PhD Université de Sherbrooke Université de Sherbrooke
Disclosure(s):
Sara Khalilipalandi, MSc: No financial relationships to disclose
Background: The causes of congenital heart disease (CHD) are intertwined, multifactorial and often elusive. There are many studies on prenatal risk factors for CHD, but the level of evidence on the quantitative effects of many of them is often low. There is no comprehensive systematic review of all prenatal CHD risk factors. Our objective is to perform a comprehensive systematic review and meta-analysis for all CHD risk factors. This abstract reports CHD risk in the presence of maternal diabetes and obesity.
METHODS AND RESULTS: PRISMA guidelines were used. A comprehensive search strategy encompassing the concepts of CHD and risk factors was used on PubMed, MEDLINE and Scopus databases. We retrieved 4862 records and screened them for the following inclusion criteria: (1) original peer-reviewed articles (2) quantifying the effects of risk factors for CHD, (3) published between 1989 and 2022. Meta-analyses with fixed and random effects models were performed. Pooled odds ratios (OR) and 95% confidence interval (CI) are reported. There were 27, 25 and 24 articles that met criteria for inclusion in meta-analyses of obesity, pre-gestational diabetes (PGDB) and gestational diabetes (GDB), respectively. There was an association between being overweight/obese and CHD (OR 1.32; 95%CI 1.16-1.50). We observed a dose-effect relationship, with ORs for being overweight, obese and morbidly obese being respectively 1.06 (95%CI 1.02-1.10), 1.17 (95%CI 1.12-1.23) and 1.43 (95%CI 1.35-1.53). PGDB was associated with CHD with an OR of 3.51 [95%CI 2.86-4.3]. Odds ratio between type I (OR 3.45; 95%CI 2.28-5.22) and type II (OR 2.88; 95%CI 1.58-5.26) diabetes were similar. Significant heterogeneity was observed (I2 = 85%, p = 0.0001), likely in part due to variations in measures of exposition. The effect size of GDB was less than PGDB (OR 1.27; 95%CI 1.06-1.53). Some studies reported a dose-effect relationship between HgA1C and CHD risk, but insufficient data existed for a meta-analysis.
Conclusion: Pre-gestational diabetes is strongly and consistently associated with CHD risk. Further studies are necessary to assess whether glycemic control decreases the risk of CHD. The association of gestational diabetes and obesity with CHD was weaker, although there was a dose-response pattern with severity of obesity.
