胎儿先天性心脏病产前超声筛查诊断模式的评价

目的 评价胎儿先天性心脏病产前超声筛查诊断模式.方法 收集2004年2月-2007年5月复旦大学附属妇产科医院产科在孕24周前行产前诊断的11 410例孕妇,应用超声筛查其11 544例胎儿的先天性心脏病发生情况.超声筛查切面包括四腔心切面、流出道切面(包括左室流出道+三血管切面),计算不同切面诊断先天性心脏病的敏感性及特异性,并随访胎儿预后.结果 (1)11 544例胎儿中,筛查出先天性心脏病48例,漏诊6例,先天性心脏病发生率为0.47%(54/11 544).(2)四腔心切面发现胎儿先天性心脏病33例,主要为室间隔缺损18例(其中9例合并锥干异常)、房室瓣膜异常6例及左、右心不对称9例.四腔心切面诊断先天性心脏病的敏感性为61.11%(33/54),特异性为99.98%(11 488/11 490).流出道切面诊断胎儿先天性心脏病15例,包括肺动脉闭锁1例,肺动脉瓣狭窄3例,大血管错位2例,肺动脉狭窄及大血管错位1例,法洛四联症6例,肺动脉狭窄2例.四腔心切面+流出道切面诊断胎儿先天性心脏病的敏感性为B8.89%(48/54),特异性99.98%(11 488/11 490).(3)48例先天性心脏病胎儿中,有11例合并其他器官系统异常,另有11例行羊膜腔穿刺检查胎儿染色体,其中5例为21三体.结论 四腔心切面+流出道切面对胎儿先天性心脏病的产前超声筛查有较高的检出率,此产前超声筛查诊断模式在临床上诊断胎儿先天性心脏病切实可行.     

胎儿心脏超声Yagel法扫描在产前诊断双胎妊娠胎儿先天性心脏病中的价值

目的探讨胎儿心脏超声Yagel法扫描对双胎妊娠胎儿先天性心脏病的产前诊断价值。方法1103例双胎妊娠孕妇中,有胎儿先天性心脏病的高危病史孕妇127例（高危双胎组）,正常双胎妊娠孕妇976例（低危双胎组）。应用超声Yagel法对两组双胎妊娠胎儿进行心脏5个心脏横切面（胎儿腹部胃泡平面、四腔心平面、五腔心平面、三血管气管平面和动脉弓平面）快速扫描,并对诊断为先天性心脏病而引产的胎儿进行尸体解剖,以核对产前超声Yagel法诊断的正确性,同时进行胎儿染色体分析;对未引产或产前诊断未发现明显异常的胎儿进行临床随访,胎儿出生后进行新生儿或婴儿的心脏超声检查,判定产前超声Yagel法诊断的正确性。结果（1）1103例双胎妊娠中,有12例产前发现有先天性心脏病,检出率为1．09％,其中4例（33．3％,4／12）来自高危双胎组,8例（66．7％,8／12）来自低危双胎组。（2）2例双胎为两个胎儿同时患同一种先天性心脏病,其中1例双胎胎儿均为法洛四联症（TOF）,另1例双胎两个胎儿均为心脏横纹肌瘤;1例双胎为两个胎儿患不同类型异常,一胎儿为TOF,另一胎儿心脏正常,但十二指肠闭锁。上述3例患者均选择终止妊娠放弃胎儿,尸体解剖结果与产前超声诊断相同。9例双胎仅一胎儿受累为先天性心脏病,另一胎儿正常,均足月分娩或自然早产,其中7例在行新生儿心脏检查时得出的诊断与产前相同。（3）12例中,2例有先天性心脏病的双胎被发现染色体异常。（4）1091例双胎妊娠孕妇产前超声检查未发现胎儿心脏异常,但其中1例双胎中的1个胎儿出生后被诊断为室间隔缺损（VSD）,染色体异常（为21三体）。另1个胎儿正常。另1例双胎中的1个胎儿出生后被诊断为动脉导管未闭,另1个胎儿正常。（5）应用超声Yagel法产前诊断双胎先天性心脏病的敏感度为82．4％,特异度为100％。结论心脏超声Yagel法是筛查和诊断双胎妊娠中胎儿先天性心脏病的简单、有效和可靠方法,值得在临床产前诊断中推广应用。     

