Association Between Preeclampsia and Congenital Heart Defects

IMPORTANCE The risk of congenital heart defects in infants of women who had preeclampsia during pregnancy is poorly understood, despite shared angiogenic pathways in both conditions. OBJECTIVE To determine the prevalence of congenital heart defects in offspring of women with preeclampsia. DESIGN, SETTING, AND PARTICIPANTS Population-level analysis of live births before discharge, 1989-2012, was conducted for the entire province of Quebec, comprising a quarter of Canada's population. All women who delivered an infant with or without heart defects in any Quebec hospital were included (N = 1 942 072 neonates). EXPOSURES Preeclampsia or eclampsia with onset before or after 34 weeks of gestation. MAIN OUTCOMES AND MEASURES Presence of any critical or noncritical congenital heart defect detected in infants at birth, comparing prevalence in those exposed and not exposed to preeclampsia. RESULTS The absolute prevalence of congenital heart defects was higher for infants of women with preeclampsia than those without it. Infants of women with preeclampsia had no increased prevalence of critical heart defects but did have an increased prevalence of noncritical heart defects compared with infants of nonpreeclamptic women. [GRAPHICS] Among specific defects, prevalence was greatest for septal defects. Compared with infants of women with late-onset preeclampsia, those with early onset (<34 weeks) had greater prevalence of critical heart defects (364.4/100 000 [20/5488]; prevalence ratio, 2.78; 95% CI, 1.71-4.50; prevalence difference, 249.6/100 000; 95% CI, 89.7-409.6) and noncritical heart defects (7306.9/100 000 [401/5488]; prevalence ratio, 5.55; 95% CI, 4.98-6.19; prevalence difference, 6089.2/100 000; 95% CI, 5350.0-6828.3). CONCLUSIONS AND RELEVANCE In this population-based study, preeclampsia was significantly associated with noncritical heart defects in offspring, and preeclampsia before 34 weeks was associated with critical heart defects. However, the absolute risk of congenital heart defects was low.