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Smith C, Olugbuyi O, Kaul P, Dover DC, Mackie AS, Islam S, Eckersley L, Hornberger LK. Lower Socioeconomic Status is Associated with an Increased Incidence and Spectrum of Major Congenital Heart Disease and Associated Extracardiac Pathology. Pediatr Cardiol 2024; 45:433-440. [PMID: 37870603 DOI: 10.1007/s00246-023-03310-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023]
Abstract
Several studies have suggested an inverse relationship between lower socioeconomic status (SES) and the incidence of congenital heart disease (CHD) among live births. We sought to examine this relationship further in a Canada-wide population study, exploring CHD subtypes, trends, and associated noncardiac abnormalities. Infants born in Canada (less Quebec) from 2008 to 2018 with CHD requiring intervention in the first year were identified using ICD-10 codes through the Canadian Institute for Health Information Discharge Abstract Database. Births of CHD patients were stratified by SES (census-based income quintiles) and compared against national birth proportions using X2 tests. Proportions with extracardiac defects (ED) and nonlethal genetic syndromes (GS) were also explored. From 2008 to 2018, 7711 infants born with CHD were included. The proportions of major CHD distributed across SES quintiles were 27.1%, 20.1%, 19.2%, 18.6%, and 15.0% from lowest to highest, with significant differences relative to national birth proportions (22.0%, 20.0%, 20.6%, 20.7%, and 16.7% from lowest (1) to highest (5)) (p < 0.0001). No temporal trends in the CHD proportions across SES categories were observed over the study period. The distribution across SES quintiles was different only for specific CHD subtypes (double-outlet right ventricle (n = 485, p = 0.03), hypoplastic left heart syndrome (n = 547, p = 0.006), heterotaxy (n = 224, p = 0.03), tetralogy of Fallot (n = 1007, p = 0.008), truncus arteriosus (n = 126, p < 0.0001), and ventricular septal defect (n = 1916, p < 0.0001)), with highest proportions observed in the lowest quintile. The proportion of the total population with ED but not GS was highest in lower SES quintiles (< 0.0001) commensurate with increased proportion of CHD. Our study suggests a negative association between SES and certain CHD lesions and ED.
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Affiliation(s)
- Christopher Smith
- School of Public Health, University of Alberta, Edmonton, Canada
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
| | - Oluwayomi Olugbuyi
- Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Padma Kaul
- School of Public Health, University of Alberta, Edmonton, Canada
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Douglas C Dover
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
| | - Andrew S Mackie
- Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | | | - Luke Eckersley
- Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Lisa K Hornberger
- Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
- Department of Obstetrics & Gynecology, Women & Children's Health Research Institute, University of Alberta, Edmonton, Canada.
- Pediatric Cardiology, Stollery Children's Hospital, 4C2, 8440 112th Street, Edmonton, AB, T6G 2B7, Canada.
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Stallings EB, Isenburg JL, Rutkowski RE, Kirby RS, Nembhard WN, Sandidge T, Villavicencio S, Nguyen HH, McMahon DM, Nestoridi E, Pabst LJ. National population-based estimates for major birth defects, 2016-2020. Birth Defects Res 2024; 116:e2301. [PMID: 38277408 PMCID: PMC10898112 DOI: 10.1002/bdr2.2301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/26/2023] [Accepted: 01/03/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND We provide updated crude and adjusted prevalence estimates of major birth defects in the United States for the period 2016-2020. METHODS Data were collected from 13 US population-based surveillance programs that used active or a combination of active and passive case ascertainment methods to collect all birth outcomes. These data were used to calculate pooled prevalence estimates and national prevalence estimates adjusted for maternal race/ethnicity for all conditions, and maternal age for trisomies and gastroschisis. Prevalence was compared to previously published national estimates from 1999 to 2014. RESULTS Adjusted national prevalence estimates per 10,000 live births ranged from 0.63 for common truncus to 18.65 for clubfoot. Temporal changes were observed for several birth defects, including increases in the prevalence of atrioventricular septal defect, tetralogy of Fallot, omphalocele, trisomy 18, and trisomy 21 (Down syndrome) and decreases in the prevalence of anencephaly, common truncus, transposition of the great arteries, and cleft lip with and without cleft palate. CONCLUSION This study provides updated national estimates of selected major birth defects in the United States. These data can be used for continued temporal monitoring of birth defects prevalence. Increases and decreases in prevalence since 1999 observed in this study warrant further investigation.
