Advertisement

Maternal Smoking and Congenital Heart Defects, National Birth Defects Prevention Study, 1997-2011

Published:September 07, 2021DOI:https://doi.org/10.1016/j.jpeds.2021.09.005

      Objectives

      To assess associations between maternal smoking and congenital heart defects (CHDs) in offspring.

      Study design

      We performed a retrospective case-control study using data for cases of CHD (n = 8339) and nonmalformed controls (n = 11 020) from all years (1997-2011) of the National Birth Defects Prevention Study. Maternal self-reported smoking 1 month before through 3 months after conception was evaluated as a binary (none, any) and categorical (light, medium, heavy) exposure. Multivariable logistic regression was used to estimate aOR and 95% CIs. Stratified analyses were performed for septal defects according to maternal age, prepregnancy body mass index, and maternal race/ethnicity.

      Results

      Multiple CHDs displayed modest associations with any level of maternal periconceptional smoking independent of potential confounders; the strongest associations were for aggregated septal defects (OR, 1.5; 95% CI, 1.3-1.7), tricuspid atresia (OR, 1.7; 95% CI, 1.0-2.7), and double outlet right ventricle (DORV) (OR, 1.5; 95% CI, 1.1-2.1). Tricuspid atresia and DORV also displayed dose-response relationships. Among heavy smokers, the highest odds were again observed for tricuspid atresia (aOR 3.0; 95% CI, 1.5-6.1) and DORV (aOR 1.5; 95% CI, 1.1-2.2). Heavy smokers ≥35 years old more frequently had a child with a septal defect when compared with similarly aged nonsmokers (aOR 2.3; 95% CI, 1.4-3.9).

      Conclusions

      Maternal periconceptional smoking is most strongly associated with septal defects, tricuspid atresia, and DORV; the risk for septal defects is modified by maternal age.

      Keywords

      Abbreviations:

