Abstract
BackgroundThe influence of maternal psychological distress on infant congenital heart defects (CHDs) has not been thoroughly investigated. Furthermore, there have been no reports on the combined effect of maternal psychological distress and socioeconomic status on infant CHDs. This study aimed to examine whether maternal psychological distress, socioeconomic status, and their combinations were associated with CHD.MethodsWe conducted a prospective cohort study using data from the Japan Environment and Children’s Study, which recruited pregnant women between 2011 and 2014. Maternal psychological distress was evaluated using the Kessler Psychological Distress Scale in the first trimester, while maternal education and household income were evaluated in the second and third trimesters. The outcome of infant CHD was determined using the medical records at 1 month of age and/or at birth. Crude- and confounder-adjusted logistic regression analyses were performed to evaluate the association between maternal psychological distress and education and household income on infant CHD.ResultsA total of 93,643 pairs of mothers and infants were analyzed, with 1.1% of infants having CHDs. Maternal psychological distress had a significantly higher odds ratio in the crude analysis but not in the adjusted analysis, while maternal education and household income were statistically insignificant. In the analysis of the combination variable of lowest education and psychological distress, the P for trend was statistically significant in the crude and multivariate model excluding anti-depressant medication, but the significance disappeared in the full model (P = 0.050).ConclusionsThe combination of maternal psychological distress and lower education may be a possible indicator of infant CHD.
Highlights
The influence of maternal psychological distress on infant congenital heart defects (CHDs) has not been thoroughly investigated
A meta-analysis published in 2014 reported that lower maternal socioeconomic status was slightly associated with increased risk of infant CHDs, while lower maternal education and household income had significantly higher relative risks of 1.11 and 1.05 for infant CHDs, respectively [6]
A lower socioeconomic status is associated with common mental disorders [9, 10], and the association between anti-depressant use during pregnancy and CHD has been reported in a metaanalysis [11]
Summary
The influence of maternal psychological distress on infant congenital heart defects (CHDs) has not been thoroughly investigated. Recent case–control studies have reported a significant risk of maternal lower education for CHD [7, 8]. A lower socioeconomic status is associated with common mental disorders [9, 10], and the association between anti-depressant use during pregnancy and CHD has been reported in a metaanalysis [11]. Concerning actual depressive symptoms, a case–control study in China reported that depressive symptoms during pregnancy were related to a significantly increased odds ratio (OR) for infant CHDs [12]. The diagnosis of depression in a UK cohort and depressive symptoms in a Northern Ireland case–control study was not related to infant CHDs [8, 13]
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