超声心动图对胎儿先天性心脏结构异常的诊断价值

目的探讨超声心动图对胎儿先天性心脏结构异常诊断的价值.方法2004-01-2005-10江门市妇幼保健院对724例胎儿心脏进行了二维、M型、彩色多普勒血流显像检查.取胎儿四腔心切面,三血管平面,大血管短轴切面,左心室长轴切面,主动脉长轴切面,右室两腔切面等多切面检查.结果724例胎儿超声心动图检查中15例诊断胎儿先天性心脏结构异常,4例伴有多发畸形.13例进行了治疗性引产,其中9例均经尸解证实超声诊断结构,4例拒绝尸解;1例心包积液;1例超声诊断为卵圆孔增大,出生后复查心脏结构未见异常.709例产前超声心动图检查未发现异常者3例于出生后发现先天性心脏病.结论超声心动图对胎儿先天性心脏结构异常的诊断具有重要价值.四腔心切面、三血管平面是超声诊断先天性心脏结构异常最重要的切面.     

超声心动图的四腔心切面产前诊断胎儿先天性心脏病的价值

目的 探讨超声心动图的四腔心切面（四腔心切面）产前诊断胎儿先天性心脏病（先心病）的价值。方法 回顾性分析780例妊娠16-36周通过四腔心切面进行产前诊断是的孕妇及其新生儿的临床资料。结果 780例胎儿中,94.6%,(738/780)的胎儿可以获取满意的四腔心切面,其中3例胎儿异常,1例为三尖瓣下移畸形（Ebstein综合征）,1例为严重的室间隔缺损,1例为单心房单心室和主动脉狭窄,例1和例3分别于出生后行尸体解剖和新生儿超声心动图检查,均符合产前诊断,例2出生后超声心动图检查证实为单心房和单心室,其余777例新生儿中,出生后身体检查并追踪至产后6周,发现3例先心病,其中1例室间隔缺损,1例房间隔缺损,1例房间隔缺伴肺动脉狭窄,四腔心切面诊断胎儿先心病的敏感性为50%,特异性为100%。结论 四腔心切面可以显示胎儿心脏的大部分结构,探测成功率高,对先心病的宫内诊断有较高的敏感性和极高的特性,可将胎儿四腔心切面作为常规的产检查项目。     

彩色多普勒超声在非高危胎儿产前心脏筛查中的临床意义

目的：探讨彩色多普勒超声在非高危胎儿产前心脏筛查中的临床意义。方法：选用我院1125例产前孕检的孕妇，通过多普勒超声的多切面检查，获得较为清晰的二维和彩色多普勒声像图，检查心脏畸形。结果：检查出9例先天性心脏病患者，其中通过产前超声筛查出7例，漏诊2例（室间隔缺损、法洛四联症），经伦理委员会和家属的同意，对引产后患儿进行尸解证实主要原因是由于母体的羊水少、胎儿体位异常、母体腹壁厚。多普勒超声对非高危胎儿的检出率0．6％，对心脏畸形的检查率是78％，诊断准确率是100％。结论：多普勒超声对非高危胎儿进行产前心脏超声筛查，检查率比较高，能够及时发现心脏畸形和做出相应的干预处理。     

