Analysis of maternal characteristics of patients with fetal hypoplastic left heart syndrome

Background: Nicotine and SSRIs have been associated with neonatal withdrawal syndromes. These syndromes may be associated with a poor response to neonatal treatment of hypoplastic left heart syndrome (HLHS). Objective: To assess the maternal characteristics of patients with fetal HLHS and analyze for association of these characteristics with response to treatment. Methods: This is a 10 year retrospective review of all patients diagnosed with fetal HLHS at a tertiary referral center. Maternal characteristics were abstract from the obstetrical history and correlated with the fetal echo findings and responses to treatment after birth from the newborn records. Logistic regression was used to analyze the data and a p-value of >0.05 was considered statistically significant. Results: Eight-two patients were identified with HLHS. Eighteen chose termination of pregnancy and 29 patients were lost to follow up, leaving 35 patients for analysis. Twelve patients had aortic stenosis with mitral stenosis, 12 had aortic atresia with mitral atresia and 11 had aortic atresia with mitral stenosis. Fifteen (43%) patients smoked tobacco, 5 (14%) reported SSRI use and 13 (32%) used some other type of prescription medication. Two patients used tobacco and were taking SSRIs. Using logistic regression there was a statistical association of tobacco and/or SSRI use with death prior to a Glenn repair (p=0.01). This statistical association was stronger for the 2 patients who abused tobacco and were on a SSRI (p=0.00). The specificity and negative predictive value were 100% and 85%, respectively. Conclusion: Although the exposure numbers are small, this analysis suggests that exposure to tobacco and/or SSRIs may be associated with poor response to neonatal treatment for HLHS. This could be related to a neonatal withdrawal syndrome at a critical time in neonatal treatment for HLHS. Larger studies are suggested to further evaluate this risk.