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Meta-Analysis
. 2015 Oct;36(7):1442-51.
doi: 10.1007/s00246-015-1182-9. Epub 2015 May 8.

Maternal Hypertension During Pregnancy and the Risk of Congenital Heart Defects in Offspring: A Systematic Review and Meta-analysis

Anushuya Ramakrishnan  1 , Laura J Lee  1 , Laura E Mitchell  1 , A J Agopian  2
Affiliations
Meta-Analysis

Maternal Hypertension During Pregnancy and the Risk of Congenital Heart Defects in Offspring: A Systematic Review and Meta-analysis

Anushuya Ramakrishnan et al. Pediatr Cardiol. 2015 Oct.

Abstract

Maternal hypertension is common during pregnancy, and multiple studies have reported on an association between maternal hypertension and congenital heart defects (CHDs) in offspring; however, there is variability in the quality of these studies. A systematic review and meta-analysis was conducted on the associations between untreated and treated maternal hypertension and the risk of CHDs, evaluating CHDs overall as well as specific CHD subtypes. A systematic search of peer-reviewed articles published before August 2013 identified 16 studies evaluating the associations between untreated and treated maternal hypertension and CHDs. Summary relative risk (RR) estimates were calculated using fixed-effects models and random-effects models. Significant associations were observed between maternal hypertension and overall CHDs, for both treated [RR 2.0; 95 % confidence interval (CI) 1.5, 2.7] and untreated (RR 1.4; 95 % CI 1.2, 1.7) hypertension, as well as for overall hypertension regardless of treatment status (RR 1.8; 95 % CI 1.5, 2.2). The magnitude of effect was similar for the majority of CHD subtypes evaluated. The effects were also similar among women with hypertension who used one of multiple specific hypertension medications. There was no evidence of publication bias, and our results were robust to several factors considered in sensitivity analyses (e.g., source of exposure data, adjustment for potential confounders, and study design). Maternal hypertension was associated with CHDs. By understanding the specific mechanisms involved, appropriate strategies may be developed to reduce this risk, in order to prevent CHDs.

Keywords: Congenital heart defects; Hypertension; Meta-analysis; Pregnancy.

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Conflict of interest statement

Conflict of interest The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1. Flowchart of study selection
Fig. 2
Fig. 2. Study-specific and summary RRs and 95 % CIs from the meta-analysis of untreated maternal hypertension and congenital heart defects
Fig. 3
Fig. 3. Study-specific and summary RRs and 95 % CIs from the meta-analysis of treated maternal hypertension and congenital heart defects
Fig. 4
Fig. 4. Study-specific and summary RRs and 95 % CIs from the meta-analysis of overall maternal hypertension and congenital heart defects
See this image and copyright information in PMC

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