Incidence and risk factors of congenital heart disease in Qingdao: a prospective cohort study

Xiao Jin, Wei Ni, Guolan Wang, Qin Wu, Jun Zhang, Guoju Li, Na Jiao, Wenjing Chen, Qing Liu, Li Gao, Quansheng Xing, Xiao Jin, Wei Ni, Guolan Wang, Qin Wu, Jun Zhang, Guoju Li, Na Jiao, Wenjing Chen, Qing Liu, Li Gao, Quansheng Xing

Abstract

Background: Many studies have been conducted to assess the incidence of congenital heart disease (CHD). However, results were greatly inconsistent among these studies with a broad range of findings.

Methods: A prospective census-based cohort study was conducted in Qingdao, China, from August 1, 2018 to April 30, 2019. All of the local registered pregnant women were continuously investigated and followed from 15 to 20 weeks of gestation to delivery, tracking the CHD cases in both the fetal and neonatal stages. A logistic regression model was applied to assess the association between CHD and possible risk factors.

Results: The positive rate of prenatal CHD screening was 14.36 per 1000 fetuses and the incidence of CHD was 9.38 per 1000 live births. Results from logistic regression indicated that, living in the countryside (odds ratio, (OR): 0.771; 95% confidence interval, (CI): 0.628-0.946) and having a childbearing history (OR: 0.802; 95%CI: 0.676-0.951) were negatively associated with CHD. However, twin pregnancy (OR: 1.957, 95% CI: 1.245-3.076), illness in the first trimester (OR: 1.306; 95% CI: 1.048-1.628), a family history of CHD (OR: 7.156; 95% CI: 3.293-15.552), and having a child with a birth defect (OR: 2.086; 95% CI: 1.167-3.731) were positively associated with CHD.

Conclusion: CHD is a serious health problem in Qingdao. The CHD incidence found in this study was similar to existing research. The positive rate of prenatal CHD screening was higher than the incidence of neonatal CHD. Moreover, CHD risk factors were identified in our study, and our findings may have great implications for formation CHD intervention strategies.

Keywords: Congenital heart defects; Epidemiologic studies; Incidence; Regression analysis; Risk factors.

Conflict of interest statement

The author declares to have no competing interests.

Figures

Fig. 1
Fig. 1
The distribution of screened CHD cases from the fetal to the neonatal stage
Fig. 2
Fig. 2
The incidence and proportion of CHD
Fig. 3
Fig. 3
Results of univariate logistic regression analysis
Fig. 4
Fig. 4
Results of multivariable logistic regression model