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Affiliation(s)
- Erin B. Stallings
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer L. Isenburg
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rachel E. Rutkowski
- Chiles Center, College of Public Health, University of South Florida, Tampa, Florida, USA
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Russell S. Kirby
- Chiles Center, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Wendy N. Nembhard
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Arkansas Center for Birth Defects Research and Prevention, Little Rock, Arkansas, USA
| | - Theresa Sandidge
- Illinois Department of Public Health, Springfield, Illinois, USA
| | - Stephan Villavicencio
- Chiles Center, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Hoang H. Nguyen
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Daria M. McMahon
- South Carolina Department of Health and Environmental Control, Columbia, South Carolina, USA
| | - Eirini Nestoridi
- Division for Surveillance, Research, and Promotion of Perinatal Health, Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Laura J. Pabst
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Mamasoula C, Bigirumurame T, Chadwick T, Addor MC, Cavero-Carbonell C, Dias CM, Echevarría-González-de-Garibay LJ, Gatt M, Khoshnood B, Klungsoyr K, Randall K, Stoianova S, Haeusler M, Nelen V, Neville AJ, Perthus I, Pierini A, Bertaut-Nativel B, Rissmann A, Rouget F, Schaub B, Tucker D, Wellesley D, Zymak-Zakutnia N, Barisic I, de Walle HEK, Lanzoni M, Sayers G, Mullaney C, Pennington L, Rankin J. Maternal age and the prevalence of congenital heart defects in Europe, 1995-2015: A register-based study. Birth Defects Res 2023; 115:583-594. [PMID: 36734416 DOI: 10.1002/bdr2.2152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/18/2022] [Accepted: 01/10/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Evidence on the direction and strength of association between maternal age and the prevalence of congenital heart defects (CHD) in different age group categories is conflicting. Some studies have illustrated different trends with an increase in prevalence in younger and older age groups while other studies have reported a linear relationship. Given the increase in maternal age over recent years, it is important to study the CHD prevalence by maternal age. OBJECTIVES To examine the association between maternal age and the prevalence of CHD in Europe between 1995 and 2015 using population-based data from 24 registries belonging to the European Surveillance of Congenital Anomalies (EUROCAT) network. METHODS Associations over time of all nonsyndromic CHD according to maternal age category and for three CHD severity groupings (severity group I: very severe; severity group II: severe; severity group III: less severe) were examined using Bayesian multilevel Poisson regression modeling. Further subgroup analyses were undertaken within four maternal age-bands: ≤24, 25-29, 30-34 and 35-44 years. Descriptive summaries are also presented. RESULTS There were 51,608 nonsyndromic CHD cases in Europe over the 20-year study period. Total prevalence for all CHD combined was increased for younger mothers (≤24 years) and for mothers 35-44 years of age when compared with mothers aged 25-29 years (reference group) (IRR: 1.05, 95% CI: 1.02, 1.07). The total prevalence was increased for severity group I (very severe) only for younger mothers compared to those aged 25-29 years (IRR: 1.14, 95% CI: 1.04, 1.23). We found an increased prevalence of the following CHD subtypes: double outlet right ventricle (IRR:1.33, 95% CI: 1.09, 1.60), hypoplastic left heart syndrome (IRR: 1.18, 95% CI: 1.05, 1.32), hypoplastic right heart syndrome (IRR: 1.41, 95% CI: 1.05, 1.84), atrioventricular septal defect (IRR: 1.15, 95% CI: 1.01, 1.32), coarctation of aorta (IRR: 1.15, 95% CI: 1.03, 1.28) and atrial septal defect (IRR: 1.08, 95% CI: 1.02, 1.13). For older mothers (35-44 years) compared to the reference category, we observed an increased risk in the prevalence for severity group II (IRR: 1.09, 95% CI: 1.03, 1.14), severity group III (IRR: 1.05, 95% CI: 1.01, 1.08) and an increased prevalence of the CHD subtypes: Pulmonary valve stenosis (IRR: 1.22, 95% CI: 1.09, 1.34), ASD (IRR: 1.07, 95% CI: 1.02, 1.13), CoA (IRR: 1.18, 95% CI: 1.06, 1.32) and Tetralogy of Fallot (IRR: 1.14, 95% CI: 1.01, 1.28). Finally, for all age categories compared to the reference category, different associations of ASD and an increased prevalence of CoA was also observed. CONCLUSIONS Based on data for cases of CHD from 24 European population-based registries, evidence of a positive association between maternal age and the total prevalence of CHD for younger (≤24 years old) and older (35-44 years old) mothers was observed. The results suggest that young maternal age (≤24 years old) is a factor associated with severe CHD phenotypes while a positive association between advanced maternal age (35-44 years old) and mild CHD phenotypes was observed.
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Affiliation(s)
| | | | - Thomas Chadwick
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Marie-Claude Addor
- Department of Woman-Mother-Child, University Medical Center CHUV, Lausanne, Switzerland
| | - Clara Cavero-Carbonell
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, Valencia, Spain
| | - Carlos M Dias
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
- Epidemiology Department, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
| | - Luis-Javier Echevarría-González-de-Garibay
- Ministry of Health of the Basque Government. Directorate for Healthcare Planning, Organisation and Evaluation, Registries and Health Information Unit, Vitoria-Gasteiz, Spain
| | - Miriam Gatt
- Malta Congenital Anomalies Register, Directorate for Health Information and Research, Pietà, Malta
| | - Babak Khoshnood
- Université de Paris, INSERM U1153, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Paris, France
| | - Kari Klungsoyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Division for Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Kay Randall
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sylvia Stoianova
- South West Congenital Anomaly Register, Bristol Medical School, University of Bristol, Bristol, UK
| | - Martin Haeusler
- Styrian Malformation Registry, Med. University of Graz, Graz, Austria
| | - Vera Nelen
- Provinciaal Instituut voor Hygiene (PIH), Antwerp, Belgium
| | - Amanda J Neville
- Registro IMER - IMER Registry (Emilia Romagna Registry of Birth Defects), Center for Clinical and Epidemiological Research, University of Ferrara, Ferrara, Italy
| | - Isabelle Perthus
- Auvergne registry of congenital anomalies (CEMC-Auvergne), Department of clinical genetics, Centre de Référence des Maladies Rares, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Anna Pierini
- Tuscany Registry of Congenital Defects (RTDC), Institute of Clinical Physiology - National Research Council/ Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty Otto-von-Guericke University, Magdeburg, Germany
| | - Florence Rouget
- Brittany Registry of Congenital Anomalies, CHU Rennes, University Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), Rennes, France
| | - Bruno Schaub
- French West Indies Registry, Registre des Malformations des Antilles (REMALAN), Maison de la Femme de la Mère et de l'Enfant, University Hospital of Martinique, Fort-de-France, France
| | - David Tucker
- CARIS, Public Health Wales, Singleton Hospital, Swansea, UK
| | - Diana Wellesley
- Wessex Clinical Genetics Department, Princess Anne Hospital, Southampton, UK
| | - Natalya Zymak-Zakutnia
- OMNI-Net Ukraine Birth Defects Program and Khmelnytsky City Children's Hospital, Khmelnytsky, Ukraine
| | - Ingeborg Barisic
- Centre of Excellence for Reproductive and Regenerative Medicine, Children's Hospital Zagreb, Medical School University of Zagreb, Zagreb, Croatia
| | - Hermien E K de Walle
- University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, Netherlands
| | - Monica Lanzoni
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - Gerardine Sayers
- Health Service Executive, Dr Steeven's Hospital, Dublin, Ireland
| | - Carmel Mullaney
- Department of Public Health, Service Executive (HSE) South East Area, Limerick, Ireland
| | - Lindsay Pennington
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
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Social determinants of health and outcomes for children and adults with congenital heart disease: a systematic review. Pediatr Res 2021; 89:275-294. [PMID: 33069160 DOI: 10.1038/s41390-020-01196-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/02/2020] [Accepted: 09/10/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Social determinants of health (SDH) can substantially impact health outcomes. A systematic review, however, has never been conducted on associations of SDH with congenital heart disease (CHD) outcomes. The aim, therefore, was to conduct such a systematic review. METHODS Seven databases were searched through May 2020 to identify articles on SDH associations with CHD. SDH examined included poverty, uninsurance, housing instability, parental educational attainment, immigration status, food insecurity, and transportation barriers. Studies were independently selected and coded by two researchers based on the PICO statement. RESULTS The search generated 3992 citations; 88 were included in the final database. SDH were significantly associated with a lower likelihood of fetal CHD diagnosis, higher CHD incidence and prevalence, increased infant mortality, adverse post-surgical outcomes (including hospital readmission and death), decreased healthcare access (including missed appointments, no shows, and loss to follow-up), impaired neurodevelopmental outcomes (including IQ and school performance) and quality of life, and adverse outcomes for adults with CHD (including endocarditis, hospitalization, and death). CONCLUSIONS SDH are associated with a wide range of adverse outcomes for fetuses, children, and adults with CHD. SDH screening and referral to appropriate services has the potential to improve outcomes for CHD patients across the lifespan. IMPACT Social determinants of health (SDH) are associated with a wide range of adverse outcomes for fetuses, children, and adults with congenital heart disease (CHD). This is the first systematic review (to our knowledge) on associations of SDH with congenital heart disease CHD outcomes. SDH screening and referral to appropriate services has the potential to improve outcomes for CHD patients across the lifespan.
