Epidemiology of Congenital Heart Defects in Live Births: Findings from a Study in Southern Brazil

Epidemiology of Congenital Heart Defects in Live Births: Findings from a Study in Southern Brazil | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Epidemiology of Congenital Heart Defects in Live Births: Findings from a Study in Southern Brazil Fabyanne Guimarães Oliveira, George Octavio Costa Salecker, Angel Larroza Souza, and 11 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7339920/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 09 Jan, 2026 Read the published version in BMC Cardiovascular Disorders → Version 1 posted 11 You are reading this latest preprint version Abstract Background Congenital heart defects (CHD) are the leading cause of infant mortality associated with birth defects in Brazil. Access to prenatal diagnosis is still considered low, and treatment is limited to referral centers, especially in large urban centers. Objectives To characterize the profile of live births diagnosed with CHD in three university hospitals in Rio Grande do Sul, a state in southern Brazil. Methodology: This study was based on an active surveillance system, and data were collected between November 2021 and February 2024 through medical record searches and maternal interviews. Statistical differences between CHD and maternal risk factors during pregnancy and neonatal variables were assessed using Fisher's exact test and Poisson regression with robust variance. Results From 381 CHD cases identified, 64.3% were classified as isolated (iCHD) and 35.7% as associated with other anomalies or syndromes (aCHD). The most frequent CHD was atrial and ventricular septal defects. Down syndrome was the most common genetic condition observed among associated cases. Maternal age, low birth weight and infant mortality were significantly more frequent in the aCHD group. Illicit drug use was more frequent in the iCHD. The rate of prenatal diagnosis by fetal echocardiography was low (15%) in both groups, and the rate of false negative results was high 14 (7.5%) iCHD and 17 (15.9%). Mortality was observed in the iCHD (n = 9; 3.7%) and in the aCHD group (n = 24; 17.8%). Conclusions These findings highlight the importance of improving access to specialized prenatal care and implementing multidisciplinary strategies for managing CHD. congenital heart defects newborns fetal echocardiography maternal risk factors pregnancy mortality Figures Figure 1 Introduction Congenital heart defects (CHD) are structural abnormalities of the heart and intrathoracic great vessels present at birth. They are estimated to affect 8 to 12 per 1,000 live births and account for approximately 40% of prenatal deaths 1 . About 70% of CHD occur as isolated defects with multifactorial etiology, while the remaining 30% are associated with extracardiac anomalies or form part of genetic syndromes 2 . The etiology of CHD includes genetic causes 3 as well as environmental exposures such as medications (e.g., lithium) 4 , alcohol 5 , recreational drugs 6 , maternal diabetes 7 , and obesity 7 , 8 . The majority of isolated CHD is of multifactorial etiology, a combination of genetic predisposition associated with environmental risk factors 2 . In Brazil, CHD represents the second most prevalent group of congenital anomalies, with a reported rate of 15 per 10,000 live births in 2022 9 . Regional geographic and cultural diversity, combined with disparities in access to healthcare services, may influence both the diagnosis and the outcomes of children with CHD 10 , 11 . Early diagnosis is essential for implementing structured care pathways and enabling timely interventions. In this regard, fetal echocardiography has become a crucial tool, contributing to improved prenatal detection rates and better perinatal outcomes 11 . Although fetal echocardiography can identify approximately 80% of CHD, many cases remain undetected due to various maternal, social, and technical factors 12 . Treatment strategies depend on the severity of the condition and may involve cardiac catheterization, surgical procedures, and/or pharmacological therapy 13 . Despite being among the anomalies considered priority for public health surveillance in Brazil 14 , CHD are frequently underreported in the Live Birth Information System (SINASC) 15 . Therefore, this study aimed to characterize the profile of live births diagnosed with CHD in three university hospitals in Rio Grande do Sul, a state in the South of Brazil, including