Risk Factors And Prenatal Diagnostic Methods For Congenital Heart Disease: A Meta-analysis

Object: Congenital heart disease（CHD）is the most common pediatric cardiovasculardisease，whose morbidity and mortality are among the first birth defects. However,their risk factors and prenatal diagnostic methods have never been evaluated in asystematic way. In order to provide theoretical basis for the future cure and prevention,the study uses the Meta-analysis retrieved CHD risk factors, early pregnancy DuctusVenosus (DV) spectrum of blood flow screening method and DV spectrum of bloodflow screening joint to Nuchal Translucency (NT) in the first-trimester, as well as thesecond trimester echocardiography system, comprehensive quantitative screeningmethod.Methods: Studies were retrieved from a search of some Chinese databases such asWangfang, China National Knowledge Infrastructure (CNKI) and Chongqing VIP aswell as some English databases such as Pubmed(Medline), Science Direct, Embaseand Cochrane Library with the key words congenital heart disease (CHD)、riskfactors、prenatal diagnostic、ductus venosus、nuchal translucency、echocardiography,and supplemented by literature retrospective manual search. Data extractions andorganisations were conducted. Statistical analysis was performed using Stata Version11.0(Stata Corporation; College Station, TX)、Comprehensive Meta-analysisVersion2(Biostat, Inc. Englewood NJ) and Meta-DiSc Version1.4(XI CochraneColloquium, Barcelona, Spain).Results: In terms of the risk factors,40studies met inclusion criteria, in which23Chinese literatures and17English literatures were included.①Through thecomprehensive analysis of the mother relationship between environmental factorswith CHD showed that mother mental stimulation(ORs=2.93,95%CI:1.72-4.98)；first trimester pregnancy cold (ORs=2.75,95%CI:2.00-3.78)；pregnancy contactingundesirable chemicals (ORs=2.38,95%CI:1.60-3.55)；noise pollution (ORs=2.36,95%CI:1.37-4.05)；adverse reproductive past history (ORs=2.16,95%CI:1.31-3.56)；pregnancy medicine using (ORs=2.07,95%CI:1.47-2.91)；smoking during pregnancy(ORs=1.58,95%CI:1.27-1.97)；older pregnant women (ORs=1.30,95%CI:1.11-1.52) and ORs value higher than1, proved to be risk factors for CHD. Although ORs valueof drinking alcohol during pregnancy is higher than1(ORs=1.17), but its confidenceinterval，95%CI (0.96-1.42) contains1, it cannot be regarded as the risk factor ofCHD.②Through the comprehensive analysis of the father relationship betweenenvironmental factors with CHD; father alcoholics (ORs=2.47,95%CI:1.07-5.75),father’s occupational to undesirable material (ORs=1.65,95%CI:1.18-2.29) ORs ishigher than1, proved to be CHD risk factors.③Through the comprehensive analysisof the relationship between the genetic factors associated with CHD showed that therisks factor of fetals from family with CHD medical past history was3.37(95%CI：2.68-4.22) times than those fetals without this history,which in this study OR valuesshould attract attention.Meta-analysis for the diagnosis CHD in early pregnancy, finally with13literatures study, whose two from Chinese literatures, and11from Englishliteratures①The DV spectrum of blood flow screening for summary sensitivity,specifity and SROC area under the curve(AUC) respectively were0.53(95%CI:0.49-0.58) and0.97(95%CI:0.97-0.97) and0.8701.②DV spectrum of blood flowcombined to NT value of screening for CHD summary sensitivity, specificity andSROC area under the curve(AUC) respectively were0.64(95%CI:0.59-0.69),0.94(95%CI:0.93-0.94), and0.9363.Meta-analysis of the second-trimester diagnosis of screening for CHD,andfinally18literature study with8chinese literatures and10English literatures,Echocardiography Figure screening for CHD are summarized sensitivity, specificityand SROC area under curve (AUC) respectively were0.91(95%CI:0.89-0.92),1.00(95%CI:1.00-1.00) and0.9852.Conclusion:①family medical past history of CHD，pregnancy mental stimulation,first trimester pregnancy colds, pregnancy contacting undesirable chemicals, noisepollution, adverse reproductive past history, pregnancy medicines using,,smokingduring pregnancy, and pregnant women older, father alcoholics, father professionalcontacting undesirable material were confirmed as risk factors of CHD. Drinkingalcohol during pregnancy was not confirmed as risk factor of CHD.②in the firsttrimester DV spectrum of blood flow Joint NT thickness screening for CHDsensitivity, SROC area under curve (AUC) values were higher than merely using DVspectrum of blood flow screening methods, the joint screening compared individually DV spectrum of blood flow for CHD screening seized with a higher accuracy.Summary of the second trimester echocardiography screening for CHD sensitivity,specificity, SROC area under curve AUC value is much larger than the various checksof the first trimester; the second trimester echocardiography compared to firsttrimester screening was higher accuracy. Fully proved that pregnant women does notonly need to be in the first trimester prenatal cardiac malformation screening andfurther screening and confirmation should be in the second trimester.