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Peyvandi S, Baer RJ, Chambers CD, Norton ME, Rajagopal S, Ryckman KK, Moon-Grady A, Jelliffe-Pawlowski LL, Steurer MA. Environmental and Socioeconomic Factors Influence the Live-Born Incidence of Congenital Heart Disease: A Population-Based Study in California. J Am Heart Assoc 2020; 9:e015255. [PMID: 32306820 PMCID: PMC7428546 DOI: 10.1161/jaha.119.015255] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The development of congenital heart disease (CHD) is multifactorial with genetic and environmental influences. We sought to determine the relationship between socioeconomic and environmental factors with the incidence of CHD among live‐born infants in California and to determine whether maternal comorbidities are in the causal pathway. METHODS AND RESULTS This was a population‐based cohort study in California (2007–2012). The primary outcome was having significant CHD. Predictors included socioeconomic status and environmental exposure to pollutants determined by U.S. Census data. A social deprivation index and environmental exposure index was assigned based on neighborhood socioeconomic variables, categorized into 4 quartiles. Quartile 1 was the best with the least exposure to pollutants and social deprivation, and quartile 4 was the worst. Multivariate logistic regression and mediation analyses were performed. Among 2 419 651 live‐born infants, the incidence of CHD was 3.2 per 1000 live births. The incidence of CHD was significantly higher among those in quartile 4 compared with quartile 1 (social deprivation index: 0.35% versus 0.29%; odds ratio [OR], 1.31; 95% CI, 1.21–1.41; environmental exposure index: 0.35% versus 0.29%; OR, 1.23; 95% CI, 1.15–1.31) after adjusting for maternal race/ethnicity and age and accounting for the relationship between the 2 primary predictors. Maternal comorbidities explained 13% (95% CI, 10%–20%) of the relationship between social deprivation index and environmental exposure index with the incidence of CHD. CONCLUSIONS Increased social deprivation and exposure to environmental pollutants are associated with the incidence of live‐born CHD in California. Maternal comorbidities explain some, but not all, of this relationship. These findings identify targets for social policy initiatives to minimize health disparities.
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Affiliation(s)
- Shabnam Peyvandi
- Division of Cardiology Department of Pediatrics University of California San Francisco Benioff Children's Hospital San Francisco CA.,Department of Epidemiology and Biostatistics University of California San Francisco Benioff Children's Hospital San Francisco CA
| | - Rebecca J Baer
- Obstetrics, Gynecology and Reproductive Sciences University of California San Francisco Benioff Children's Hospital San Francisco CA.,California Preterm Birth Initiative University of California San Francisco Benioff Children's Hospital San Francisco CA.,Department of Pediatrics University of California San Diego La Jolla CA
| | | | - Mary E Norton
- Obstetrics, Gynecology and Reproductive Sciences University of California San Francisco Benioff Children's Hospital San Francisco CA
| | - Satish Rajagopal
- Division of Critical Care University of California San Francisco Benioff Children's Hospital San Francisco CA
| | - Kelli K Ryckman
- Department of Epidemiology College of Public Health University of Iowa Iowa City IA
| | - Anita Moon-Grady
- Division of Cardiology Department of Pediatrics University of California San Francisco Benioff Children's Hospital San Francisco CA
| | - Laura L Jelliffe-Pawlowski
- Department of Epidemiology and Biostatistics University of California San Francisco Benioff Children's Hospital San Francisco CA.,California Preterm Birth Initiative University of California San Francisco Benioff Children's Hospital San Francisco CA
| | - Martina A Steurer
- Division of Critical Care University of California San Francisco Benioff Children's Hospital San Francisco CA.,Department of Epidemiology and Biostatistics University of California San Francisco Benioff Children's Hospital San Francisco CA.,California Preterm Birth Initiative University of California San Francisco Benioff Children's Hospital San Francisco CA
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Cotteret C, Pham YV, Marcais A, Driessen M, Cisternino S, Schlatter J. Maternal ABVD chemotherapy for Hodgkin lymphoma in a dichorionic diamniotic pregnancy: a case report. BMC Pregnancy Childbirth 2020; 20:231. [PMID: 32306909 PMCID: PMC7168968 DOI: 10.1186/s12884-020-02928-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 04/07/2020] [Indexed: 12/20/2022] Open
Abstract
Background Hodgkin lymphoma (HL) is the most common hematological malignancy during pregnancy. The first-line treatment for HL in pregnancy is the standard ABVD regimen without any drug and/or dose adjustment. However, data on chemotherapy during twin pregnancies are sparse, and a better understanding of the mechanisms involved in exposure to and the toxic effects of anticancer drugs in the fetuses is needed. Case presentation A 41-year-old dichorionic diamniotic pregnant patient was given ABVD treatment for HL at a gestational age of 28 weeks and 3 days. The patient received 2 cycles of chemotherapy with a 15-day therapeutic window including an actual 25 mg/m2 dose of doxorubicin per cycle. Unlike the female twin, the male twin presented four days after birth a left cardiac dysfunction. Doxorubicin cardiotoxicity in the male newborn was also supported by high blood levels of troponin. At one month of age, echocardiography findings were normal. We investigated literature data on physiological aspects of pregnancy that may influence doxorubicin pharmacokinetics, and pharmacodynamic and pharmacokinetic data on the use of doxorubicin in pregnancy. We detailed the role of the transporters in doxorubicin placenta distribution, and tried to understand why only one fetus was affected. Conclusions Fetal safety depends at least on maternal doxorubicin pharmacokinetics.Because of drug interactions (i.e. drug metabolism and drug transport), care should always be taken to avoid maternal pharmacokinetic variability. The toxic effects were discrepant between the dizygotic twins, suggesting additional fetus-specific pharmacokinetic/pharmacodynamic factors in doxorubicin toxicity.
