Associations Between Maternal Fever and Influenza and Congenital Heart Defects

• Published in: The Journal of pediatrics Vol. 158; no. 6; pp. 990 - 995
• Main Authors: Oster, Matthew E., MD, Riehle-Colarusso, Tiffany, MD, Alverson, Clinton J., MS, Correa, Adolfo, MD, PhD
• Format: Journal Article
• Language: English
• Published: Maryland Heights, MO Mosby, Inc 01.06.2011; Elsevier
• Subjects: acetaminophen; Adult; antipyretics; Antipyretics - therapeutic use; Biological and medical sciences; Body Mass Index; Cardiology. Vascular system; Case-Control Studies; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Down syndrome; Down Syndrome - complications; Female; fever; Fever - complications; Fever - physiopathology; General aspects; Heart; Heart Defects, Congenital - etiology; Heart Septal Defects, Ventricular - complications; Human viral diseases; Humans; infants; Infectious diseases; influenza; Influenza, Human - complications; Influenza, Human - physiopathology; Male; Maternal Age; Medical sciences; Models, Statistical; mothers; nonsteroidal anti-inflammatory agents; Pediatrics; Pregnancy; regression analysis; Viral diseases; Viral diseases of the respiratory system and ent viral diseases; BWIS; Body mass index; Congenital heart defect; AVSD; Atrioventricular septal defect; Baltimore-Washington Infant Study; CHD; BMI; Infection; Pediatrics; Association; Mother; Viral disease; Influenza; Cardiovascular disease; Congenital cardiopathy; Fever
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2010.11.058

Objective To examine associations between maternal reports of prenatal fever or influenza and congenital heart defects (CHDs), and to evaluate whether those associations varied with antipyretic use. Study design We analyzed case infants with CHD (n = 2361) and control infants without CHD (n = 3435) from the Baltimore-Washington Infant Study (1981-1989). Participating mothers were asked whether they experienced a “fever of 101°F or higher,” had “influenza (flu),” or used an antipyretic agent (ie, acetaminophen, salicylate, or nonsteroidal anti-inflammatory drug) during the period extending from 3 months before pregnancy through the end of the third month of pregnancy. We used logistic regression to compute ORs and 95% CIs while controlling for potential confounders. Results There were significant associations between fever and influenza and specific CHDs, namely right-sided obstructive defects (fever: OR, 2.04; 95% CI, 1.27 to 3.27; influenza: OR, 1.75; 95% CI, 1.16 to 2.62) and atrioventricular septal defects in infants with Down syndrome (fever: OR, 1.92; 95% CI, 1.10 to 3.38; influenza: OR, 1.66; 95% CI, 1.04 to 2.63). Maternal antipyretic use in the setting of fever or influenza tended to decrease these associations. Conclusions Prenatal maternal fever or influenza may be associated with right-sided obstructive lesions in all infants and with atrioventricular septal defects in infants with Down syndrome. The use of antipyretics might attenuate such associations.