the main types of CHD identified, the presence of associated congenital anomalies, and related maternal risk factors. Methods The study included live-born infants up to one year of age with a confirmed diagnosis of congenital heart defects (CHD), born in Rio Grande do Sul state and admitted in three regional referral hospitals: Hospital de Clínicas de Porto Alegre (HCPA/UFRGS), University Hospital FURG, and the Teaching Hospital of the Federal University of Pelotas (HE/UFPEL). Cases were searched through physical examination, echocardiogram exams, medical records, and maternal interviews. Data were collected between November 2021 and February 2024, and CHD were classified according to the 10th Revision of the International Classification of Diseases (ICD-10). Cases in which the only diagnosis was a patent ductus arteriosus in preterm infants (< 37 weeks of gestation) were excluded. CHD were classified as (1) isolated, when the cardiac defect was the only anomaly identified, or (2) associated, when accompanied by a genetic syndrome or other extracardiac anomalies. The following maternal variables were analyzed: age, skin color, education level, number of prenatal consultations, and parity. Neonatal variables included birth weight, length, head circumference, and gestational age. Exposure to potential risk factors such as alcohol, tobacco, illicit recreational drugs, infections, diabetes, and obesity was also evaluated. Additionally, data regarding the timing of CHD diagnosis, fetal echocardiography, and pulse oximetry screening were assessed. Gestational age was categorized as preterm (< 37 weeks) or at term (≥ 37 and < 42 weeks). Birth weight, length, and head circumference were corrected for gestational age and sex using the INTERGROWTH-21st standards ( https://intergrowth21.tghn.org/ ). Associations between CHD with maternal risk factors during pregnancy, and neonatal variables were assessed using Fisher’s exact test. Multivariate analysis was performed using Poisson regression with robust variance only for isolated congenital heart defects (iCHD). Two separate models were constructed. The first model included neonatal variables that were statistically significant in the univariate analysis (birth length and death), or considered relevant (birth weight), and adjusted for the newborn’s sex. The second model included maternal variables that were either statistically significant (maternal age and illicit drug use) or considered relevant (obesity and infections). A significance level of 5% (p < 0.05) was adopted. Statistical analyses were conducted using the Statistical Package for the Social Sciences (SPSS), version 18.0. Ethics statement The study was approved by the Research Ethics Committee of Hospital de Clinicas de Porto Alegre (# CAAE: 30886520.9.1001.5327) and was conducted according to the principles expressed in the Declaration of Helsinki. A written informed consent was obtained from the parents or legal guardians of all participating children to participate in the study and to publish results. Clínical Trial Number: not applicable Results During the study period, 547 live births with selected priority congenital anomalies 14 were registered through the active surveillance system in the three reference hospitals. Among them, 381 were diagnosed with CHD (HCPA: n = 315, 82.6%; HE-UFPEL and FURG: n = 66, 17.3%). Two cases were excluded because the births occurred outside the state. Most newborns were from the metropolitan region of Porto Alegre, the capital of Rio Grande do Sul (n = 269, 70.6%) (Fig. 1 ). iCHD : isolated congenital heart defects; aCHD : associated congenital heart defects; BMI : Body Mass Index. Of the 381 CHD cases, 254 (64.3%) were classified as isolated (iCHD), and 136 (35.7%) were associated with genetic syndromes or other congenital anomalies (aCHD). The most frequently diagnosed CHD was atrial septal defect (n = 174; 45.6%), followed by ventricular septal defect (n = 110; 28.8%). Other congenital malformations of the great arteries were also identified, such as patent ductus arteriosus (n = 103; 27.0%) and other malformations of the aorta (n = 10; 2.7%). Among the valvular anomalies, the most frequent were pulmonary valve stenosis (n = 24, 6.2%) and other tricuspid valve malformations (n = 14, 3.6%). Table 1 shows the distribution of CHD types between the iCHD and aCHD groups. Among the aCHD cases, 67 (49.2%) were part of known genetic syndromes, and 69 (50.8%) had other extracardiac congenital