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Affiliation(s)
- Camille Cotteret
- Hôpital universitaire Necker - Enfants malades, Pharmacie, F-75015, Paris, France
| | - Yen-Vi Pham
- Hôpital universitaire Necker - Enfants malades, Pharmacie, F-75015, Paris, France
| | - Ambroise Marcais
- Hôpital universitaire Necker - Enfants malades, Hématologie adultes, F-75015, Paris, France
| | - Marine Driessen
- Hôpital universitaire Necker - Enfants malades, gynécologie-obstétrique, F-75015, Paris, France
| | - Salvatore Cisternino
- Hôpital universitaire Necker - Enfants malades, Pharmacie, F-75015, Paris, France.,Inserm UMR-S 1144, Team "Blood-brain barrier in brain pathophysiology and therapy", Université Paris Descartes, F-75006, Paris, France
| | - Joël Schlatter
- Hôpital universitaire Necker - Enfants malades, Pharmacie, F-75015, Paris, France.
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Lahiri S, Gil W, Daria S, Joshua G, Parul J, Redmond B, Elizabeth W. Genetic abnormalities/syndromes significantly impact perioperative outcomes of conotruncal heart defects. Ann Pediatr Cardiol 2019; 13:38-45. [PMID: 32030034 PMCID: PMC6979035 DOI: 10.4103/apc.apc_51_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/05/2019] [Accepted: 07/23/2019] [Indexed: 12/13/2022] Open
Abstract
Objectives: The main objective of the study is to characterize the effects of genetic abnormalities/syndromes (GA/S) on perioperative outcomes of cardiac surgeries involving repair of conotruncal heart defects (CTHD). Design: The study involves a single-center retrospective analysis of patients who underwent complete repair of CTHDs (tetralogy of Fallot [TOF], truncus arteriosus, interrupted aortic arch, and ventricular septal defect with coarctation) between January 2000 and December 2015. The primary outcome was the post operative length of stay (PLOS). The secondary outcomes were mortality, cardiac complications, hematologic complications, infections, and number of medications-at-discharge. Setting: Cardiac intensive care unit in a tertiary pediatric hospital in South Florida that performs around 300 open-heart surgeries a year. Subjects: A total of 177 patients with CTHDs who underwent cardiac surgeries in the stated time period were included in the final study cohort. Measurements and Main Results: Majority of patients had TOF (72.5%) and 46 (26%) had GA/S. The most common GA/S was 22q11 deletion (37%). PLOS was significantly increased in patients with GA/S (P < 0.05). Patients with GA/S were 4.5 times more likely to have a postoperative cardiac complication, 4.2 times more likely to have a postoperative infection, and received 1.6 times more medications at discharge than those without GA/S. However, GA/S was not associated with increased perioperative mortality. Black patients were three times more likely to have a longer PLOS than White patients. Conclusions: Perioperative outcomes in patients with GA/S suggested an increased residual cardiovascular disease and increased resource usage. Notably, this is the first study demonstrating the effect of race and ethnicity on PLOS in CTHD patients.
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Affiliation(s)
- Subhrajit Lahiri
- Pediatric Cardiology, Texas Children's Hospital, Houston, Texas, USA
| | - Wernovsky Gil
- Pediatric Cardiology, Children's National Health System, Washington, DC, USA
| | - Salyakina Daria
- Heart Center, Nicklaus Children's Hospital, Miami, Florida, USA
| | - Gruber Joshua
- Heart Center, Nicklaus Children's Hospital, Miami, Florida, USA
| | - Jayakar Parul
- Heart Center, Nicklaus Children's Hospital, Miami, Florida, USA
| | - Burke Redmond
- Heart Center, Nicklaus Children's Hospital, Miami, Florida, USA
| | - Welch Elizabeth
- Heart Center, Nicklaus Children's Hospital, Miami, Florida, USA
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Cook JC, Lynch ME, Coles CD. Association Analysis: Fetal Alcohol Spectrum Disorder and Hypertension Status in Children and Adolescents. Alcohol Clin Exp Res 2019; 43:1727-1733. [DOI: 10.1111/acer.14121] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 05/27/2019] [Indexed: 11/26/2022]
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Moe TG, Bardo DME. Long-term Outcomes of the Arterial Switch Operation for d-Transposition of the Great Arteries. Prog Cardiovasc Dis 2018; 61:360-364. [PMID: 30227186 DOI: 10.1016/j.pcad.2018.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 08/22/2018] [Indexed: 12/16/2022]
Abstract
Dextrotransposition of the great arteries (d-TGA) is a relatively rare form of complex childhood congenital heart disease, which occurs in approximately 0.2 in 1000 live births (Long et al, 2010). The most common palliative procedure for this anatomy has become the arterial switch operation (ASO). We will review in this paper the evidence that is currently available regarding the clinical management following the ASO. Individuals with d-TGA who undergo ASO at a young age thus far have excellent long-term outcomes. Long-term complications for the ASO should be monitored for and patients should have routine follow-up with specialists in adult congenital heart disease.
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Affiliation(s)
- Tabitha G Moe
- Arizona Cardiology Group, 340 E Palm Lane Ste A175, Phoenix, AZ 85004, United States of America.
| | - Dianna M E Bardo
- Phoenix Children's Hospital, Radiology Dept., 1919 E Thomas Rd., Phoenix, AZ 85006, United States of America.
