Supported by a grant from STN What do we know about congenital heart defects in twin gestations? The search for maternal and environmental risk factors. Burchardt B., Musik M., Sławiński G. Tutor: Prof. dr hab. Marta Szymankiewicz Department of Neonatology at Poznań University of Medical Sciences Studenckie Koło Naukowe Medycyny Perinatalnej Supported by a grant from STN

Aim of the study to evaluate the maternal and environmental risk factors of congenital heart defects in twins choć część autorów zwraca uwagę na fakt, iż liczby te mogą być niedoszacowane, ze względu na lepszą wykrywalność przerzutów nowotworowych przy pomocy stosowanych metod obrazowych, które dodatkowo pojawiają się w krótszym okresie po operacji wyprzedając tym samym wznowę miejscową

Why this topic ?

Congenital heart defects (CHD) are the most common type of anomalies occurring in newborns, affecting approximately 70.9 per 10 000 neonates in Poland. [Polish Registry of Congenital Malformations ]

(…) Congenital heart defect is more common in twins than in singletons, and the increased occurrence is not restricted to monochorionic twins. Intrauterine surveillance and a postnatal comprehensive cardiac assessment for both twins may be considered regardless of chorionicity and zygosity.(…) „Increased prevalence of congenital heart defects in monozygotic and dizygotic twins.” [Herskind AM, Almind Pedersen D, Christensen K. Circulation. 2013 Sep 10;128(11):1182-8. doi: 10.1161]

(…) The increase in babies who are both from a multiple pregnancy and affected by a congenital anomaly has implications for prenatal and postnatal service provision. The contribution of assisted reproductive technologies to the increase in risk needs further research. The deficit of chromosomal anomalies among multiple births has relevance for prenatal risk counselling(…) [Trends in the prevalence, risk and pregnancy outcome of multiple births with congenital anomaly: a registry-based study in 14 European countries 1984-2007.] Boyle B, McConkey R, Garne E, BJOG. 2013 May;120(6):707-16. doi: 10.1111]

Material and methods The study included 101 sets of twins born in 2011 at the Gynecology and Obstetrics University Hospital in Poznań. Clinical data were analyzed retrospectively and compiled with accessory information obtained from a survey performed among the children’s mothers. The survey questions concerned a mother health, a course of pregnancy as well as the use of assisted reproductive techniques 6750 children born in 2011 in University Hospital 408 born as a result of twin pregnancy The studied group: 202 neonates whose mothers responded to a survey 92 female 110 male Mean gestational age: 35 weeks

The survey questions concerned a mother health, a course of pregnancy as well as the use of assisted reproductive techniques.

Results CHD was found in 28.2% (n=57). All heart defects were confirmed in postnatal echocardiographic examination. The most common CHD was patent foramen ovale (n=30), followed by atrial septal defect (n=23).

No. of cases significance P value maternal age 202 no - BMI before pregnancy 198 gestational diabetes mellitus gestational hypertension maternal heart defects asthma hypo/hyperthyroidism epilepsy polycystic ovary syndrome folic acid/ vitamine intake before and during pregnancy seasonal infection during first 8 weeks of pregnancy occupational activity during first 8 weeks of pregnancy maternal cardiac arrhythmia yes p=0.036 nephrolithiasis Table 1 Maternal factors of CHD in our study

No. of cases significance P value gestational age 197 yes p<0.0001 chorionicity 202 no - gender Apgar w 1 minute 195 p=0.0002 Apgar w 5 minute 177 p=0.0004 Neonatal Unit admission p<0.0001; NICU admission Need for hospital re- admission in 1st year of life p=0.0036 Table 2 Neonatal factors and CHD in our study

CHD and the use of assisted reproductive techniques (1) Forty eight newborns (23.8%) were born using assisted reproductive techniques use.

CHD and the use of assisted reproductive techniques (2) No. of cases significance P value IUI 202 yes-positive p=0.022 IVF yes- negative p=0.031 ICSI no - Table 3 Assisted reproductive techniques and CHD in our study

Conclusions –risk factors (1) There was a significant negative correlation between CHD and MGA. There was a significant correlation between maternal cardiac arrhythmia and nephrolithiasis and CHD in an offspring. CHD were significantly most common in children born as a result of IUI use . On the other hand CHD were diagnosed less frequently in children born as a result of IVF. There were no significant relationship between ICSI and CHD.

Conclusions – the impact of CHD (2) Neonates with CHD were in worse general condition assesed shortly after birth ( worse Apgar score at 1 and 5 minute) and statisically more often were admitted on Neonatology Unit and Neonatal Intensive Care Unit . CHD was a significant risk factor for a hospital re-admission during first year of life.

Thank you for your attention ! …and we would like to thank our Tutor: Prof. dr hab. Marta Szymankiewicz

Supported by a grant from STN What do we know about congenital heart defects in twin gestations? The search for maternal and environmental risk factors. Burchardt B., Musik M., Sławiński G. Tutor: Prof. dr hab. Marta Szymankiewicz Department of Neonatology at Poznań University of Medical Sciences Studenckie Koło Naukowe Medycyny Perinatalnej Supported by a grant from STN