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

Authors

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

Source

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

Abstract

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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