"胎儿心脏筛查指南"在产前超声筛查胎儿先天性心脏病中的应用价值

目的 探讨2006年国际妇产科超声协会公布的"胎儿心脏筛查指南"在产前超声筛查胎儿先天性心脏病中的应用价值.方法 2006年9月-2007年7月在南京大学医学院附属鼓楼医院母胎医学中心接受胎儿超声筛查的单胎孕妇5000例.平均年龄28岁(18～48岁),平均孕周27周(妊娠18～40周).以"胎儿心脏筛查指南"为标准对胎儿四腔心和左、右心事流出道及三血管切面进行扫查,对疑有心脏异常者进一步行胎儿超声心动图枪查,对确诊先天性心脏病胎儿建议羊水或脐血穿刺行染色体核型分析,终止妊娠者行胎儿尸体心脏解剖;继续妊娠者,于胎儿出生后2～6个月行超声心动图随访.结果 (1)超声筛查各切面获取率:5000例单胎孕妇中,四腔心切面获取率为97.64%(4882/5000),其中左、右心室流出道及三血管切面的获取率分别为87.69%(4281/4882)、82.51%(4028/4882)和96.29%(4701/4882).5000例孕妇中,孕中期筛查2750例,孕晚期筛查2250例,孕晚期各标准切面的获取率明显低于孕中期(P<0.05).(2)胎儿先天性心脏病发病率:4882例胎儿中最终诊断先大性心脏病73例,发病率为1.50%(73/4882),其中产前超声确诊50例(孕中期24例、孕晚期26例).超声漏诊23例,误诊1例,合并其他器官畸形18例.(3)随访结局:产前诊断为先天性心脏病的胎儿中接受尸体心脏解剖19例,均与产前超声诊断结果一致;继续妊娠者胎儿出生后接受超声心动图检查12例,其中与产前诊断符合11例,另1例产前诊断三尖瓣关闭不全,产后超声检查正常.接受染色体检查23例,染色体核型异常7例.(4)产前超声筛查的敏感性与特异性:四腔心切面确诊先天性心脏病胎儿28例,同时加入左、右心室流出道及三血管切面共诊断先天性心脏病50例,诊断的敏感性为69%(50/73)、特异性为99.98%(4808/4809),假阴性率为0.48%(23/4831),假阳性率为2%(1/51).结论 国际妇产科超声协会2006年公布的"胎儿心脏筛查指南"临床实用、易于遵循、便于操作.就最佳超声切面获得来说,孕中期(18～27周)是最佳筛查时间.胎儿四腔心和左、右心窒流出道及三血管切面同时筛查,可产前诊断69%的先天性心脏病胎儿.     

七切面联合筛查法在孕中晚期胎儿先天性心脏病检查中的应用价值

目的 探讨七切面联合筛查法在孕中晚期胎儿先天性心脏病检查中的可行性和临床价值.方法 2006年9月至2007年2月,在南京医科大学鼓楼临床学院母胎医学中心对妊娠18周以上的2000例单胎孕妇进行胎儿系统结构筛查的同时进行胎儿心脏七切面联合扫查,对先天性心脏病胎儿终止妊娠者进行胎儿尸体心脏解剖;继续妊娠者,于婴儿出生后6个月内进行超声心动图随访.结果 2000例单胎妊娠胎儿中,最终四腔心切面获取率为99.0%,其中左心室流出道、右心室流出道、三血管、主动脉弓、动脉导管弓和上下腔静脉切面的获取率分别为92.5%、90.9%、98.5%、86.8%、84.6%和91.6%.心脏筛查中,脊后位时心脏七切面的获取率均在80%以上.2000例单胎妊娠胎儿中,发现先天性心脏病19例,发生率为0.95%.产前诊断13例(其中误诊1例),漏诊7例,误诊1例,诊断敏感性63.2%、特异性99.9%.结论 七切面联合筛查法在孕中晚期胎儿先天性心脏病检查中切实可行,能在产前诊断出大部分心脏畸形,尤其是心脏复杂畸形.     