anomalies. Trisomy 21 was the most frequent (n = 33; 48.5%), followed by Trisomy 13 (n = 4; 5.9%) and the VACTERL association (n = 4; 5.9%). The most frequent extracardiac anomalies involved the central nervous system (n = 17; 25.0%), genitourinary system (n = 15; 22.0%), and craniofacial anomalies (n = 14; 20.0%). Table 2 summarizes the genetic syndromes and extracardiac anomalies associated with CHD. Cases diagnosed as syndromes, associations, or sequences were further characterized based on clinical profile and are presented in detail in Table Supplementary 1. Table 3 presents the characteristics of the newborns in both groups, and Table 4 presents the maternal characteristics. Statistically significant differences in univariate analysis were observed between the iCHD and aCHD for birth length, head circumference, and death. Low birth weight, microcephaly, and infant death were more prevalent in the aCHD group. Multivariate analysis using Poisson regression with robust variance was conducted with iCHD as the outcome. In the model evaluating neonatal characteristics, high birth weight ( > + 2 SD) was observed to have statistically significant differences in iCHD (PR = 1.245; 95% CI: 1.053–1.473; p = 0.011). A lower prevalence of death was observed among those with iCHD (PR = 0.302; 95% CI: 0.136–0.667; p = 0.003) (Table 5 ). In the multivariate analysis for maternal risk factors, we observed statistically significant differences for maternal age (≥ 35 anos) and BMI (underweight and overweight/obesity) for aCHD, while illicit drug use was statistically different for iCHD (Table 5 ). Since the proportion of overweight/obesity women was similar between the iCHD and aCHD groups in the univariate analysis, the significance observed in the multivariate analysis reflects interactions with other variables included in the adjusted model. Maternal medication use during pregnancy was evaluated, with 245 (59.0%) women reporting the use of various drug classes. The most commonly used medications included antibiotics, vitamin supplements, and hormones. Regarding infections, 161 (42.2%) mothers received treatment during pregnancy. The most frequently reported infections were caused by Streptococcus (n = 58; 36.0%), urinary tract infections (UTIs) (n = 55; 34.1%), and syphilis (n = 30; 18.6%). Among maternal health conditions, preeclampsia was reported in 14 (3.6%) cases, while psychiatric disorders were noted in 13 (3.4%) cases (Table 4 ). Fetal echocardiography was performed in only 43 cases (23.0%) of the iCHD group and in 33 cases (30.9%) in the aCHD group but a normal result was accomplished in 14 (14/43 ; 32,5%) of iCHD and in 17 (17/33 ; 51,5%) of aCHD (Table 3 ). Pulse oximetry screening was not performed in 40 infants (19,5%) of iCHD group and in 24 infants (24,7% ) of aCHD group. (Table 3 ) Discussion This study provides an overview of the clinical and epidemiological profile of congenital heart defects (CHD) diagnosed in live births at three referral hospitals in Rio Grande do Sul, Brazil. Through active surveillance, we identified a high proportion of CHD (69.6%) among newborns with selected priority congenital anomalies. Data recorded in SINASC registered a prevalence of 8/10,000 15 , which is much less than the expected 1% 16 . In contrast, data from the Mortality Information System (SIM) 17 showed a proportion of deaths due to CHD of 11/10,000, suggesting that this system can capture cases more accurately, while SINASC still needs improvements in the reporting and recording of CHD. A predominance of iCHD was observed, accounting for 64.3% of cases, similar to previous hospital-based studies conducted in Brazil and other countries, in which iCHD represented approximately 60% to 70% of all CHD 18 , 19 , 20 , 21 . Atrial septal defects (ASD, 45.6%) and ventricular septal defects (VSD, 28.8%) were the most frequently diagnosed types of CHD, followed by patent ductus arteriosus (PDA, 27.0%), reflecting the pattern commonly reported in the literature for live births 16 , 18 , 22 . Amorim et al. 18 also observed that ASD, VSD, and PDA accounted for 62.6% of all CHDs in a hospital-based study conducted in Minas Gerais. Globally, these lesions are among the most prevalent, with VSD (34.0%), ASD (13.0%), and PDA (10.0%) being the most frequent, as reported by van der Linde et al. 16 . However, when comparing our findings to those of Pinheiro et al. 23 which analyzed children with CHD referred to a cardiac surgery center in Rio Grande do Sul, they