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Agopian AJ, Goldmuntz E, Hakonarson H, Sewda A, Taylor D, Mitchell LE. Genome-Wide Association Studies and Meta-Analyses for Congenital Heart Defects. ACTA ACUST UNITED AC 2018; 10:e001449. [PMID: 28468790 DOI: 10.1161/circgenetics.116.001449] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 02/01/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Maternal and inherited (ie, case) genetic factors likely contribute to the pathogenesis of congenital heart defects, but it is unclear whether individual common variants confer a large risk. METHODS AND RESULTS To evaluate the relationship between individual common maternal/inherited genotypes and risk for heart defects, we conducted genome-wide association studies in 5 cohorts. Three cohorts were recruited at the Children's Hospital of Philadelphia: 670 conotruncal heart defect (CTD) case-parent trios, 317 left ventricular obstructive tract defect (LVOTD) case-parent trios, and 406 CTD cases (n=406) and 2976 pediatric controls. Two cohorts were recruited through the Pediatric Cardiac Genomics Consortium: 355 CTD trios and 192 LVOTD trios. We also conducted meta-analyses using the genome-wide association study results from the CTD cohorts, the LVOTD cohorts, and from the combined CTD and LVOTD cohorts. In the individual genome-wide association studies, several genome-wide significant associations (P≤5×10-8) were observed. In our meta-analyses, 1 genome-wide significant association was detected: the case genotype for rs72820264, an intragenetic single-nucleotide polymorphism associated with LVOTDs (P=2.1×10-8). CONCLUSIONS We identified 1 novel candidate region associated with LVOTDs and report on several additional regions with suggestive evidence for association with CTD and LVOTD. These studies were constrained by the relatively small samples sizes and thus have limited power to detect small to moderate associations. Approaches that minimize the multiple testing burden (eg, gene or pathway based) may, therefore, be required to uncover common variants contributing to the risk of these relatively rare conditions.
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Affiliation(s)
- A J Agopian
- From the Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Houston (A.J.A., A.S., L.E.M.); Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (E.G.); and Division of Cardiology (E.G., H.H.), Center for Applied Genomics (H.H.), and Department of Biomedical and Health Informatics (D.T.), The Children's Hospital of Philadelphia, PA
| | - Elizabeth Goldmuntz
- From the Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Houston (A.J.A., A.S., L.E.M.); Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (E.G.); and Division of Cardiology (E.G., H.H.), Center for Applied Genomics (H.H.), and Department of Biomedical and Health Informatics (D.T.), The Children's Hospital of Philadelphia, PA
| | - Hakon Hakonarson
- From the Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Houston (A.J.A., A.S., L.E.M.); Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (E.G.); and Division of Cardiology (E.G., H.H.), Center for Applied Genomics (H.H.), and Department of Biomedical and Health Informatics (D.T.), The Children's Hospital of Philadelphia, PA
| | - Anshuman Sewda
- From the Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Houston (A.J.A., A.S., L.E.M.); Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (E.G.); and Division of Cardiology (E.G., H.H.), Center for Applied Genomics (H.H.), and Department of Biomedical and Health Informatics (D.T.), The Children's Hospital of Philadelphia, PA
| | - Deanne Taylor
- From the Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Houston (A.J.A., A.S., L.E.M.); Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (E.G.); and Division of Cardiology (E.G., H.H.), Center for Applied Genomics (H.H.), and Department of Biomedical and Health Informatics (D.T.), The Children's Hospital of Philadelphia, PA
| | - Laura E Mitchell
- From the Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Houston (A.J.A., A.S., L.E.M.); Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (E.G.); and Division of Cardiology (E.G., H.H.), Center for Applied Genomics (H.H.), and Department of Biomedical and Health Informatics (D.T.), The Children's Hospital of Philadelphia, PA.
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Update on the Management of Adults With Arterial Switch Procedure for Transposition of the Great Arteries. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:4. [PMID: 28155117 DOI: 10.1007/s11936-017-0505-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OPINION STATEMENT The arterial switch operation (ASO) is now the most frequently performed surgical correction in individuals with dextro-transposition of the great arteries (D-TGA). Patients who undergo this procedure as neonates have overall good clinical outcomes yet continued clinical follow-up is important to evaluate for postoperative complications. In this group, the highest mortality is in the immediate postoperative period and is generally associated with reimplantation of the coronary arteries. As these patients live into adulthood, longitudinal follow-up for other ASO complications including neo-pulmonary stenosis, right ventricular outflow tract (RVOT) obstruction, or neo-aortic root dilation and resulting aortic insufficiency should be performed. In adults, extra care should be taken to identify and treat traditional cardiovascular risk factors as individuals with coronary obstruction may not present with typical anginal symptoms. Management of these patients should be performed in collaboration with an adult congenital heart center of excellence. This population offers a unique opportunity to provide timely feedback to adult congenital heart community of providers regarding late outcomes from surgical intervention and in the next decade will hopefully demonstrate a model for clinical feedback cycles in lifelong congenital care.
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Kasmi L, Bonnet D, Montreuil M, Kalfa D, Geronikola N, Bellinger DC, Calderon J. Neuropsychological and Psychiatric Outcomes in Dextro-Transposition of the Great Arteries across the Lifespan: A State-of-the-Art Review. Front Pediatr 2017; 5:59. [PMID: 28393063 PMCID: PMC5364136 DOI: 10.3389/fped.2017.00059] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 03/10/2017] [Indexed: 11/17/2022] Open
Abstract
Advances in prenatal diagnosis, perioperative management, and postoperative care have dramatically increased the population of survivors of neonatal and infant heart surgery. The high survival rate of these patients into adulthood has exposed the alarming prevalence of long-term neuropsychological and psychiatric morbidities. Dextro-transposition of the great arteries (d-TGA) is one of the most extensively studied cyanotic congenital heart defect (CHD) with regard to neurodevelopmental outcomes. Landmark studies have described a common neurodevelopmental and behavioral phenotype associated with d-TGA. Children with d-TGA display impairments in key neurocognitive areas, including visual-spatial and fine motor abilities, executive functioning, processing speed, and social cognition. As they grow older, they may face additional challenges with a worsening of deficits in higher order cognitive skills, problems in psychosocial adjustment and a higher-than-expected rate of psychiatric disorders, such as attention-deficit hyperactivity disorder, depression, and anxiety. The aim of this review is to summarize the available recent data on neuropsychological and psychiatric outcomes in individuals with d-TGA after the arterial switch operation. We present findings within a life-span perspective, with a particular emphasis on the emerging literature on adolescent and young adult outcomes. Finally, we propose avenues for future research in the CHD adult neuropsychology field. Among these avenues, we explore the potential mechanisms by which pediatric neurodevelopmental impairments may have lifelong adverse effects as well as alternative interventions that could optimize outcomes.