      ASD (Atrial septal defect), AVSD (Atrioventricular septal defect), CHD (Congenital heart defect), DORV (Double outlet right ventricle), NBDPS (National Birth Defects Prevention Study), VSD (Ventricular septal defect)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Nighbor T.D.
        • Coleman S.R.M.
        • Bunn J.Y.
        • Kurti A.N.
        • Zvorsky I.
        • Orr E.J.
        • et al.
        Smoking prevalence among U.S. national samples of pregnant women.
        Prev Med. 2020; 132: 105994
        • Anderson T.M.
        • Lavista Ferres J.M.
        • Ren S.Y.
        • Moon R.Y.
        • Goldstein R.D.
        • Ramirez J.M.
        • et al.
        Maternal smoking before and during pregnancy and the risk of sudden unexpected infant death.
        Pediatrics. 2019; 143: e20183325
        • Abraham M.
        • Alramadhan S.
        • Iniguez C.
        • Duijts L.
        • Jaddoe V.W.
        • Den Dekker H.T.
        • et al.
        A systematic review of maternal smoking during pregnancy and fetal measurements with meta-analysis.
        PLoS One. 2017; 12: e0170946
        • Simon L.
        • Pastor-Barriuso R.
        • Boldo E.
        • Fernandez-Cuenca R.
        • Ortiz C.
        • Linares C.
        • et al.
        Smoke-free legislation in Spain and prematurity.
        Pediatrics. 2017; 139: e20162068
        • Little J.
        • Cardy A.
        • Munger R.G.
        Tobacco smoking and oral clefts: a meta-analysis.
        Bull World Health Organ. 2004; 82: 213-218
        • Warren G.W.
        • Alberg A.J.
        • Kraft A.S.
        • Cummings K.M.
        The 2014 Surgeon General's report: “The health consequences of smoking–50 years of progress”: a paradigm shift in cancer care.
        Cancer. 2014; 120: 1914-1916
        • Marelli A.J.
        • Mackie A.S.
        • Ionescu-Ittu R.
        • Rahme E.
        • Pilote L.
        Congenital heart disease in the general population: changing prevalence and age distribution.
        Circulation. 2007; 115: 163-172
        • Simeone R.M.
        • Oster M.E.
        • Cassell C.H.
        • Armour B.S.
        • Gray D.T.
        • Honein M.A.
        Pediatric inpatient hospital resource use for congenital heart defects.
        Birth Defects Res A Clin Mol Teratol. 2014; 100: 934-943
        • Malik S.
        • Cleves M.A.
        • Honein M.A.
        • Romitti P.A.
        • Botto L.D.
        • Yang S.
        • et al.
        Maternal smoking and congenital heart defects.
        Pediatrics. 2008; 121: e810-e816
        • Alverson C.J.
        • Strickland M.J.
        • Gilboa S.M.
        • Correa A.
        Maternal smoking and congenital heart defects in the Baltimore-Washington Infant Study.
        Pediatrics. 2011; 127: e647-e653
        • Sullivan P.M.
        • Dervan L.A.
        • Reiger S.
        • Buddhe S.
        • Schwartz S.M.
        Risk of congenital heart defects in the offspring of smoking mothers: a population-based study.
        J Pediatr. 2015; 166: 978-984.e2
        • Reefhuis J.
        • Gilboa S.M.
        • Anderka M.
        • Browne M.L.
        • Feldkamp M.L.
        • Hobbs C.A.
        • et al.
        The National Birth Defects Prevention Study: a review of the methods.
        Birth Defects Res A Clin Mol Teratol. 2015; 103: 656-669
        • National Birth Defects Prevention Study
        Mother Questionnaire CATI Version 5.1: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Publich Health Service.
        (Accessed 2020)
        • Bensemlali M.
        • Stirnemann J.
        • Le Bidois J.
        • Levy M.
        • Raimondi F.
        • Hery E.
        • et al.
        Discordances between pre-natal and post-natal diagnoses of congenital heart diseases and impact on care strategies.
        J Am Coll Cardiol. 2016; 68: 921-930
        • Botto L.D.
        • Lin A.E.
        • Riehle-Colarusso T.
        • Malik S.
        • Correa A.
        • National Birth Defects Prevention Study
        Seeking causes: classifying and evaluating congenital heart defects in etiologic studies.
        Birth Defects Res A Clin Mol Teratol. 2007; 79: 714-727
        • Yoo S.J.
        • Saito M.
        • Hussein N.
        • Golding F.
        • Goo H.W.
        • Lee W.
        • et al.
        Systematic approach to malalignment type ventricular septal defects.
        J Am Heart Assoc. 2020; 9: e018275
        • Anderson R.H.
        • Wessels A.
        • Vettukattil J.J.
        Morphology and morphogenesis of atrioventricular septal defect with common atrioventricular junction.
        World J Pediatr Congenit Heart Surg. 2010; 1: 59-67
        • Husten C.G.
        How should we define light or intermittent smoking? Does it matter?.
        Nicotine Tob Res. 2009; 11: 111-121
        • Schane R.E.
        • Ling P.M.
        • Glantz S.A.
        Health effects of light and intermittent smoking: a review.
        Circulation. 2010; 121: 1518-1522
        • Srisukhumbowornchai S.
        • Krikov S.
        • Feldkamp M.L.
        Self-reported maternal smoking during pregnancy by source in Utah, 2003-2007.
        Birth Defects Res A Clin Mol Teratol. 2012; 94: 996-1003