observed a higher prevalence of critical and complex CHDs, such as multiple cardiac malformations (21.9%), hypoplastic left heart syndrome (14.5%), and transposition of the great arteries (11.5%). These differences reflect the referral profile of the respective hospitals, while Pinheiro et al. 23 focused on cases requiring surgical intervention, our study captured a large spectrum of CHDs, including milder forms. This study demonstrated significant differences between CHD groups in terms of birth length and mortality. In the multivariate analysis, mortality remained significantly higher frequency among aCHD cases, as well as low birth weight. Neonatal outcomes in CHD cases may be influenced by multiple non-cardiac and genetic factors, including adverse neonatal conditions such as low birth weight and the presence of extracardiac anomalies or genetic syndromes 24 . Low birth weight is recognized as an important predictor of neonatal morbidity and mortality, especially in CHD cases requiring early surgical intervention 24 . In our study, the higher prevalence of low birth weight among aCHD cases reinforces the need for interdisciplinary care to ensure adequate growth and development of these patients. Regarding neonatal mortality, the lower number of deaths observed among iCHD compared with an increased number in aCHD cases indicates that the presence of extracardiac anomalies or syndromic conditions plays a critical role in increasing the risk of mortality, as also reported in previous studies 25 , 26 . However, when analyzing the characteristics of the children with iCHD who died, we found that none had received a prenatal diagnosis. At birth, CHD was identified as ASD in five cases (55.5%) and other cardiac anomalies in eight cases (88.8%). Among these neonates, three (33.3%) presented extreme prematurity, two (22.2%) had short length for gestational age, and one (11.1%) had low birth weight for gestational age. Seven (77.8%) deaths occurred in the neonatal period, and two (22.2%) in the postneonatal period. In Brazil, neonatal and postneonatal mortality are strongly associated with prematurity and birth defects 27 . Therefore, adequate prenatal care, including access to diagnostic tools such as morphological ultrasound and fetal echocardiography is essential to enable timely referral to specialized services and ensure proper management of newborns. In addition to neonatal characteristics, maternal factors also showed significant differences between iCHD and aCHD groups, particularly maternal age and illicit drug use. Maternal age is a well-recognized factor in the literature for its impact on CHD risk, especially in syndromic cases, which is related to the increased occurrence of aneuploidies with advancing maternal age, such as trisomies 21, 18, and 13 28,29 . Conversely, in iCHD cases, this effect of advanced maternal age is not commonly observed 5 . Exposure to illicit drugs during pregnancy has also been suggested as a potential risk factor for CHD development, with associations described for defects such as dextrocardia (cocaine) 30 and septal defects (marijuana) 31 . However, the mechanisms by which these substances may influence cardiac development are not yet fully understood and are better documented in experimental animal studies 6 , 32 . Mersereau et al. 6 used a zebrafish model to investigate the effects of embryonic pre-exposure to cocaine on development and cardiovascular physiology. Their findings demonstrated that the primary developmental effects of cocaine are mediated by elevated monoamine levels, especially dopamine, which sensitize both the cardiovascular and behavioral responses to the drug, persisting into adulthood. Although fetal cocaine exposure may not lead to structural cardiac defects, it induces cellular signaling alterations that can increase the long-term risk of cardiovascular disease in both neonates and adults 32 . However in our study we couldn't see association with any specific illicit drug. The association between maternal BMI and CHD risk has been described in different populations, with evidence of increased risk for left ventricle outflow tract obstruction, right ventricle outflow tract obstruction and complex defects, among offspring of obese women 7 , 33 . In the present study, we observed similar proportions of overweight and obesity between the two CHD groups. The population of Porto Alegre presented a prevalence of overweight (50.0%) and obesity (20%) for women over 18 years of age