胎儿心脏锥干畸形产前诊断评价

目的评价胎儿心脏锥干畸形产前超声心动图诊断准确性。方法运用胎儿超声心动图进行先天性心脏病产前诊断，并与心脏病理诊断或新生儿心脏超声诊断进行比较分析。结果2063例胎儿进行心脏超声检查，产前发现胎儿心脏锥干畸形28例，诊断时平均孕周26．6周（16～40周），产前诊断包括大血管转位5例，法洛四联症5例，右室双出口6例，永存动脉干9例，室间隔缺损合并主动脉骑跨可能1例，2例检查发现大血管位置异常但胎儿超声心动图未予明确诊断。24例经胎儿心脏病理检查或新生儿心脏超声检查确诊，4例失访（包括1例TOF／TA？，2例“大血管发育异常”，1例TGA）。比较产前诊断与产后诊断，分析大血管位置关系诊断准确性为75．0％（18／24）。结论胎儿超声心动图可正确诊断胎儿心脏锥干畸形，需运用多种超声切面及彩色脉冲多普勒确定大血管位置关系。     

先天性心脏畸形的产前诊断及临床分析

目的探讨先天性心脏畸形的产前诊断及临床意义。方法本研究应用Yagel5个心脏横面和心脏长轴切面进行胎儿心脏扫描，并有效多普勒血流技术、彩色血流、M型超声等超声仪器各项功能技术，对2002至2004年982例先天心脏畸形高危患者进行胎儿心脏全方位检查，并对引产胎儿进行尸体解剖核对产前诊断的正确性，并进行胎儿染色体分析；对产前诊断未发现明显异常的胎儿进行临床随访，胎儿出生后进行新生儿或要儿心脏超声检查，判定产前诊断的正确性。结果（1）982例先天心脏畸形高危患者中，检查发现胎儿心脏结构异常为46例（4．7％）。其中应用单纯四腔心即能诊断的先天性胎儿心脏结构异常为32例，其余14例需同时结合其他心脏检测平面诊断。（2）41例引产胎儿中，32例进行尸体解剖，病理结果与产前超声检查符合率为93．8％（30／32），其中1例患者病理诊断为永存动脉干畸形，产前诊断为法洛四联症；另1例为右心室双流出道畸形，产前诊断为大动脉转位。（3）46例患者中，32例进行胎儿染色体检测，合并染色体异常8例（25．0％）。（4）5例为产前诊断右心系统略大胎儿，分娩后新生儿或要儿心脏超声检查，结果与产前基本相同，表现为单纯右心系统略大，但新生儿和要儿无任何临床症状。（5）936例产前诊断为正常胎儿心脏患者，新生儿或要儿心脏超声检查发现室间隔缺损1例，动脉导管未闭2例，房间隔缺损1例。结论（1）应用本研究方法，以先天心脏畸形高危患者为筛查对象，产前诊断先天性心脏畸形阳性率为4．7％，产前诊断与尸体解剖符合率为93．8％。（2）应用本研究方法可使高危人群产前诊断胎儿先天性心脏畸形的敏感性达92．0％，特异性达99．6％。（3）单纯左右心比例轻中度失调胎儿可能有较好的临床预后。     

高危妊娠中孕11～16周应用超声筛查胎儿心脏畸形的价值

目的：探讨高危妊娠中孕11~16周应用超声筛查胎儿心脏畸形的意义。方法：回顾性分析天津市中心妇产科医院与美国费城儿童医院胎儿心脏中心就诊的高危妊娠孕妇668例,于孕11～16周胎儿心脏超声筛查,其中404例采用四腔心切面筛查法,264例采用心脏节段性扫查法。结果：在所有高危妊娠孕妇中,应用四腔心切面筛查法,严重复杂性先心病的检出率为5.7%（23/404）,应用心脏节段性扫查法严重复杂性先心病检出率为9.5%（25/264）,两者比较差异无统计学意义（P＞0.05）。胎儿颈部透明层（nuchal translucency,NT）增高与淋巴水囊瘤患者中,应用四腔心切面筛查法,严重复杂性先心病的检出率为2.5%（9/362）,心脏节段性扫查法检出率为10.0%（7/70）,两者比较差异有统计学意义（P＜0.05）。同一孕期（孕12~14周前）比较,四腔心切面筛查法与心脏节段性扫查法对于严重复杂性先心病的检出率分别为5.9%（21/358）、10.4%（8/77）,两者比较差异无统计学意义（P＞0.05）。结论：随着心脏畸形的高危因素如NT值增高、淋巴水囊瘤、胎儿心外畸形等在早期得以越来越多地检出,在同一时间段内应用超声筛查胎儿心脏畸形尤为必要。四腔心切面作为胎儿超声心动图中最重要、最易获得的切面,尤其在早期胎儿心脏体积较小的情况下,对于严重复杂性先心病的检出具有较高的临床应用价值。先心病的早期检出能最大限度减轻对孕妇本身的损害。     