        • Glidewell J.
        • Grosse S.D.
        • Riehle-Colarusso T.
        • Pinto N.
        • Hudson J.
        • Daskalov R.
        • et al.
        Actions in support of newborn screening for critical congenital heart disease–United States, 2011-2018.
        MMWR Morb Mortal Wkly Rep. 2019; 68: 107-111
        • Johnson L.C.
        • Lieberman E.
        • O'Leary E.
        • Geggel R.L.
        Prenatal and newborn screening for critical congenital heart disease: findings from a nursery.
        Pediatrics. 2014; 134: 916-922
        • Lindsey J.B.
        • Hillis L.D.
        Clinical update: atrial septal defect in adults.
        Lancet. 2007; 369: 1244-1246
        • Murphy J.G.
        • Gersh B.J.
        • McGoon M.D.
        • Mair D.D.
        • Porter C.J.
        • Ilstrup D.M.
        • et al.
        Long-term outcome after surgical repair of isolated atrial septal defect. Follow-up at 27 to 32 years.
        N Engl J Med. 1990; 323: 1645-1650
        • Ebadi A.
        • Spicer D.E.
        • Backer C.L.
        • Fricker F.J.
        • Anderson R.H.
        Double-outlet right ventricle revisited.
        J Thorac Cardiovasc Surg. 2017; 154: 598-604
        • Haiman C.A.
        • Stram D.O.
        • Wilkens L.R.
        • Pike M.C.
        • Kolonel L.N.
        • Henderson B.E.
        • et al.
        Ethnic and racial differences in the smoking-related risk of lung cancer.
        N Engl J Med. 2006; 354: 333-342
        • Persson M.
        • Razaz N.
        • Edstedt Bonamy A.K.
        • Villamor E.
        • Cnattingius S.
        Maternal overweight and obesity and risk of congenital heart defects.
        J Am Coll Cardiol. 2019; 73: 44-53
        • Gittenberger-de Groot A.C.
        • Bartelings M.M.
        • Deruiter M.C.
        • Poelmann R.E.
        Basics of cardiac development for the understanding of congenital heart malformations.
        Pediatr Res. 2005; 57: 169-176
        • Keyte A.
        • Hutson M.R.
        The neural crest in cardiac congenital anomalies.
        Differentiation. 2012; 84: 25-40
        • Hobbs C.A.
        • James S.J.
        • Jernigan S.
        • Melnyk S.
        • Lu Y.
        • Malik S.
        • et al.
        Congenital heart defects, maternal homocysteine, smoking, and the 677 C>T polymorphism in the methylenetetrahydrofolate reductase gene: evaluating gene-environment interactions.
        Am J Obstet Gynecol. 2006; 194: 218-224
        • Miao Q.
        • Dunn S.
        • Wen S.W.
        • Lougheed J.
        • Reszel J.
        • Lavin Venegas C.
        • et al.
        Neighbourhood maternal socioeconomic status indicators and risk of congenital heart disease.
        BMC Pregnancy Childbirth. 2021; 21: 72
        • Bingol N.
        • Schuster C.
        • Fuchs M.
        • Iosub S.
        • Turner G.
        • Stone R.K.
        • et al.
        The influence of socioeconomic factors on the occurrence of fetal alcohol syndrome.
        Adv Alcohol Subst Abuse. 1987; 6: 105-118
        • Newton S.
        • Braithwaite D.
        • Akinyemiju T.F.
        Socio-economic status over the life course and obesity: systematic review and meta-analysis.
        PLoS One. 2017; 12: e0177151
        • Pouchieu C.
        • Levy R.
        • Faure C.
        • Andreeva V.A.
        • Galan P.
        • Hercberg S.
        • et al.
        Socioeconomic, lifestyle and dietary factors associated with dietary supplement use during pregnancy.
        PLoS One. 2013; 8: e70733
        • Cedergren M.I.
        • Selbing A.J.
        • Lofman O.
        • Kallen B.A.
        Chlorination byproducts and nitrate in drinking water and risk for congenital cardiac defects.
        Environ Res. 2002; 89: 124-130
        • Hoyt A.T.
        • Canfield M.A.
        • Romitti P.A.
        • Botto L.D.
        • Anderka M.T.
        • Krikov S.V.
        • et al.
        Associations between maternal periconceptional exposure to secondhand tobacco smoke and major birth defects.
        Am J Obstet Gynecol. 2016; 215: 613.e1-613.e11
        • Stingone J.A.
        • Luben T.J.
        • Daniels J.L.
        • Fuentes M.
        • Richardson D.B.
        • Aylsworth A.S.
        • et al.
        Maternal exposure to criteria air pollutants and congenital heart defects in offspring: results from the National Birth Defects Prevention Study.
        Environ Health Perspect. 2014; 122: 863-872
        • Zhang B.
        • Zhao J.
        • Yang R.
        • Qian Z.
        • Liang S.
        • Bassig B.A.
        • et al.
        Ozone and other air pollutants and the risk of congenital heart defects.
        Sci Rep. 2016; 6: 34852
        • Curtin S.C.
        • Matthews T.J.
        Smoking prevalence and cessation before and during pregnancy: data from the birth certificate, 2014.
        Natl Vital Stat Rep. 2016; 65: 1-14
        • Hanslik A.
        • Pospisil U.
        • Salzer-Muhar U.
        • Greber-Platzer S.
        • Male C.
        Predictors of spontaneous closure of isolated secundum atrial septal defect in children: a longitudinal study.
        Pediatrics. 2006; 118: 1560-1565

      Linked Article