in 2023 34 . Therefore, this reflects the high prevalence of overweight/obese pregnant women identified in our study, considering that BMI was analyzed before pregnancy. However, the high prevalence of overweight/obese pregnant women has already been observed in other national studies 35 , 36 , 37 , demonstrating the need to promote an adequate and safe nutritious diet for these pregnant women. In this study, we also observed a high frequency of infections during pregnancy, with a particular emphasis on urinary tract infections and syphilis. In 2023, approximately 68.6% of pregnant women diagnosed with syphilis were identified in the first or second trimesters of pregnancy in Brazil, while Rio Grande do Sul, for the same period, had a prevalence of 41/1,000 pregnancy 38 . This data reflects a high notification rate and adequate screening during prenatal care, which is necessary to avoid adverse neonatal outcomes such as neonatal deaths, premature births or low birth weight, in addition to vertical transmission of the disease to the newborn 39 . Several studies have pointed out that certain maternal infections, especially during the period of cardiogenesis, may increase the risk of CHD development 1 , 21 , 40 . Although we did not assess the direct association between these factors and CHD types in this study, our findings reinforce the importance of adequate prenatal care for the identification and management of these conditions. Our results also showed a low rate of prenatal diagnosis by fetal echocardiography, especially considering the high complexity of some observed cases. This result is consistent with that of Huber et al 19 also from Rio Grande do Sul, where reported that only 3.1% of live births referred to a specialized CHD center had a prenatal diagnosis. Notably, many of the CHD cases identified in our study were not diagnosed prenatally, and were associated with important maternal risk factors, such as advanced maternal age, obesity, and diabetes. Among the 14 pregnant women with normal fetal echocardiography results in the iCHD group, nine (64.2%) were overweight/obesity, five (35.7%) had diabetes, and three (21.4%) were of advanced maternal age. In the aCHD group, eight (47.0%) were overweight/obesity, one (5.8%) had diabetes, and 11 (64.7%) were of advanced maternal age. These findings suggest that, in addition to limited access to specialized prenatal care 11 , 41 , both maternal and technical factors may interfere with the effectiveness of prenatal CHD detection. Maternal obesity can reduce the image quality of fetal echocardiography 11 , while technical limitations, including the imaging protocol used, ultrasound modality (transabdominal or transvaginal), the experience of the medical professional 12 , and gestational age at the time of examination 23 , may also impact diagnostic accuracy. Despite national recommendations for performing fetal echocardiography, coverage remains insufficient in many regions, especially outside major urban centers, when compared to hospitals specialized to care for CHD, where prenatal detection rates are significantly higher 23 . The diagnosis of congenital heart defects (CHD) is essential for ensuring proper clinical management, while the investigation of risk factors plays a key role in understanding the etiology of these conditions. In this context, there is a need for more studies addressing the various aspects of CHD, allowing for their temporal and regional monitoring in Brazil, especially considering that these anomalies remain among the most prevalent in live births in the country 42 . Fernandes et al 20 , through a population-based analysis of SINASC data from 2005 to 2018 in the state of São Paulo, identified a rising trend in the prevalence of CHD (12.4 per 10,000 live births), with a higher incidence among children born to mothers aged ≥ 35 years. The increasing prevalence of CHD has been observed worldwide 16 , 43 , suggesting that this increase may be attributed to improvements in prenatal and postnatal diagnostic methods, the implementation of pulse oximetry screening in neonatal care, and improved management of high-risk pregnancies. Encouraging epidemiological studies of congenital heart disease has been essential to improve our understanding of its distribution and associated risk factors. Our study was based on an active surveillance system in three tertiary referral centers, which enhances diagnostic accuracy, as all included cases had diagnoses confirmed by