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Affiliation(s)
- Leila Kasmi
- Laboratory of Psychopathology and Neuropsychology, Department of Psychology, University Paris 8, Paris Lumières - CNRS , Saint-Denis , France
| | - Damien Bonnet
- Referral Center for Complex Congenital Cardiac Malformations, Department of Congenital and Pediatric Cardiology, Necker Hospital, University Paris Descartes, Sorbonne Paris Cité , Paris , France
| | - Michèle Montreuil
- Laboratory of Psychopathology and Neuropsychology, Department of Psychology, University Paris 8, Paris Lumières - CNRS , Saint-Denis , France
| | - David Kalfa
- Division of Cardiac, Thoracic, and Vascular Surgery, Section of Pediatric Cardiac Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Irving Medical Center, Columbia University , New York, NY , USA
| | - Nikoletta Geronikola
- Laboratory of Psychopathology and Neuropsychology, Department of Psychology, University Paris 8, Paris Lumières - CNRS , Saint-Denis , France
| | - David C Bellinger
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Johanna Calderon
- Department of Psychiatry, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA
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Nelson JS, Stebbins RC, Strassle PD, Meyer RE. Geographic distribution of live births with tetralogy of Fallot in North Carolina 2003 to 2012. ACTA ACUST UNITED AC 2016; 106:881-887. [PMID: 27891781 DOI: 10.1002/bdra.23566] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/21/2016] [Accepted: 08/24/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Geographic variation in congenital heart disease is not well-described. This study uses geographic information systems (GIS) to describe the spatial epidemiology of tetralogy of Fallot (TOF), in North Carolina (NC) and to compare travel time for cases to congenital heart centers in NC. METHODS Using the NC Birth Defects Monitoring Program database, live births with TOF born between 2003 and 2012 were identified. Birth certificates provided demographic variables. A denominator of live births/zip code was obtained from the NC live births database. ArcGIS® software was used to illustrate TOF prevalence by zip code, and SatScanTM was used to identify spatial clusters of TOF cases and to identify changes in cluster location over time. Driving time to each of five NC congenital heart centers was predicted based on road systems information. RESULTS A total of 496 infants were born with TOF between 2003 and 2012. The prevalence was 4.2/10,000 live births. A large cluster (330 zip codes, 306 cases) was identified in northeastern NC. Average driving time for each case to closest congenital heart center was: University of North Carolina 37 min, Vident Medical Center 64 min, Duke University 58 min, Carolina's Medical Center 89 min, and Wake Forest Baptist Health 57 min. Overall, average predicted driving time to the nearest congenital heart center was 61 min. CONCLUSION Approximately 50 infants/year were born with TOF in NC. One cluster was identified. Further study is necessary to explore potential explanations for the observed case cluster. As interest in regionalization of congenital heart surgery grows, GIS and spatial analysis can become increasingly useful tools for health care planning. Birth Defects Research (Part A) 106:881-887, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jennifer S Nelson
- Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Rebecca C Stebbins
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Paula D Strassle
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Robert E Meyer
- North Carolina State Center for Health Statistics Birth Defects Monitoring Program, Raleigh, North Carolina
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Best KE, Rankin J. Is advanced maternal age a risk factor for congenital heart disease? ACTA ACUST UNITED AC 2016; 106:461-7. [DOI: 10.1002/bdra.23507] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 03/10/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Kate E. Best
- Institute of Health & Society; Newcastle University; Newcastle upon Tyne United Kingdom
| | - Judith Rankin
- Institute of Health & Society; Newcastle University; Newcastle upon Tyne United Kingdom
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Feng Y, Wang S, Zhao L, Yu D, Hu L, Mo X. Maternal reproductive history and the risk of congenital heart defects in offspring: a systematic review and meta-analysis. Pediatr Cardiol 2015; 36:253-63. [PMID: 25500695 DOI: 10.1007/s00246-014-1079-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 12/05/2014] [Indexed: 01/09/2023]
Abstract
Epidemiological studies have reported conflicting results on the association of congenital heart defect (CHD) risk in offspring with a maternal history of prior pregnancies and abortions, but no meta-analysis has been reported. We searched MEDLINE and EMBASE from their inception to April 14, 2014, for relevant studies that assessed the association between maternal reproductive history and CHD risk. Two authors independently assessed eligibility and extracted data. Fixed-effects or random-effects models were used to calculate the pooled odds ratios (ORs). Among 1,599 references, 17 case-control studies and one nested case-control study were included in this meta-analysis. The summary OR for the ever versus nulligravidity was 1.18 (95% CI 1.03-1.34). A dose-response analysis also indicated a positive effect of maternal gravidity on CHD risk, and the summary OR for each increment in number of pregnancies was 1.13 (95% CI 1.08-1.18). A history of abortion was associated with a 24% higher risk of CHD, OR = 1.24 (95% CI 1.11-1.38). When stratified by abortion category, CHD risk increased by 18 and 58% with a history of spontaneous abortion and induced abortion, respectively. The summary OR for each increment of one abortion was 1.28 (95% CI 1.18-1.40). In summary, this study provides evidence that increased maternal gravidity was positively associated with a risk of CHDs in offspring. Meanwhile, our results demonstrate a positive association of any history of abortion with an increased risk of CHDs.
