Risk Factors And Prenatal Diagnostic Methods For Congenital Heart Disease:a Meta-analysis

Object:Congenital heart disease (CHD) is the most common pediatric cardiovascular disease, whose morbidity and mortality are among the first birth defects. However, their risk factors and prenatal diagnostic methods have never been evaluated in a systematic way. In order to provide theoretical basis for the future cure and prevention, the study uses the Meta-analysis retrieved CHD risk factors, early pregnancy Ductus Venosus (DV) spectrum of blood flow screening method and DV spectrum of blood flow screening joint to Nuchal Translucency (NT) in the first-trimester, as well as the second trimester echocardiography system, comprehensive quantitative screening method.Methods:Studies were retrieved from a search of some Chinese databases such as Wangfang, China National Knowledge Infrastructure (CNKI) and Chongqing VIP as well as some English databases such as Pubmed(Medline), Science Direct. Embase and Cochrane Library with the key words congenital heart disease (CHD)、risk factor、prenatal diagnostic、ductus venosus、nuchal translucency、echocardiography, and supplemented by literature retrospective manual search. Data extractions and organisations were conducted. Statistical analysis was performed using Stata Version11.0(Stata Corporation; College Station, TX)、Comprehensive Meta analysis Version2(Biostat, Inc. Englewood NJ) and Meta-DiSc Versionl.4(XI Cochrane Colloquium, Barcelona, Spain).Results:In terms of the risk factors,40studies met inclusion criteria, in which23Chinese literatures and17English literatures were included.①Through the comprehensive analysis of the mother relationship between environmental factors with CHD showed that mother mental stimulation(ORs=2.93,95%CI:1.72-4.98); first trimester pregnancy cold (ORs=2.75,95%CI:2.00-3.78); pregnancy contacting undesirable chemicals (ORs=2.38,95%CI:1.60-3.55); noise pollution (ORs=2.36,95%CI:1.37-4.05); adverse reproductive past history (ORs=2.16,95%CI:1.31-3.56); pregnancy medicine using (ORs=2.07,95%CI:1.47-2.91); smoking during pregnancy (ORs=1.58,95%CI:1.27-1.97); older pregnant women (ORs=1.30,95%CI:1.11-1.52) and ORs value higher than1, proved to be risk factors for CHD. Although ORs value of drinking alcohol during pregnancy is higher than1(ORs=1.17), but its confidence interval,95%CI (0.96-1.42) contains1, it cannot be regarded as the risk factor of CHD.②Through the comprehensive analysis of the father relationship between environmental factors with CHD; father alcoholics (ORs=2.47,95%CI:1.07-5.75), father’s occupational to undesirable material (ORs=1.65,95%CI:1.18-2.29) ORs is higher than1, proved to be CHD risk factors.③Through the comprehensive analysis of the relationship between the genetic factors associated with CHD showed that the risks factor of fetals from family with CHD medical past history was3.37(95%CI:2.68-4.22) times than those fetals without this history,which in this study OR values should attract attention.Meta-analysis for the diagnosis CHD in early pregnancy, finally with13literatures study, whose two from Chinese literatures, and11from English literatures①The DV spectrum of blood flow screening for summary sensitivity, specifity and SROC area under the curve(AUC) respectively were0.53(95%CI:0.49-0.58) and0.97(95%CI:0.97-0.97) and0.8701.②DV spectrum of blood flow combined to NT value of screening for CHD summary sensitivity, specificity and SROC area under the curve(AUC) respectively were0.64(95%CI:0.59-0.69),0.94(95%CI:0.93-0.94), and0.9363.Meta-analysis of the second-trimester diagnosis of screening for CHD,and finally18literature study with8chinese literatures and10English literatures, Echocardiography Figure screening for CHD are summarized sensitivity, specificity and SROC area under curve (AUC) respectively were0.91(95%CI:0.89-0.92),1.00(95%CI:1.00-1.00) and0.9852.Conclusion:①family medical past history of CHD, pregnancy mental stimulation, first trimester pregnancy colds, pregnancy contacting undesirable chemicals, noise pollution, adverse reproductive past history, pregnancy medicines using,,smoking during pregnancy, and pregnant women older, father alcoholics, father professional contacting undesirable material were confirmed as risk factors of CHD. Drinking alcohol during pregnancy was not confirmed as risk factor of CHD.②in the first trimester DV spectrum of blood flow Joint NT thickness screening for CHD sensitivity, SROC area under curve (AUC) values were higher than merely using DV spectrum of blood flow screening methods, the joint screening compared individually DV spectrum of blood flow for CHD screening seized with a higher accuracy. Summary of the second trimester echocardiography screening for CHD sensitivity, specificity, SROC area under curve AUC value is much larger than the various checks of the first trimester; the second trimester echocardiography compared to first trimester screening was higher accuracy. Fully proved that pregnant women does not only need to be in the first trimester prenatal cardiac malformation screening and further screening and confirmation should be in the second trimester.