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 (16.7 per 1000 [1219/72 782]) than without it (8.6 per 1000 [16 077/1 869 290]; prevalence ratio [PR], 1.57; 95% CI, 1.48 to 1.67). Infants of preeclamptic women had no increased prevalence of critical heart defects (123.7 vs 75.6 per 100 000 [90/72 782 vs 1414/1 869 290]; PR, 1.25; 95% CI, 1.00 to 1.57; prevalence difference [PD], 23.6 per 100 000; 95% CI, −1.0 to 48.2) but did have an increased prevalence of noncritical heart defects (1538.8 vs 789.2 per 100 000 [1120/72 782 vs 14 752/1 869 290]; PR, 1.56; 95% CI, 1.47 to 1.67; PD, 521.1 per 100 000; 95% CI, 431.1 to 611.0) compared with infants of nonpreeclamptic women. Among specific defects, prevalence was greatest for septal defects. When stratified by variant of preeclampsia, infants of women with early onset (