From Department of Pediatrics, Aarhus University Hospital, Denmark (N.B.M., T.B.H., P.A., C.C.B., J.R.O.); Centre for Rare Diseases, Aarhus University Hospital, Denmark (N.B.M., J.R.O.); Perinatal Epidemiology Research Unit, Aarhus University Hospital, Denmark (T.B.H., C.C.B., N.B.M.); Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, PA (J.W.G.); and Department of Cardiothoracic Surgery, Aarhus University Hospital, Denmark (V.H.).
Circulation. 2016 Feb 9;133(6):566-75. doi: 10.1161/CIRCULATIONAHA.115.019089. Epub 2016 Jan 14.
Neurodevelopmental disorders are the most common and distressful comorbidities associated with congenital heart defects (CHD). Head circumference at birth (HC), a proxy for prenatal cerebral growth, is an established risk factor for neurodevelopmental disorders.
In a nationwide cohort, we included all 924 422 liveborn Danish singletons, 1997 to 2011. CHD was present in 5519. The association between CHD and growth indices was analyzed by multivariable linear regression, adjusted for potential confounders. We report mean differences in gestational age-specific z scores in comparison with the general population. CHD was associated with lower HC z scores, -0.10 (95% confidence interval [CI], -0.13 to -0.08). Several CHD subtypes were associated with smaller HC, eg, hypoplastic left heart syndrome, -0.39 (95% CI, -0.58 to -0.21); common arterial trunk, -0.41 (95% CI, -0.74 to -0.09); and major ventricular septal defects, -0.25 (95% CI, -0.35 to -0.15). Other single-ventricle defects, transposition of the great arteries, tetralogy of Fallot, and anomalous pulmonary venous return, were also associated with smaller HC. Transposition of the great arteries was associated with smaller HC relative to birth weight, -0.26 (95% CI, -0.39 to -0.13). Major ventricular septal defects were associated with larger HC relative to birth weight. The results were consistent under various conditions, eg, when siblings of infants with CHD (n=5311) or infants with other major malformations (n=24 974) were used as the reference.
Several subtypes of CHD were associated with smaller HC. The associations with major ventricular septal defects, common arterial trunk, and anomalous pulmonary venous return have not previously been described. Only infants with transposition of the great arteries had smaller HC relative to birth weight.
神经发育障碍是与先天性心脏病（CHD）相关的最常见和最痛苦的合并症。出生头围（HC）是产前大脑生长的代表，是神经发育障碍的既定危险因素。
在一项全国性队列研究中，我们纳入了 1997 年至 2011 年期间所有 924422 名丹麦活产单胎儿。CHD 存在于 5519 例中。通过多变量线性回归分析 CHD 与生长指数之间的关系，调整了潜在的混杂因素。我们报告了与一般人群相比，特定胎龄的 z 评分的平均差异。CHD 与较低的 HC z 评分相关，-0.10（95％置信区间[CI]，-0.13 至-0.08）。几种 CHD 亚型与较小的 HC 相关，例如左心发育不全综合征，-0.39（95％CI，-0.58 至-0.21）；共同动脉干，-0.41（95％CI，-0.74 至-0.09）；和大型室间隔缺损，-0.25（95％CI，-0.35 至-0.15）。其他单心室缺陷、大动脉转位、法洛四联症和肺静脉异常回流也与较小的 HC 相关。大动脉转位与相对于出生体重的较小 HC 相关，-0.26（95％CI，-0.39 至-0.13）。大型室间隔缺损与相对于出生体重的较大 HC 相关。在各种情况下，例如当 CHD 婴儿（n=5311）或其他主要畸形婴儿（n=24974）的兄弟姐妹作为参考时，结果是一致的。
几种 CHD 亚型与较小的 HC 相关。与大型室间隔缺损、共同动脉干和肺静脉异常回流的关联以前没有描述过。只有大动脉转位的婴儿相对于出生体重有较小的 HC。
