart J. 2009; 31(4):464-71. DOI: 10.1093/eurheartj/ehp479. View

15.

Cleves M, Ghaffar S, Zhao W, Mosley B, Hobbs C . First-year survival of infants born with congenital heart defects in Arkansas (1993-1998): a survival analysis using registry data. Birth Defects Res A Clin Mol Teratol. 2004; 67(9):662-8. DOI: 10.1002/bdra.10119. View

16.

Reller M, Strickland M, Riehle-Colarusso T, Mahle W, Correa A . Prevalence of congenital heart defects in metropolitan Atlanta, 1998-2005. J Pediatr. 2008; 153(6):807-13. PMC: 2613036. DOI: 10.1016/j.jpeds.2008.05.059. View

17.

Botto L, Olney R, Erickson J . Vitamin supplements and the risk for congenital anomalies other than neural tube defects. Am J Med Genet C Semin Med Genet. 2004; 125C(1):12-21. DOI: 10.1002/ajmg.c.30004. View

18.

Meszaros M, Nagy A, Czeizel A . Incidence of congenital heart disease in Hungary. Hum Hered. 1975; 25(6):513-9. DOI: 10.1159/000152769. View

19.

Czeizel A, Toth M, Rockenbauer M . Population-based case control study of folic acid supplementation during pregnancy. Teratology. 1996; 53(6):345-51. DOI: 10.1002/(SICI)1096-9926(199606)53:6<345::AID-TERA5>3.0.CO;2-Z. View

20.

Czeizel A, Dudas I . Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation. N Engl J Med. 1992; 327(26):1832-5. DOI: 10.1056/NEJM199212243272602. View