Giving birth to an infant with a congenital heart defect may be a novel risk factor for the later development of cardiovascular disease in the mother, a new study suggests
Among a large cohort of women tracked for up to 25 years, those who had an infant with a critical or noncritical heart defect were at greater risk for cardiovascular disease later in life, including atherosclerotic disease and cardiac hospitalization, than women who had infants without a congenital heart defect.
“There is no previous study looking at this issue,” lead author and epidemiologist Nathalie Auger, MD, University of Montreal Hospital Research Centre, Quebec, Canada, told theheart.org | Medscape Cardiology.
“Having an infant with a heart defect is rare,” Auger noted. “However, if a physician is aware of a woman who recently had a child with a heart defect, they could be on alert, inform the woman of this, and attempt to help her modify certain behaviors that can minimize her risk of heart disease: for example, maintaining healthy weight, exercising, changing diet, quitting smoking.”
Mary Ann Bauman, MD, spokesperson for the American Heart Association, Seattle, Washington, agrees.
“It’s important for physicians to make these women aware that they need to take care of their own health to better take care of their baby’s health. These women have a higher incidence of stress and depression, obviously, when they have a child with a congenital heart defect. We want to give these women permission to take care of themselves and good reason to do it,” Bauman told theheart.org | Medscape Cardiology.
The study was published online April 2 in Circulation.
Auger and colleagues studied more than 1 million women who delivered infants between 1989 and 2013 in Quebec, Canada. They identified women whose infants had critical, noncritical, or no heart defects and followed them for up to 25 years past pregnancy. A total of 1516 infants had critical heart defects and 14,884 had noncritical heart defects.
There were 3.38 cardiovascular hospitalizations per 1000 person-years for women who had infants with critical defects (95% confidence interval [CI], 2.67 – 4.27), 3.19 for women who had infants with noncritical defects (95% CI, 2.96 – 3.45), and 2.42 (95% CI, 2.39 – 2.44) for those who had infants with no heart defects.
In adjusted models, there was a 43% higher risk for any cardiovascular hospitalization in mothers of infants with a critical heart defect (adjusted hazard ratio [HR], 1.43; 95 CI, 1.13 – 1.82; P = .003) and a 24% higher risk for any cardiovascular hospitalization in mothers of infants with a noncritical defect (adjusted HR, 1.24; 95% CI, 1.15 – 1.34; P < .0001) compared with mothers of infants without any congenital heart defect.
The risk for specific causes of cardiovascular hospitalization, including myocardial infarction (MI), heart failure (HF), and other atherosclerotic disorders, was also higher for mothers of infants with congenital heart defects.
Women whose infants had a critical heart defect had about a 2.6-fold higher risk for MI (95% CI, 1.31 – 5.20; P = .007), a 3-fold higher risk for other atherosclerotic disease (95% CI, 1.72 – 5.36; P = .0001), and about a 43-fold higher risk for cardiac transplant (95% CI, 6.41 – 291.7; P = .0001).
Women whose infants had a noncritical defect had about a 2-fold increased risk for HF (95% CI, 1.53 – 2.82; P < .0001), 2.5 times the risk for pulmonary vascular disease (95% CI, 1.54 – 4.11; P = .0002), and 2.1 times the risk for needing a pacemaker (95% CI, 1.29 – 3.52; P = .003).
Mechanism Unclear
The risk for cardiovascular hospitalization also varied by type of congenital heart defect.
Relative to no heart defect, women whose infants had tetralogy of Fallot had a 1.5 times higher risk (95% CI, 0.95 – 2.34) of any cardiovascular hospitalization and those whose infants had hypoplastic left heart had a 2.2 times higher risk (95% CI, 1.27 – 3.96).
Risks were also elevated for several noncritical defects. For example, women whose infants had noncritical pulmonary artery defects had 1.7 times the risk (95% CI, 1.27 – 2.17) for any cardiovascular hospitalization, and women whose infants had noncritical heterotaxy defects had 2.4 times the risk (95% CI, 1.15 – 5.08).
Women whose infants had noncritical ventricular septum defects or atrial septum defects had 1.2 times the risk for a cardiovascular hospitalization.
Exactly how congenital heart defects in infants may raise the risk for later maternal cardiovascular disease is unclear, the authors say, but stress-related pathways are a possibility. They say more study is needed to determine whether mothers of infants with a congenital heart defect may benefit from targeted prevention strategies.
Bauman said it’s important to note that the researchers started looking at these women in 1989 and did not always have information on smoking and body mass index, “so we don’t know how some of those factors that we know are critical in terms of cardiovascular disease might have skewed the results.”
Nonetheless, she said it is “important for doctors to speak with their patients” about this potential risk.
Funding for the study was provided by the Heart and Stroke Foundation of Canada, with support from the Canadian government. The authors and Bauman have disclosed no relevant financial relationships.
Circulation. Published online April 2, 2018. Abstract
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