Gynecology and Obstetrics Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Vita-Salute University, Milan, Italy.
Ultrasound Obstet Gynecol. 2024 Sep;64(3):294-307. doi: 10.1002/uog.27659.
To assess the association between increased maternal prepregnancy body mass index (BMI) and the risk of congenital heart defect (CHD) in offspring.
This systematic review and meta-analysis searched PubMed/MEDLINE, Web of Science and Scopus from inception to 20 April 2023. Risk estimates were abstracted or calculated for increased BMI categories (overweight, obesity, moderate obesity and severe obesity) compared with normal weight (reference). Fixed-effects or random-effects models were used to combine individual study risk estimates based on the degree of heterogeneity. Sensitivity analyses were conducted to weight pooled estimates for relevant moderators, particularly diabetes before and during pregnancy. Subgroup analyses for specific CHD subtypes were conducted if there were at least two studies with available data. Findings were presented for groups of defects, categorized using severity and topographic-functional criteria, and for individual defects. The certainty of the evidence for each effect estimate was evaluated according to Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines.
Overall, 31 studies comprising 4 861 693 patients and 86 136 CHD cases were included. The risk of CHD increased progressively from moderate to severe obesity (pooled odds ratio (OR), 1.15 (95% CI, 1.11-1.20) and 1.39 (95% CI, 1.27-1.53), respectively). Sensitivity analysis indicated that this effect persisted independently of maternal diabetes status before or during pregnancy. In the subgroup analysis, obesity was associated with up to a 1.5-fold increase in the risk of severe CHD (pooled OR, 1.48 (95% CI, 1.03-2.13)). Severe obesity was associated with an even higher risk, with 1.8-times higher odds compared with the reference group for specific CHD subtypes, including tetralogy of Fallot (pooled OR, 1.72 (95% CI, 1.38-2.16)), pulmonary valve stenosis (pooled OR, 1.79 (95% CI, 1.39-2.30)) and atrial septal defect (pooled OR, 1.71 (95% CI, 1.48-1.97)).
Maternal weight is a crucial modifiable risk factor for CHD, particularly for severe forms of defect. Further research is needed to investigate whether weight management before pregnancy might serve as a preventive measure against CHD. In pregnant women with obesity, fetal echocardiography should be a routine diagnostic procedure. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
评估母亲孕前体质量指数（BMI）增加与后代先天性心脏病（CHD）风险之间的关联。
本系统评价和荟萃分析检索了 PubMed/MEDLINE、Web of Science 和 Scopus 自成立至 2023 年 4 月 20 日的数据。将超重、肥胖、中度肥胖和重度肥胖等 BMI 类别与正常体重（参照）进行比较，提取或计算风险估计值。基于异质性程度，使用固定效应或随机效应模型对个体研究风险估计值进行合并。如果有至少两项具有可用数据的研究，将进行敏感性分析以调整汇总估计值的权重，特别是妊娠前和妊娠期间的糖尿病。如果有足够的研究数据，将进行特定 CHD 亚型的亚组分析。根据推荐、评估、制定和评估（GRADE）指南，对每项效应估计的证据确定性进行评估。
共有 31 项研究纳入了 4861693 名患者和 86136 例 CHD 病例，纳入研究的结果显示，CHD 的风险从中度肥胖到重度肥胖呈逐渐增加趋势（汇总比值比（OR）分别为 1.15（95%置信区间（CI），1.11-1.20）和 1.39（95%CI，1.27-1.53））。敏感性分析表明，这种效应独立于母亲妊娠前或妊娠期间的糖尿病状态而存在。在亚组分析中，肥胖与严重 CHD 风险增加 1.5 倍相关（汇总 OR，1.48（95%CI，1.03-2.13））。重度肥胖与更高的风险相关，与参照组相比，特定 CHD 亚型的患病风险增加 1.8 倍，包括法洛四联症（汇总 OR，1.72（95%CI，1.38-2.16））、肺动脉瓣狭窄（汇总 OR，1.79（95%CI，1.39-2.30））和房间隔缺损（汇总 OR，1.71（95%CI，1.48-1.97））。
母亲体重是 CHD 的一个重要可改变危险因素，尤其是对于严重的 CHD 类型。需要进一步研究以探讨妊娠前的体重管理是否可以作为预防 CHD 的措施。对于肥胖孕妇，胎儿超声心动图应作为常规诊断程序。© 2024 作者。超声在妇产科由 John Wiley & Sons Ltd 出版，代表国际妇产科超声学会。
