© 2021 Elsevier B.V.

Progress in Pediatric Cardiology (2021) vol 62

DOI 10.1016/j.ppedcard.2021.101385

Received: 26 October 2020 / Accepted: 13 April 2021


Advanced maternal age and critical congenital cardiac malformations in Nevada



William N Evans, MD, Ruben J Acherman, MD, Humberto Restrepo, MD, MPH



Children’s Heart Center Nevada, 3006 S Maryland Parkway, Ste 690, Las Vegas, NV 89109, USA. Email: WNevans50@aol.com.



Our purpose was to undertake a retrospective, multi-year review of critical congenital heart disease in Nevada to investigate a possible association with advanced maternal age. We identified all those prenatally and post-natally diagnosed between September 2012 and August 2020. For each identified case, we tabulated each pregnant woman's age at the estimated date or actual date of delivery. Using Nevada population demographic data, we calculated the percentages of pregnant women ≥35 years old (defined as advanced maternal age) and of pregnant women <35 years old. Subsequently, we calculated occurrence rates for critical congenital cardiac mal-formations in advanced and non-advanced maternal age populations. A chi-square risk ratio analysis, excluding aneuploidy cases, was used to determine statistical significance for each malformation. We identified 467 total cases. Of the 467, 39 (8.4%) had aneuploidy. Of the 467, 413, (88.4%) were live born, 32 (6.9%) had fetal demise, and 22 (4.7%) had elective termination. There were approximately 280,000 live births during the study period for a prevalence of 14.8 cases (inclusive of both those with and without aneuploidies) per 10,000 live births. From the 428 cases exclusive of aneuploidy, the following malformations were statistically significantly associated with advanced maternal age (risk ratios with 95% CI): 1) coarctation ± ventricular septal defect 1.75 (1.12, 2.73) p = 0.01, 2) D-transposition of the great arteries ± ventricular septal defect 2.13 (1.18, 2.83) p = 0.01, 3) double outlet right ventricle 2.10 (1.01, 4.35) p = 0.04, and 4) tetralogy of Fallot ± pulmonary atresia 2.40 (1.39, 4.31) p = 0.001. Excluding aneuploidy cases, advanced maternal age was statistically significantly associated with some critical congenital cardiac malformations and lacked association with others. 


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