DOI: 10.1002/uog.27659 ISSN: 0960-7692

Maternal prepregnancy weight as an independent risk factor for congenital heart defects: systematic review and meta‐analysis stratified by cardiac defect subtypes and severity

N. Salmeri, A. Seidenari, P. I. Cavoretto, M. Papale, M. Candiani, A. Farina
  • Obstetrics and Gynecology
  • Radiology, Nuclear Medicine and imaging
  • Reproductive Medicine
  • General Medicine
  • Radiological and Ultrasound Technology

ABSTRACT

Objectives

To assess and quantify the association between pre‐pregnancy maternal overweight and obesity, and the risk of congenital heart defects (CHDs) in offspring.

Methods

This systematic review and meta‐analysis included searches of PubMed, Medline, Web of science, and Scopus up to April 20th, 2023. Risk estimates were abstracted or calculated for rising body mass index categories (overweight, obesity, moderate and severe obesity) compared to normal weight (reference). Fixed‐effects or random‐effects models were used to combine individual study risk estimates based on the degree of heterogeneity. Sensitivity analyses were conducted to weight pooled estimates for relevant moderators, particularly diabetes prior and during pregnancy. Subgroup analyses for specific congenital heart defects were conducted if there were at least two studies with accessible data. The findings were presented in two ways: as groups of defects, categorized using severity and topographic‐functional criteria, and as individual defects. The certainty of the evidence for each effect estimate was evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines.

Results

Twenty studies for a total of 4,861,693 patients and 86,136 CHDs cases were included. The risk for CHDs progressively increases from moderate to severe obesity (pooled odds ratio (OR), respectively: 1.15, 95% confidence interval (CI), 1.11‐1.20, and 1.39, 95% CI, 1.27‐1.53). Sensitivity analysis indicated that this effect persists independently of maternal diabetes status before or during pregnancy. In subgroup analysis, obesity was associated with up to a 1.5‐fold increase in the risk of severe CHDs (pooled OR, 1.48; 95% CI, 1.03‐2.13). Specifically, severe obesity was found to be associated with an even higher risk, increasing up to 1.8 times for specific CHDs including tetralogy of Fallot (pooled OR, 1.72; 95% CI, 1.38‐2.16), pulmonary valve stenosis (pooled OR, 1.79; 95% CI, 1.39‐2.30), and atrial septal defects (pooled OR, 1.71; 95% CI, 1.48‐1.97).

Conclusions

Maternal weight emerged as a crucial modifiable risk factor for preventing CHDs, particularly the severe forms. Future research is needed to investigate whether weight management prior to pregnancy might serve as a preventive measure against CHDs. Additionally, for pregnant women with obesity, fetal echocardiography ought to be a routine diagnostic procedure.

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