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Affiliation(s)
- Yu Feng
- Department of Cardiothoracic Surgery, The Affiliated Children's Hospital of Nanjing Medical University, 72 Guangzhou Rd, Nanjing, 210008, Jiangsu, People's Republic of China
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Zhang Y, Kang Y, Zhou Q, Zhou J, Wang H, Jin H, Liu X, Ma D, Li X. Quantitative proteomic analysis of serum from pregnant women carrying a fetus with conotruncal heart defect using isobaric tags for relative and absolute quantitation (iTRAQ) labeling. PLoS One 2014; 9:e111645. [PMID: 25393621 PMCID: PMC4230941 DOI: 10.1371/journal.pone.0111645] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 10/03/2014] [Indexed: 12/13/2022] Open
Abstract
Objective To identify differentially expressed proteins from serum of pregnant women carrying a conotruncal heart defects (CTD) fetus, using proteomic analysis. Methods The study was conducted using a nested case-control design. The 5473 maternal serum samples were collected at 14–18 weeks of gestation. The serum from 9 pregnant women carrying a CTD fetus, 10 with another CHD (ACHD) fetus, and 11 with a normal fetus were selected from the above samples, and analyzed by using isobaric tags for relative and absolute quantitation (iTRAQ) coupled with two-dimensional liquid chromatography-tandem mass spectrometry(2D LC-MS/MS). The differentially expressed proteins identified by iTRAQ were further validated with Western blot. Results A total of 105 unique proteins present in the three groups were identified, and relative expression data were obtained for 92 of them with high confidence by employing the iTRAQ-based experiments. The downregulation of gelsolin in maternal serum of fetus with CTD was further verified by Western blot. Conclusions The identification of differentially expressed protein gelsolin in the serum of the pregnant women carrying a CTD fetus by using proteomic technology may be able to serve as a foundation to further explore the biomarker for detection of CTD fetus from the maternal serum.
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Affiliation(s)
- Ying Zhang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Yuan Kang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Qiongjie Zhou
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Jizi Zhou
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Huijun Wang
- Children's Hospital, Fudan University, Shanghai, China
| | - Hong Jin
- Department of Chemistry, Fudan University, Shanghai, China
- Institute of Biomedicine, Fudan University, Shanghai, China
| | - Xiaohui Liu
- Department of Chemistry, Fudan University, Shanghai, China
| | - Duan Ma
- Key Laboratory of Molecular Medicine, Ministry of Education, Department of Biochemistry and Molecular Biology, Institute of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
- * E-mail: (XL); (DM)
| | - Xiaotian Li
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- Key Laboratory of Molecular Medicine, Ministry of Education, Department of Biochemistry and Molecular Biology, Institute of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
- * E-mail: (XL); (DM)
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Maternal socioeconomic status and the risk of congenital heart defects in offspring: a meta-analysis of 33 studies. PLoS One 2014; 9:e111056. [PMID: 25347676 PMCID: PMC4210244 DOI: 10.1371/journal.pone.0111056] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 09/17/2014] [Indexed: 01/12/2023] Open
Abstract
Background We conducted this meta-analysis to address the open question of a possible association between maternal socioeconomic status and congenital heart defects (CHDs). Methods We searched MEDLINE and EMBASE from their inception to January 1, 2014 for case-control and cohort studies that assessed the association between maternal socioeconomic status and the risk of CHDs. Study-specific relative risk estimates were polled according to random-effect or fixed-effect models. Results From 3343 references, a total of 31 case-control studies and 2 cohort studies were enrolled in this meta-analysis, including more than 50,000 cases. We observed that maternal educational attainment, family income and maternal occupation were negatively associated with an 11% (pooled RR = 1.11, 95% CI: 1.03, 1.21), 5% (pooled RR = 1.05, 95% CI: 1.01, 1.09) and 51% (pooled RR = 1.51, 95% CI: 1.02, 2.24) increased risk of CHDs, respectively. In a subgroup analysis by geographic region, the results were inconsistent for the European region (RR = 1.29, 95% CI: 0.99–1.69) and USA/Canada region (RR = 1.06, 95% CI: 0.97, 1.16) in maternal educational attainment. Conclusion In summary, this meta-analysis suggests that a lower degree of maternal socioeconomic status is modestly associated with an increased risk of CHDs. However, further investigations are needed to confirm the association.
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Villafañe J, Lantin-Hermoso MR, Bhatt AB, Tweddell JS, Geva T, Nathan M, Elliott MJ, Vetter VL, Paridon SM, Kochilas L, Jenkins KJ, Beekman RH, Wernovsky G, Towbin JA. D-transposition of the great arteries: the current era of the arterial switch operation. J Am Coll Cardiol 2014; 64:498-511. [PMID: 25082585 DOI: 10.1016/j.jacc.2014.06.1150] [Citation(s) in RCA: 175] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 06/20/2014] [Indexed: 01/25/2023]
Abstract
This paper aims to update clinicians on "hot topics" in the management of patients with D-loop transposition of the great arteries (D-TGA) in the current surgical era. The arterial switch operation (ASO) has replaced atrial switch procedures for D-TGA, and 90% of patients now reach adulthood. The Adult Congenital and Pediatric Cardiology Council of the American College of Cardiology assembled a team of experts to summarize current knowledge on genetics, pre-natal diagnosis, surgical timing, balloon atrial septostomy, prostaglandin E1 therapy, intraoperative techniques, imaging, coronary obstruction, arrhythmias, sudden death, neoaortic regurgitation and dilation, neurodevelopmental (ND) issues, and lifelong care of D-TGA patients. In simple D-TGA: 1) familial recurrence risk is low; 2) children diagnosed pre-natally have improved cognitive skills compared with those diagnosed post-natally; 3) echocardiography helps to identify risk factors; 4) routine use of BAS and prostaglandin E1 may not be indicated in all cases; 5) early ASO improves outcomes and reduces costs with a low mortality; 6) single or intramural coronary arteries remain risk factors; 7) post-ASO arrhythmias and cardiac dysfunction should raise suspicion of coronary insufficiency; 8) coronary insufficiency and arrhythmias are rare but are associated with sudden death; 9) early- and late-onset ND abnormalities are common; 10) aortic regurgitation and aortic root dilation are well tolerated; and 11) the aging ASO patient may benefit from "exercise-prescription" rather than restriction. Significant strides have been made in understanding risk factors for cardiac, ND, and other important clinical outcomes after ASO.
