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Background Events in pregnancy play an important role in predisposing the newborn to the risk of developing CHD. This study evaluated the association between maternal preeclampsia and her offspring risk of CHD. Methods This is a cohort study of 90 sex-matched neonates (45 each born to women with preeclampsia and normal pregnancy) in Jos, Nigeria. Anthropometry was taken shortly after delivery using standard protocols. Echocardiography was performed within 24 hours of life and repeated 7 and 28 days later. SPSS version 25 was used in all analyses. Statistical significance was set at p<0.05. Results Congenital heart disease (CHD) was observed in 27 (30.0%) of newborns of women with preeclampsia compared with 11 (12.1%) of newborns without preeclampsia (p<0.001) at the end of 7 days and in 19 (21.1%) of newborns of women with preeclampsia and 3 (3.3%) of newborns of women without preeclampsia by the end of the 4th week of life (p<0.001). Overall, ASD (4 newborns), PDA (21 newborns), patent foramen ovale (14 newborns) and VSD (2 newborns) were the prevalent lesions found among all the newborns studied in the first week of life. Isolated atrial and ventricular septal defects were seen in 4 (4.4%) of the newborns of women with preeclampsia. Being the infant of a woman with preeclampsia was associated with about 8-fold increased risk of having CHD (OR = 7.9, 95% CI = 2.5–24.9, p<0.001). Conclusion CHD may be more common in newborns of women with preeclampsia underscoring the need for fetal and newborn screening for CHD in women with preeclampsia so as to improve their infant’s well being.
We conducted this study in the 4 tertiary health facilities in Jos namely; Jos University Teaching Hospital (JUTH), Plateau Specialist Hospital (PSSH), Bingham University Teaching Hospital (BhUTH) and Our Lady of Apostle (OLA) Hospital. Each of these hospitals has specialist obstetric care services. Altogether, they have an annual delivery rate of about 14,000 babies with preeclampsia/eclampsia accounting for about 5% of the deliveries annually. This study was carried out between April 2017 and May 2018 as part of the infant outcomes study on women with preeclampsia in Jos. All the women were recruited antenatally and followed up to delivery. At delivery, all the infants had anthropometry and echocardiography done. We identified 45 newborns from women with preeclampsia at birth in the delivery room and matched them for sex with 45 newborns of women with normal pregnancy. We used OpenEpi version 3.03a to determine a minimum sample size of 80 (40 neonates in each arm) based on the estimated effect size of 20%, a power of 80% and an α level of 0.05.[13] We excluded newborns of women with other chronic disorders like diabetes, HIV and Sickle cell anemia in the control and exposure groups in order to avoid confounding. Ethical approval was obtained from each of the participating hospitals before commencement of the study. Written informed consent was obtained from the mothers before recruiting the newborns. Preeclampsia was defined as systolic blood pressure ≥140 mmHg or diastolic pressure ≥90 mmHg (or increases of 30 mmHg systolic or 15 mmHg diastolic from the baseline) on at least two occasions, six or more hours apart and associated proteinuria that develops from the 20th gestational week in a previously normotensive woman. This study was a cohort design that compared the spectrum of CHD in newborns of women with preeclampsia versus those with normal pregnancy in the four tertiary care centers in Jos Nigeria. Each newborn had a transthoracic echocardiography done at least 4 hours post-delivery in the nursery to assess for the presence of CHD. This was repeated for all the infants at 7 days and 28 days of life in order to exclude physiologic patent ductus arteriosus and foramen ovale. All measurements were performed according to American Society of Echocardiography guidelines by an experienced Paediatric Cardiologist.[14] Echocardiography was done following a standard examination protocol using a Vivid e ultrasound machine (General Electric, USA) equipped with a P6 Phased Array ultrasound transducer.[14] Anthropometric measurements were done by weighing each naked newborn to the nearest 50g using a way master bassinet weighing scale operated by a trained midwife. [15,16] The institutional review board of the Jos University Teaching Hospital reviewed and approved the study (JUTH/DCS/ADM/127/XIX/6632). Each infant was identified with a code that does not contain their name. Only the principal investigator has access to the database linking the name of the individual with the code. All material data including the study forms and specimen bottles were labeled accordingly with the printed unique identification numbers. Different biological fluids (i.e. serum and plasma specimen) were marked with different prefixes for ease of identification. Statistical analysis was done using SPSS version 25.[17] Mean differences in maternal age, booking weight and parity as well as infant weight and gestational age were compared between babies born following preeclamptic pregnancy and those born following normal pregnancy using a t-test. Difference in proportion of the newborns by sex as well as maternal education, fever in pregnancy, alcohol use and contraceptive use was done using 2 by 2 table cross tabulations. Spectrum of CHD was depicted using bar charts and a frequency table. Univariate analysis was done to evaluate the relationship of each of the maternal and infant variables with CHD. Those that were found to be significant were then included in Multivariable logistic regression analysis to assess the relationship between CHD and these maternal and infant characteristics. The criterion for significance for all analyses was set at a P-value of < 0.05.