(02-06-2010) Maternal obesity and congenital heart defects: a population-based study1,2,3

James L Mills, James Troendle, Mary R Conley, Tonia Carter and Charlotte M Druschel

1 From the Division of Epidemiology StatisticsPrevention Research Eunice Kennedy Shriver National Institute of Child HealthHuman Development National Institutes of Health Bethesda MD (JLM JT MRCTC)New York State Congenital Malformations Registry New York State Department of Health New York NY (CMD).
2 Supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda. MD.
3 Address correspondence to JL Mills, 6100 Building, Room 7B03, NICHD, NIH, Bethesda, MD 20892. E-mail: [email protected] .

Background: Obesity affects almost one-third of pregnant women and causes many complications, including neural tube defects. It is not clear whether the risk of congenital heart defects, the most common malformations, is also increased.
Objective: This study was conducted to determine whether obesity is associated with an increased risk of congenital heart defects.
Design: A population-based, nested, case-control study was conducted in infants born with congenital heart defects and unaffected controls from the cohort of all births (n = 1,536,828) between 1993 and 2003 in New York State, excluding New York City. The type of congenital heart defect, maternal body mass index (BMI; in kg/m2), and other risk factors were obtained from the Congenital Malformations Registry and vital records. Mothers of 7392 congenital heart defect cases and 56,304 unaffected controls were studied.
Results: All obese women (BMI 30) were significantly more likely than normal-weight women (BMI: 19?24.9) to have children with a congenital heart defect [odds ratio (OR): 1.15; 95% CI: 1.07, 1.23; P < 0.0001]. Overweight women were not at increased risk (OR: 1.00; 95% CI: 0.94, 1.06). The risk in morbidly obese women (BMI 40) was higher (OR: 1.33; 95% CI: 1.15, 1.54; P = 0.0001) than that in obese women with a BMI of 30?39.9 (OR: 1.11; 95% CI: 1.04, 1.20; P = 0.004). There was a highly significant trend of increasing OR for congenital heart defects with increasing maternal obesity (P < 0.0001). The offspring of obese women had significantly higher ORs for atrial septal defects, hypoplastic left heart syndrome, aortic stenosis, pulmonic stenosis, and tetralogy of Fallot.
Conclusions: Obese, but not overweight, women are at significantly increased risk of bearing children with a range of congenital heart defects, and the risk increases with increasing BMI. Weight reduction as a way to reduce risk should be investigated.

Source: Am J Clin Nutr 91: 1543-1549, 2010.

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