References

    1. Qiang S. Cardiothoracic surgery. In: Ning S, Shan Z, editors. Pediatric surgery (in Chinese) China: People's medical publishing house; 2015. pp. 541–604.
    1. Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol. 2002;39(12):1890–1900. doi: 10.1016/S0735-1097(02)01886-7.
    1. van der Linde D, Konings EE, Slager MA, Witsenburg M, Helbing WA, Takkenberg JJ, et al. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol. 2011;58(21):2241–2247. doi: 10.1016/j.jacc.2011.08.025.
    1. Liu Y, Chen S, Zühlke L, Black GC, Choy M-k, Li N, et al. Global birth prevalence of congenital heart defects 1970–2017: updated systematic review and meta-analysis of 260 studies. Int J Epidemiol. 2019. 10.1093/ije/dyz009.
    1. Zhao Q-M, Liu F, Wu L, Ma X-J, Niu C, Huang G-Y. Prevalence of congenital heart disease at live birth in China. J Pediatr. 2019;204:53–58. doi: 10.1016/j.jpeds.2018.08.040.
    1. Hanaoka T, Tamura N, Ito K, Sasaki S, Araki A, Ikeno T, Miyashita C, Ito S, Minakami H, Cho K, Endo T, Baba T, Miyamoto T, Sengoku K, Kishi R, other members of the Hokkaido Study on Environment and Children’s Health Prevalence and risk of birth defects observed in a prospective cohort study: the Hokkaido study on environment and children’s health. J Epidemiol. 2018;28(3):125–132. doi: 10.2188/jea.JE20160108.
    1. Gelb BD, Chung WK. Complex genetics and the etiology of human congenital heart disease. Csh Perspect Med. 2014. 10.1101/cshperspect.a0139539.
    1. Liu S, Liu J, Tang J, Ji J, Chen J, Liu C. Environmental risk factors for congenital heart disease in the Shandong peninsula, China: a hospital-based case–control study. J Epidemiol. 2009;19(3):122–130. doi: 10.2188/jea.JE20080039.
    1. Tania M, Amitoz M, Paul V, Cheryl H-G, Heather LB. Prevalence of congenital cardiovascular malformations varies by race and ethnicity. Int J Cardiol. 2010;143(3):317–322. doi: 10.1016/j.ijcard.2009.03.054.
    1. Mir A, Jan M, Ali I, Ahmed K, Radhakrishnan S. Congenital heart disease in neonates: their clinical profile, diagnosis, and their immediate outcome. 2019.
    1. Prakash A, Torres AJ, Printz BF, Prince MR, Nielsen JC. Usefulness of magnetic resonance angiography in the evaluation of complex congenital heart disease in newborns and infants. Dig World Core Med J. 2007;100(4):715–721. doi: 10.1016/j.amjcard.2007.03.090.
    1. Donofrio MT, Moon-Grady AJ, Hornberger LK, Copel JA, Sklansky MS, Abuhamad A, et al. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation. 2014. 10.1161/01.cir.0000437597.44550.5d.
    1. Wong KK, Fournier A, Fruitman DS, Graves L, Human DG, Narvey M, Russell JL. Canadian Cardiovascular Society/Canadian Pediatric Cardiology Association position statement on pulse oximetry screening in newborns to enhance detection of critical congenital heart disease. Can J Cardiol. 2017;33(2):199–208. doi: 10.1016/j.cjca.2016.10.006.
    1. Hiatt PW, Mahony L, Tepper RS. Oxygen desaturation during sleep in infants and young children with congenital heart disease. J Pediatr. 1992;121(2):226–232. doi: 10.1016/s0022-3476(05)81193-x.
    1. Reddy VK, Holzman IR, Wedgwood JF. Pulse oximetry saturations in the first 6 hours of life in normal term infants. Clin Pediatr. 1999;38(2):87–92. doi: 10.1177/000992289903800204.
    1. Usen S, Weber M, Mulholland K, Jaffar S, Oparaugo A, Omosigho C, Adegbola R, Greenwood B. Clinical predictors of hypoxaemia in Gambian children with acute lower respiratory tract infection: prospective cohort study. BMJ. 1999;318(7176):86–91. doi: 10.1136/bmj.318.7176.86.
    1. Liu WT, Ning SB, Hua BJ, Chen YT, Zhou SY, Guo AL, et al. The incidence and characteristics of children’s congenital heart disease in Yangpu and Xuhui districts of Shanghai (in Chinese) Chin J Pediatr. 1995;26(6):832–835. doi: 10.1007/s00246-005-0981-9.
    1. Qu Y, Liu X, Zhuang J, Chen G, Mai J, Guo X, Ou Y, Chen J, Gong W, Gao X, Wu Y, Nie Z. Incidence of congenital heart disease: the 9-year experience of the Guangdong registry of congenital heart disease, China. PLoS One. 2016;11(7):e0159257. doi: 10.1371/journal.pone.0159257.
    1. Yang M, Zhang S, Du Y. Epidemiology characteristics of birth defects in Shenzhen city during 2003 to 2009, China. J Matern Fetal Neonatal Med. 2015;28(7):799–803. doi: 10.3109/14767058.2014.932767.
    1. Wu MH, Chen HC, Lu CW, Wang JK, Huang SC, Huang SK, et al. Prevalence of congenital heart disease at live birth in Taiwan. J Pediatr. 2010. 10.1016/j.jpeds.2009.11.062.
    1. Sun PF, Ding GC, Zhang MY, He SN, Gao Y, Wang JH, et al. Prevalence of congenital heart disease among infants from 2012 to 2014 in Langfang, China. Chin Med J. 2017. 10.4103/0366-6999.204923.
    1. Pei L, Kang Y, Zhao Y, Yan H. Prevalence and risk factors of congenital heart defects among live births: a population-based cross-sectional survey in Shaanxi province, Northwestern China. BMC Pediatr. 2017;17(1):18. doi: 10.1186/s12887-017-0784-1.
    1. Yokouchi-Konishi T, Yoshimatsu J, Sawada M, Shionoiri T, Nakanishi A, Horiuchi C, Tsuritani M, Iwanaga N, Kamiya CA, Neki R, Miyake A, Kurosaki K, Shiraishi I. Recurrent congenital heart diseases among neonates born to mothers with congenital heart diseases. Pediatr Cardiol. 2019;40(4):865–870. doi: 10.1007/s00246-019-02083-6.
    1. Carmichael SL, Nelson V, Shaw GM, Wasserman CR, Croen LA. Socio-economic status and risk of conotruncal heart defects and orofacial clefts. Paediatr Perinat Epidemiol. 2003. 10.1046/j.1365-3016.2003.00498.x.
    1. Liu SW, Liu JX, Tang J, Ji JF, Chen JW, Liu CY, et al. Environmental risk factors for congenital heart disease in the Shandong Peninsula, China: a hospital-based case–control study. J Epidemiol. 2009;19(3):122–130. doi: 10.2188/jea.JE20080039.
    1. Gianicolo EAL, Mangia C, Cervino M, Bruni A, Andreassi MG, Latini G. Congenital anomalies among live births in a high environmental risk area—a case-control study in Brindisi (southern Italy) Environ Res. 2014;128:9–14. doi: 10.1016/j.envres.2013.11.002.
    1. Liang Q, Gong W, Zheng D, Zhong R, Wen Y, Wang X. The influence of maternal exposure history to virus and medicine during pregnancy on congenital heart defects of fetus. Environ Sci Pollut R. 2017;24(6):5628–5632. doi: 10.1007/s11356-016-8198-4.
    1. Best K, Rankin J. Increased risk of congenital heart disease in twins in the North of England between 1998 and 2010. Heart. 2015;101(22):1812. doi: 10.1136/heartjnl-2015-307826.
    1. Ionescu-Ittu R, Marelli AJ, Mackie AS, Pilote L. Prevalence of severe congenital heart disease after folic acid fortification of grain products: time trend analysis in Quebec, Canada. Bmj. 2009;338(may12 2):b1673. doi: 10.1136/bmj.b1673.
    1. van Beynum IM, Kapusta L, Bakker MK, den Heijer M, Blom HJ, de Walle HE. 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. 2010;31(4):464–471. doi: 10.1093/eurheartj/ehp479.

Source: PubMed

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