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Affiliation(s)
- Juan Villafañe
- Department of Pediatrics (Cardiology), University of Kentucky, Lexington, Kentucky.
| | | | - Ami B Bhatt
- Adult Congenital Heart Disease Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - James S Tweddell
- Cardiothoracic Surgery, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Meena Nathan
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Martin J Elliott
- Department of Pediatric Cardiothoracic Surgery, The Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Victoria L Vetter
- Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen M Paridon
- Department of Exercise Physiology, Perlman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Lazaros Kochilas
- University of Minnesota Children's Hospital, Minneapolis, Minnesota
| | - Kathy J Jenkins
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert H Beekman
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Gil Wernovsky
- The Heart Program, Miami Children's Hospital, Florida International University Herbert Wertheim College of Medicine, Miami, Florida
| | - Jeffrey A Towbin
- The Heart Institute, Division of Cardiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Feng Y, Yu D, Chen T, Liu J, Tong X, Yang L, Da M, Shen S, Fan C, Wang S, Mo X. Maternal parity and the risk of congenital heart defects in offspring: a dose-response meta-analysis of epidemiological observational studies. PLoS One 2014; 9:e108944. [PMID: 25295723 PMCID: PMC4189919 DOI: 10.1371/journal.pone.0108944] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 08/27/2014] [Indexed: 01/28/2023] Open
Abstract
Background Epidemiological studies have reported conflicting results regarding maternal parity and the risk of congenital heart defects (CHDs). However, a meta-analysis of the association between maternal parity and CHDs in offspring has not been conducted. Methods We searched MEDLINE and EMBASE for articles catalogued between their inception and March 8, 2014; we identified relevant published studies that assessed the association between maternal parity and CHD risk. Two authors independently assessed the eligibility of the retrieved articles and extracted data from them. Study-specific relative risk estimates were pooled by random-effects or fixed-effects models. From the 11272 references, a total of 16 case-control studies and 3 cohort studies were enrolled in this meta-analysis. Results The overall relative risk of CHD in parous versus nulliparous women was 1.01 (95% CI, 0.97–1.06; Q = 32.34; P = 0.006; I2 = 53.6%). Furthermore, we observed a significant association between the highest versus lowest parity number, with an overall RR = 1.20 (95% CI, 1.10–1.31; (Q = 74.61, P<0.001, I2 = 82.6%). A dose–response analysis also indicated a positive effect of maternal parity on CHD risk, and the overall increase in relative risk per one live birth was 1.06 (95% CI, 1.02–1.09); Q = 68.09; P<0.001; I2 = 80.9%). We conducted stratified and meta-regression analyses to identify the origin of the heterogeneity among studies. A Galbraith plot was created to graphically assess the sources of heterogeneity. Conclusion In summary, this meta-analysis provided a robust estimate of the positive association between maternal parity and risk of CHD.
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Affiliation(s)
- Yu Feng
- Department of Cardiothoracic Surgery, The Affiliated Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Di Yu
- Department of Cardiothoracic Surgery, The Affiliated Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Tao Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jin Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xing Tong
- Atherosclerosis Research Center, Key Laboratory of Cardiovascular Disease and Molecular Intervention, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lei Yang
- Department of Cardiothoracic Surgery, The Affiliated Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Min Da
- Department of Cardiothoracic Surgery, The Affiliated Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Shutong Shen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Changfeng Fan
- Department of Cardiothoracic Surgery, The Affiliated Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Song Wang
- Department of Cardiothoracic Surgery, The Affiliated Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xuming Mo
- Department of Cardiothoracic Surgery, The Affiliated Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- * E-mail:
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Saleh DA, Ezzat S, Hamza H, Abdel-Hamid M, Kuehl KS, Loffredo CA. Conotruncal heart malformations in Egypt: An epidemiological study. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojepi.2013.34025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Long-term management of adults with conotruncal lesions: the diagnostic approach at All Children's Hospital. Cardiol Young 2012; 22:768-79. [PMID: 23331601 DOI: 10.1017/s104795111200203x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Improved survival in children with complex congenital cardiac disease, such as conotruncal abnormalities, has created a sub-population of children and young adults who need comprehensive multi-disciplinary long-term follow-up. Routine surveillance with comprehensive screening for structural heart disease, functional heart disease, thromboembolic disease, arrhythmias, and associated end-organ dysfunction is important. Future research will better define the care plans for routine surveillance in patients with conotruncal abnormalities.
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Congenital heart defects in La Réunion Island: a 6-year survey within a EUROCAT-affiliated congenital anomalies registry. Cardiol Young 2012; 22:547-57. [PMID: 22325463 DOI: 10.1017/s1047951112000054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES This study compares the prevalence and perinatal mortality of congenital heart defects on La Réunion with European (EUROCAT) standards. METHODS AND RESULTS Data were extracted from a EUROCAT-affiliated congenital malformations registry, covering 88,025 births during the period 2002-2007, on the whole island territory. A total of 512 congenital heart defects were registered, including 424 live births, 18 foetal deaths from 16 weeks of gestation, and 70 terminations of pregnancy. The total prevalence of congenital heart defects was 5.8 per 1000 births and live birth prevalence was 4.8 per 1000. The total prevalence of non-chromosomal congenital heart defects was 5.1 per 1000 births, of which 3% were perinatal deaths, 33.3% prenatally diagnosed, and 11.6% termination of pregnancy. Severe non-chromosomal congenital heart defects - excluding ventricular septal defects, atrial septal defects, and pulmonary valve stenosis - occurred in 2.1 per 1000 births, of which 10.3% were perinatal deaths, 59.1% prenatally diagnosed, and 24.3% termination of pregnancy. Of the severe congenital heart defects, the rates of single ventricle (0.20‰), Ebstein anomaly (0.11‰), common arterial trunk (0.25‰), and atrioventricular septal defect (0.62‰) exceeded averages found in Europe, although coarctation of the aorta was infrequent. Conversely, rates of ventricular septal defects, atrial septal defects, and pulmonary valve stenosis were inferior to European standards. Slightly less than half of the congenital heart defects of chromosomal origin were associated with Down syndrome. CONCLUSION In La Réunion, the total prevalence of congenital heart defects is far inferior to that found in Europe. The difference can be attributable to lower prevalences of mild congenital heart defects.
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Current World Literature. Curr Opin Rheumatol 2012; 24:237-44. [DOI: 10.1097/bor.0b013e3283513e33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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