Incidence And Risk Factors Of Congenital Heart Disease In Qingdao:A Prospective Cohort Study

Objectives This study is a population-based cohort study aimed at identifying the incidence and risk factors of congenital heart disease(CHD)in Qingdao,and providing a reliable basis for reducing the occurrence of CHD in formulating relevant health policies and implementing intervention measures.MethodsBased on “the study of Comprehensive Prevention and Treatment of Birth Defects in Qingdao”,a prospective census-based cohort study was conducted in Qingdao,China,from August 1,2018 to April 30,2019.All of the local registered pregnant women were continuously investigated and followed up from 15-20 weeks of gestation to delivery,collecting the information of pregnant women(Demographic and sociological data,pregnancy and childbirth history,personal disease history,hazardous substance exposure,behavior and lifestyle,etc).Two screenings for CHD were performed on enrolled pregnant women.One was performed on fetuses during 20–28 weeks of gestation,and another was performed on newborns at birth.Compile the data to calculate the positive rate of prenatal CHD screening and the incidence of CHD.A logistic regression model was applied to assess the association between CHD and possible risk factors,and calculated the odds ratio(OR)and 95% confidence interval(CI)of each factor.ResultsA total of 64,763 pregnant the local registered women were enrolled in the cohort.The positive rate of prenatal CHD screening was 14.36 per 1000 fetuses,the predominant types of CHD in the fetal stage were congenital tricuspid regurgitation(31.64%),ventricular septal defect(31.10%),vascular ring(8.53%),and congenital pulmonary regurgitation(5.72%).The incidence of CHD was 9.38 per 1000 live births,the predominant types of CHD were ventricular septal defect(35.38%),congenital tricuspid regurgitation(15.95%),vascular ring(13.95%).In prenatal screening,the positive rate of prenatal screening for congenital tricuspid regurgitation was 4.54‰,and the positive rate of prenatal screening for ventricular septal defect was 4.47‰;while in the screening and diagnosis of neonatal CHD,the incidence of congenital tricuspid regurgitation was 1.5‰,and the incidence of ventricular septal defect was 3.32‰.Results from logistic regression indicated that,living in the countryside have a lower risk than urban(OR: 0.77;95% CI:0.63–0.95)and the risk of congenital heart disease in pregnant women who have a childbearing history is 0.80 times than that of pregnant women who have never given birth to a newborn(OR: 0.80;95%CI: 0.68–0.95).Twin pregnancy(OR: 1.96;95% CI:1.25–3.07),illness in the first trimester(OR: 1.31;95% CI: 1.05–1.63),a family history of CHD(OR: 7.16;95% CI: 3.29–15.55),and having a child with a birth defect(OR: 2.09;95% CI: 1.17–3.73)were positively associated with CHD.ConclusionsThe positive rate of prenatal CHD screening was higher than the incidence of CHD.The positive rate of prenatal screening for congenital tricuspid regurgitation and ventricular septal defect is significantly higher than that of congenital tricuspid regurgitation and ventricular septal defect.The incidence of CHD found in this study is higher than developed countries such as Europe and America,CHD is a serious health problem in Qingdao.Moreover,CHD risk factors were identified that living in the countryside and having a childbearing history were negatively associated with CHD.It is recommended that pregnant women live in rural areas Twin pregnancy,illness in the first trimester,family history of CHD,and having a child with a birth defect in our study were positively associated with CHD,which prompts the need to focus on twin pregnancies.Pay attention to the monitoring and control of various examination indicators during pregnancy for pregnant women with family history of CHD,and having a child with a birth defect,and it is necessary to take targeted intervention measures for pregnant women suffering from the disease in the first trimester of pregnancy.Strengthening and popularizing health education,enhancing the health awareness of the population,and advocating regular check-ups will help curb the occurrence of congenital heart disease.