Department of Cardiothoracic Surgery Copenhagen University Hospital - Rigshospitalet Denmark.
Faculty of Health Sciences Copenhagen University Denmark.
J Am Heart Assoc. 2024 Apr 2;13(7):e031575. doi: 10.1161/JAHA.123.031575. Epub 2024 Mar 27.
Studies show that an impaired maternal-fetal environment (iMFE) increases the mortality risk in children with single-ventricle congenital heart defects (CHDs). We investigated the impact of an iMFE on death in children with various surgically corrected CHDs.
In this nationwide register-based study, we examined the association between an iMFE (including preeclampsia, gestational hypertension, gestational diabetes, maternal smoking during pregnancy) and death in a large cohort of children with surgically corrected CHDs in Denmark (1994-2018). Survival analysis was done using Cox regression, adjusted for confounding and mediating covariates. The cohort included 3304 children: 1662 (50.3%) with minor CHD and 1642 (49.7%) with major CHD. Among them, 792 (24%) children were exposed to an iMFE. During the study, there were 290 deaths: 71 (9.3%) in children exposed to an iMFE and 219 (8.7%) in those unexposed. There were no differences in mortality risk between children with CHD exposed to an iMFE and those unexposed (hazard ratio [HR], 1.12 [95% CI, 0.86-1.47]; =0.4). This was consistent across subgroups, including minor CHD (HR, 0.76 [95% CI, 0.39-1.47]; =0.4), major CHD (HR, 1.23 [95% CI, 0.92-1.64]; =0.2), and hypoplastic left heart syndrome/univentricular heart (HR, 1.08 [95% CI, 0.64-1.85]; =0.8).
Impairment of the maternal-fetal environment did not impact the mortality rate in children with CHD undergoing operation in Denmark from 1994 to 2018. We believe the cause of these discrepant findings to previous studies may be due to differences in the composition of CHD and prenatal maternal health care and health status of the population.
研究表明，受损的母胎环境（iMFE）会增加患有单心室先天性心脏病（CHD）儿童的死亡率。我们研究了 iMFE 对各种手术矫正的 CHD 儿童死亡的影响。
在这项全国性的基于登记的研究中，我们检查了 iMFE（包括子痫前期、妊娠高血压、妊娠糖尿病、孕妇吸烟）与丹麦大量接受手术矫正的 CHD 儿童（1994-2018 年）之间的关联。使用 Cox 回归进行生存分析，调整了混杂和中介协变量。该队列包括 3304 名儿童：1662 名（50.3%）患有轻微 CHD，1642 名（49.7%）患有严重 CHD。其中，792 名（24%）儿童暴露于 iMFE 中。在研究期间，有 290 人死亡：暴露于 iMFE 的 CHD 儿童中 71 人（9.3%），未暴露于 iMFE 的儿童中 219 人（8.7%）。暴露于 iMFE 的 CHD 儿童与未暴露于 iMFE 的儿童的死亡率无差异（风险比[HR]，1.12[95%CI，0.86-1.47]；=0.4）。这在亚组中是一致的，包括轻微 CHD（HR，0.76[95%CI，0.39-1.47]；=0.4）、严重 CHD（HR，1.23[95%CI，0.92-1.64]；=0.2）和左心发育不良综合征/单心室心脏（HR，1.08[95%CI，0.64-1.85]；=0.8）。
1994 年至 2018 年，丹麦接受手术矫正的 CHD 儿童的母胎环境受损并未影响其死亡率。我们认为，这些与以往研究结果不一致的原因可能是 CHD 的构成以及产前母婴保健和人群健康状况的差异。
