Simeone Regina M, Tinker Sarah C, Gilboa Suzanne M, Agopian A J, Oster Matthew E, Devine Owen J, Honein Margaret A
Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA.
Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA.
Ann Epidemiol. 2016 Dec;26(12):838-845. doi: 10.1016/j.annepidem.2016.10.003. Epub 2016 Oct 26.
To assess the contribution of multiple risk factors for two congenital heart defects-hypoplastic left heart syndrome (HLHS) and tetralogy of Fallot (TOF).
We used data from the National Birth Defects Prevention Study (1997-2011) to estimate average adjusted population attributable fractions for several recognized risk factors, including maternal prepregnancy overweight-obesity, pregestational diabetes, age, and infant sex.
There were 594 cases of isolated simple HLHS, 971 cases of isolated simple TOF, and 11,829 controls in the analysis. Overall, 57.0% of HLHS cases and 37.0% of TOF cases were estimated to be attributable to risk factors included in our model. Among modifiable HLHS risk factors, maternal prepregnancy overweight-obesity accounted for the largest proportion of cases (6.5%). Among modifiable TOF risk factors, maternal prepregnancy overweight-obesity and maternal age of 35 years or older accounted for the largest proportions of cases (8.3% and 4.3%, respectively).
Approximately half of HLHS cases and one-third of TOF cases were estimated to be attributable to risk factors included in our models. Interventions targeting factors that can be modified may help reduce the risk of HLHS and TOF development. Additional research into the etiology of HLHS and TOF may reveal other modifiable risk factors that might contribute to primary prevention efforts.
评估多种风险因素对两种先天性心脏病——左心发育不全综合征（HLHS）和法洛四联症（TOF）的影响。
我们使用了国家出生缺陷预防研究（1997 - 2011年）的数据，来估计几种已确认风险因素的平均调整人群归因分数，这些因素包括孕妇孕前超重 - 肥胖、孕前糖尿病、年龄和婴儿性别。
分析中包括594例孤立性单纯HLHS病例、971例孤立性单纯TOF病例和11,829例对照。总体而言，估计57.0%的HLHS病例和37.0%的TOF病例可归因于我们模型中的风险因素。在可改变的HLHS风险因素中，孕妇孕前超重 - 肥胖占病例的比例最大（6.5%）。在可改变的TOF风险因素中，孕妇孕前超重 - 肥胖和孕妇年龄35岁及以上占病例的比例最大（分别为8.3%和4.3%）。
估计约一半的HLHS病例和三分之一的TOF病例可归因于我们模型中的风险因素。针对可改变因素的干预措施可能有助于降低HLHS和TOF发生的风险。对HLHS和TOF病因的进一步研究可能会揭示其他有助于一级预防工作的可改变风险因素。