What to expect from routine midtrimester screening for congenital heart disease

The four-chamber view is the standard screening view of the fetal heart. However, it detects only about half of cardiac defects. Because this view does not show the great vessels, only conotruncal abnormalities with substantial septal defects will be seen. Second, septal defects may be too small at the time of screening to be detected. In addition, some defects such as pulmonic stenosis are late appearing. The addition of the aortic outflow tract view increases sensitivity by approximately 20%. Although all components of the four-chamber view may not be seen, there is still considerable information supplied by each of its parts.     

胎儿先天性心脏病和风疹病毒感染的关系

目的 探讨和分析孕妇风疹病毒感染与胎儿先天性心脏病(简称先心病)的关系,为提高先天性风疹综合征产前诊断率寻求方法.方法 对超声心动图诊断并要求引产的38例先心病胎儿行脐带穿刺,采用酶联免疫吸附试验测定脐血风疹病毒特异性抗体IgM. 结果 38例先心病胎儿中18例脐血风疹病毒IgM(+),占47.4%,其余20例IgM(-).18例风疹病毒IgM(+)胎儿按心脏异常结构出现频率排序:室间隔缺损10例、肺动脉发育异常9例、房室瓣异常6例、大动脉转位5例、主动脉骑跨4例.IgM(+)和IgM(-)组中属于圆锥动脉分隔异常或圆锥动脉干间隔旋转不足或方向相反的病例数分别为11例(61.1%)和5例(25.0%)(P<0.05). 结论 风疹病毒与胎儿先心病的发生有一定关联,可能影响胎儿心室分隔和圆锥动脉干发育.B超提示胎儿室间隔缺损、肺动脉发育异常、心肌瓣膜异常、大动脉转位时,应考虑到风疹病毒感染的可能.     

Using ultrasonic measurement of cardiac size in predicting congenital heart defect.

A Duplex Color apparatus equipped with real-time imaging and Doppler sector scanner was used to scan fetal hearts, ranging from 17 to 41 weeks gestational age. A total of 323 normal fetuses were studied. The four-chamber view was obtained in a horizontal section just above the level of the fetal diaphragm. Five variables of the Chinese fetal heart in relation to the width of the right ventricle, width of the left ventricle, ratio of right ventricle/left ventricle (RV/LV), length of the fetal heart and the cardiac volume of a four-chamber view were set against gestational age in weeks and expressed in regression equations. The ratio of RV/LV is quite constant in relation to the gestational age. The mean ranges between 0.9916 for 17 weeks gestation and 1.0045 for a term fetus. In 10 abnormal cases with congenital cardiac defects, using the 5th and the 95th percentiles of this normal data as cutoff points, the RV/LV ratio had the highest sensitivity rate of 70% (7/10) in predicting fetal cardiac anomaly. The width of the left ventricle was the second most sensitive parameter with a sensitivity of 4/10 (40%). The RV/LV ratio of a four-chamber view is a simple, time-saving screening parameter for predicting congenital cardiac defects antenatally.     

