title: Maternal obesity and congenital heart defects: a population-based study.
abstract: BACKGROUND
  Obesity affects almost one-third of pregnant women and causes many complications, including neural tube defects. It is not clear whether the risk of congenital heart defects, the most common malformations, is also increased.
  
  
  OBJECTIVE
  This study was conducted to determine whether obesity is associated with an increased risk of congenital heart defects.
  
  
  METHODS
  A population-based, nested, case-control study was conducted in infants born with congenital heart defects and unaffected controls from the cohort of all births (n = 1,536,828) between 1993 and 2003 in New York State, excluding New York City. The type of congenital heart defect, maternal body mass index (BMI; in kg/m(2)), and other risk factors were obtained from the Congenital Malformations Registry and vital records. Mothers of 7392 congenital heart defect cases and 56,304 unaffected controls were studied.
  
  
  RESULTS
  All obese women (BMI > or = 30) were significantly more likely than normal-weight women (BMI: 19-24.9) to have children with a congenital heart defect [odds ratio (OR): 1.15; 95% CI: 1.07, 1.23; P < 0.0001]. Overweight women were not at increased risk (OR: 1.00; 95% CI: 0.94, 1.06). The risk in morbidly obese women (BMI > or = 40) was higher (OR: 1.33; 95% CI: 1.15, 1.54; P = 0.0001) than that in obese women with a BMI of 30-39.9 (OR: 1.11; 95% CI: 1.04, 1.20; P = 0.004). There was a highly significant trend of increasing OR for congenital heart defects with increasing maternal obesity (P < 0.0001). The offspring of obese women had significantly higher ORs for atrial septal defects, hypoplastic left heart syndrome, aortic stenosis, pulmonic stenosis, and tetralogy of Fallot.
  
  
  CONCLUSIONS
  Obese, but not overweight, women are at significantly increased risk of bearing children with a range of congenital heart defects, and the risk increases with increasing BMI. Weight reduction as a way to reduce risk should be investigated.
authors.affiliation: Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda MD 20892, USA. jamesmills@nih.gov <jamesmills@nih.gov>
authors.forename: James L
authors.initials: JL
authors.lastname: Mills
authors.forename: James
authors.initials: J
authors.lastname: Troendle
authors.forename: Mary R
authors.initials: MR
authors.lastname: Conley
authors.forename: Tonia
authors.initials: T
authors.lastname: Carter
authors.forename: Charlotte M
authors.initials: CM
authors.lastname: Druschel
mesh_terms: D000328:Adult; D015992:Body Mass Index; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006330:Heart Defects, Congenital / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007231:Infant, Newborn; D009518:New York / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology* / Q000503:physiopathology; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000503:physiopathology; D012044:Regression Analysis; D055815:Young Adult