心脏轴测定在胎儿先天性心脏病产前超声诊断中的临床意义

目的探讨超声心动图测定心脏轴变化在胎儿先天性心脏病（先心病）产前诊断中的临床意义。方法应用Ａｃｕｓｏｎ１２８×Ｐ／１０彩色多普勒超声诊断仪检查５１８例胎龄１８～４０周的先心病高危胎儿和９０例正常胎儿,在心脏超声四腔观基础上测定胎儿心脏轴,并从多切面观察胎儿心内结构,以确定胎儿有无先心病。结果正常胎儿心脏轴为（４４．８±１０．３）度,先心病胎儿心脏轴为（５８．１±１５．７）度,两者比较,差异有显著性（Ｐ＜０．０１）。单纯四腔观检测胎儿先心病的敏感性为６８．５％,应用心脏超声四腔观加心脏轴测定检测胎儿先心病的敏感性为９１．４％,两者比较,差异有显著性（Ｐ＜０．０５）;５１８例先心病高危胎儿中,产前超声正确诊断先心病３４例,假阳性１例,假阴性１例。结论正常胎儿心脏轴范围２０～７５度,如心脏轴＞７５度,应高度怀疑胎儿先心病;心脏轴测定在胎儿先心病筛查中具有重要作用,可作为一种常规测量指标。     

Can live xPlane imaging of the in-plane view of interventricular septum be used to detect fetal conotruncal anomalies?

Objective: To evaluate the feasibility of live xPlane imaging visualizing the in-plane view of IVS in the screening of the fetal conotruncal anomalies. Method: One hundred and fifty-two consecutive normal singleton fetuses and forty-eight fetal cardiac defects (27 conotruncal and 21 non-conotruncal cases), were enrolled in this study. The in-plane view of IVS was firstly acquired with live xPlane imaging and then judged whether it is normal or not by one operator. The focus was put on observing the relationship of pulmonary artery and aorta. The comparison between conotruncal and non-conotruncal anomalies in demonstrating the relationship of pulmonary artery and aorta was performed. Result: There were 27 cases of conotruncal anomalies enrolled in this study and 19 cases (70.4%) had the abnormal relationship of aorta and pulmonary artery in the in-plane view of IVS. In 21 cases of non-conotruncal CHDs, however, there were only 5 cases (23.8%) had the abnormal relationship in the in-plane view of IVS (p < 0.001). Conclusion: Live xPlane imaging of the in-plane view of IVS is feasible to detect the fetal conotruncal anomalies, which may potentially be a useful tool for the non-experienced operators to screen the fetal conotruncal anomalies.     

Fetal echocardiography: accuracy and limitations in a population at high and low risk for heart defects.

OBJECTIVE: Our objective was to assess the accuracy of prenatal echocardiography in detecting congenital heart defects in patients at high and low risk for structural cardiac anomalies. STUDY DESIGN: Sixty-nine consecutive fetuses with congenital heart defects who had had prenatal ultrasonography at greater than or equal to 18 weeks' gestation were evaluated to determine the accuracy of prenatal ultrasonography in identifying structural cardiac defects. Thirty-nine patients were at high risk and 30 patients were at low risk for cardiac anomalies. All fetuses were scanned with standard four-chamber and outflow tract views. Data concerning extracardiac anomalies and karyotypic abnormalities were tabulated. The accuracy of the four-chamber view alone in identifying congenital heart defects was evaluated. RESULTS: Fifty-seven of 69 fetuses (83%) were prenatally identified ultrasonographically as having a heart defect. There was no difference in the sensitivity of detecting cardiac anomalies between high-risk and low-risk groups. When the four-chamber view was used, only 63% of fetuses were recognized as having an abnormal heart. Extracardiac anomalies were noted in 36% and karyotypic abnormalities in 17% of patients. CONCLUSION: The four-chamber and outflow tract views done routinely in an ultrasonography laboratory seeing a mixed population of patients was successful in detecting 83% of fetuses with structural cardiac malformations. Because 43% of the fetuses with heart defects were referred for low-risk indications, systematic ultrasonographic examination of the fetal heart should not be reserved only for those at high risk.     

Biometry of the fetal heart between 10 and 17 weeks of gestation

OBJECTIVES: Assessment of the dimensions of the cardiac chambers and the great arteries in the human fetus may be helpful in the prenatal diagnosis of congenital heart disease. The purpose of this prospective cross-sectional study was to compile normative data in fetal cardiac measurements in early pregnancy. The structure of the fetal heart was examined in 136 normal singleton fetuses between 10 and 17 weeks of gestation. METHODS: The transversal heart diameter, both ventricular dimensions, interventricular septal thickness, heart area, heart circumference, thoracic diameter, thoracic circumference and thoracic area were measured in the four-chamber view during diastole. Diameters of the pulmonary trunk and ascending aorta were obtained in the short axis and long axis view during systole. Ultrasound examinations were performed with a 5.0-MHz transvaginal and/or transabdominal phased-array sector scanner. RESULTS: The four-chamber view and the cross-over of the pulmonary artery and the aorta were adequately visualized in 44% of the fetuses at 10 weeks of gestation, in 75% at 11 weeks of gestation, in 93% at 12 weeks of gestation and in 100% of the fetuses at 13-17 weeks of gestation. Before 14 weeks of gestation transvaginal sonography was superior to the transabdominal sonography in visualization of the fetal heart and great arteries. After 14 weeks of gestation transabdominal sonography accurately demonstrated the structure of the fetal heart. The ratio of right and left ventricle (RV/LV) and the ratio of the pulmonary trunk and aorta (PT/AO) were constant during this period of gestation (approximately 1.00 and 1. 10, respectively). The ratio of the cardiac and thoracic area showed only a slight increase with advancing gestational age, but with significant correlation. The fetal heart rate showed a slow decrease from 167 to 150 bpm in this period of gestation. The transversal heart diameter, both ventricular dimensions, interventricular septal thickness, heart area, cardiothoracic diameter ratio, aortic diameter and the pulmonary trunk diameter showed a highly significant linear correlation to the gestational age and the biparietal diameter. CONCLUSION: The advancing quality of ultrasound images allows fetal echocardiography in the first and early second trimester. Our normative data could be the basis of studying the development of cardiac structures in congenital heart disease and it might be helpful in the detection of some congenital heart defects in early pregnancy.     

Maternal influenza-like illness,medication use during pregnancy and risk of congenital heart defects in offspring

Abstract

Objective: To evaluate the association between maternal influenza and congenital heart defects (CHDs), and whether the use of traditional Chinese medicine (TCM) or Western medicine (antibiotics, antipyretic-analgesic drugs) modified this association.

Method: We analysed 294 fetuses with CHDs and 416 control fetuses without any abnormalities identified from February 2010 through October 2011 in this hospital-based case-control study. Participating mothers were interviewed to determine whether they had been infected with “influenza” during the early pregnancy period or had used any medicine (TCM, Western medicine) to treat influenza. A logistic regression model was used to calculate ORs and 95% CIs while controlling for potential confounders.

Results: There were significant associations between maternal influenza and CHDs in the aggregate (AOR, 1.60; 95%CI, 1.12 to 2.28) and specific subtypes, namely septal defects (AOR, 2.12; 95%CI, 1.38 to 3.26) and conotruncal defects (AOR, 1.60; 95%CI, 1.01 to 2.51). Maternal medication use (i.e. TCM or Western medicine) in the setting of influenza tended to decrease these associations.

Conclusions: Maternal influenza during second–third months of pregnancy increased the risk for CHDs, with septal defects and conotruncal defects in particular being observed. The use of medication for influenza might attenuate such associations.     

Maternal obesity and neonatal congenital cardiovascular defects.

OBJECTIVE: To determine whether isolated congenital heart defects (CHDs) were associated with maternal obesity. METHOD: In a retrospective study we compared the incidence and severity of isolated CHDs in the offspring of 428 women divided into 3 groups, one of women of normal weight (n=141), one of obese women (n=228), and one of morbidly obese women (n=59) according to their body mass index. RESULTS: There were 143 mild (66.8%), 44 moderate (20.6%), and 27 complex (12.6%) forms of CHDs in the offspring and septal defects were the most common (61.7%). No significant differences were found among the 3 groups of women regarding the type or severity of CHDs in their respective offspring, or the corrective cardiac surgery required. CONCLUSION: No association was found between maternal weight and isolated CHDs in the offspring.