echocardiography. However, some limitations must be acknowledged, such as the overrepresentation of syndromic cases or high-risk pregnancies, reflecting the care profile of the participating hospitals, especially HCPA, a regional referral center for complex cases. Therefore, considering that CHD has a multifactorial etiology, we emphasize the importance of expanding investigations in specialized centers, incorporating the analysis of environmental, clinical, and genetic factors. This integrated approach can contribute to a better understanding of associated risks and the improvement of diagnostic, prevention, and management strategies for these patients. Conclusion This study described the clinical and epidemiological profile of congenital heart defects (CHD) diagnosed in live births at referral hospitals in Rio Grande do Sul, Brazil, based on an active surveillance system. A predominance of isolated CHD cases was observed, with atrial and ventricular septal defects and patent ductus arteriosus being the most frequently diagnosed anomalies. Neonatal factors such as low birth weight and mortality showed significant differences when comparing CHD with additional anomalies, while high birth weight was more frequent among isolated cases. Among maternal characteristics, advanced maternal age and illicit drug use showed significant differences with aCHD and iCHD, respectively, reinforcing the influence of both genetic and environmental factors in the etiology of these malformations. Furthermore, the low rate of prenatal diagnosis by fetal echocardiography highlights the need to improve access to specialized services to facilitate early detection of these conditions. These findings underscore the importance of continuous surveillance and early diagnostic strategies, as well as the need for a multidisciplinary approach in the care of pregnant women and newborns with CHD. Future studies should further investigate the genetic, environmental, and social factors associated with the development of these anomalies to strengthen prevention and management policies. Abbreviations ASD Atrial Septal Defects BMI Body Mass Index CHD Congenital Heart Defects CI Confidence Interval FURG Universidade Federal do Rio Grande do Sul GDM Gestational Diabetes Mellitus HCPA Hospital de Clínicas de Porto Alegre HE/UFPEL Teaching Hospital of the Federal University of Pelotas ICD-10 International Classification of Diseases iCHD Isolated Congenital Heart Defects PDA Patent Ductus Arteriosus PR Prevalence Ratio SIM Mortality Information System SINASC Live Birth Information System SPSS Statistical Package for the Social Sciences UFRGS Universidade Federal do Rio Grande do Sul UTI Urinary tract infection VSD Ventricular Septal Defects Declarations All authors approved the final version of the manuscript and consent to its publication. Clinical Trial Number : not applicable Author information Authors and Affiliations 1. Graduate Program in Genetics and Molecular Biology, Genetics Department, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. Fabyanne Guimarães de Oliveira, Angel Larroza de Souza, Cláudia Fernandes Lorea, Maria Teresa Vieira Sanseverino, Thayne Woycinck Kowalski and Lavinia Schuler-Faccini. 2. Teratogen Information System (SIAT), Medical Genetics Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil. Fabyanne Guimarães de Oliveira, Maria Teresa Vieira Sanseverino, Thayne Woycinck Kowalski and Lavinia Schuler-Faccini. 3. Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. George Octavio da Costa Salecker, Carolina Sayuri Arashiro, Júlia Rei Pires, Vinicius Barreto Nolibos, Rosa Maria Moreno Barbosa and Taís Sica da Rocha. 4. Faculty of Medicine, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil. Simone de Menezes Karam 5. Cardiology Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil. Andrea Tomasi Sutil 6. Laboratory of Genomic Medicine, Center of Experimental Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil. Thayne Woycinck Kowalski 7. Graduate Program in Medicine: Medical Sciences, Medicine Faculty, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. Thayne Woycinck Kowalski 8. School of Medicine. Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil Maria Teresa Vieira Sanseverino Corresponding author Correspondence to Taís Sica da Rocha. Ethics approval: This study was approved by the Research Ethics Committee of HCPA (CAAE: 30886520.9.1001.5327). Conflicts of Interest: The authors declare no conflicts of interest. Funding: This study was funded by the Accord OPAS / Ministério da Saúde / Fundação Médica do RS Projeto (2178-4) SCON2020-00173 - Vigilância e Atenção em Anomalias Congênitas no RS; Hospital de Clínicas de Porto Alegre (HCPA) - Fundo de Incentivo à Pesquisa e Eventos (FIPE), grants no. 2019 − 0792 and 2020 − 0174. The scholarships of the authors were funded by the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Fundação Médica do RS - Vigilância e Atenção em Anomalias Congênitas no RS. F.G.O is the recipient of a CNPq scholarship (grant no 165593/2021-0), T.W.K. is the recipient of a Fundação Médica do RS - Vigilância e Atenção em Anomalias Congênitas no RS. Author Contribution F.G.O., L.S.-F. and T.S.R. designed the work; G.O.C.S., C.S.A., J.R.P., V.B.N. and R.M.M.B. collected the data from the databases; F.G.O. and A.L.S. analyzed the data from the databases; F.G.O wrote the first draft of the manuscript; S.M.M., C.F.L., M.T.V.S., A.T.S., T.W.K., L.S.-F. and T.S.R. revised the manuscript. All authors have read and agreed to the published version of the manuscript. Acknowledgements: Not applicable. Data availability: The data that support the findings of this study are available from the medical records department of Hospital de Clínicas de Porto Alegre (HCPA/UFRGS), University Hospital FURG, and the Teaching Hospital of the Federal University of Pelotas (HE/UFPEL). However, restrictions apply to the availability of these data due to patient confidentiality and ethical considerations. Data are available from the corresponding author upon reasonable request and with permission from the hospital’s ethics committee. References Boyd R, McMullen H, Beqaj H, Kalfa D. Environmental exposures and congenital heart disease. Pediatrics. 2021;149(1):e20210521. 10.1542/peds.2021-052151 . Digilio MC, Marino B. What is new in genetics of congenital heart defects? Front Pediatr. 2016;4:120. 10.3389/fped.2016.00120 . Yasuhara J, Garg V. Genetics of congenital heart disease: a narrative review of recent advances and clinical implications. Transl Pediatr. 2021;10(9):2366–86. 10.21037/tp-21-297 . Diav-Citrin O, Shechtman S, Tahover E, et al. Pregnancy outcome following in utero exposure to lithium: a prospective, comparative, observational study. Am J Psychiatry. 2014;171(7):785–94. 10.1176/appi.ajp.2014.12111402 . Wu L, Li N, Liu Y. Association between maternal factors and risk of congenital heart disease in offspring: a systematic review and meta-analysis. Matern Child Health J. 2022;27(1):29–48. 10.1007/s10995-022-03538-8 . Mersereau E, Boyle C, Poitra S, et al. Longitudinal effects of embryonic exposure to cocaine on morphology, cardiovascular physiology, and behavior in zebrafish. Int J Mol Sci. 2016;17(6):847. 10.3390/ijms17060847 . Turunen R, Pulakka A, Metsälä J, et al. Maternal Diabetes and Overweight and Congenital Heart Defects in Offspring. JAMA Netw Open. 2024;7(1):e2350579. 10.1001/jamanetworkopen.2023.50579 . Salmeri N, Seidenari A, Cavoretto PI, Papale M, Candiani M, Farina A. Maternal prepregnancy weight as an independent risk factor for congenital heart defect: systematic review and meta-analysis stratified by subtype and severity of defect. Ultrasound Obstet Gynecol. 2024;64(3):294–307. 10.1002/uog.27659 . Ministério da Saúde (Brasil). Epidemiological report [Internet]. Brasília: Ministério da Saúde. 2024 Mar 4. Available from: https://www.gov.br/saude/pt-br/../boletim-epidemiologico-volume-55-no-06 Lopez KN, Baker-Smith C, Flores G, et al. Addressing social determinants of health and mitigating health disparities across the lifespan in congenital heart disease: a scientific statement from the American Heart Association. J Am Heart Assoc. 2022;11(8):e025358. 10.1161/jaha.122.025358 . Pedra SRFF, Zielinsky P, Binotto CN, et al. Brazilian fetal cardiology guidelines – 2019. Arq Bras Cardiol. 2019. 10.5935/abc.20190075 . published online. Karim JN, Bradburn E, Roberts N, Papageorghiou AT. First-trimester ultrasound detection of fetal heart anomalies: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2022;59(1):11–25. 10.1002/uog.23740 . Sun R, Liu M, Lu L, Zheng Y, Zhang P. Congenital heart disease: causes, diagnosis, symptoms, and treatments. Cell Biochem Biophys. 2015;72(3):857–60. 10.1007/s12013-015-0551-6 . Cardoso-dos-Santos AC, Medeiros-de-Souza AC, Bremm JM, et al. Lista de anomalias congênitas prioritárias para vigilância no âmbito do Sistema de Informações sobre Nascidos Vivos do Brasil. Epidemiol Serv Saúde. 2021;30(1):e20210030. 10.1590/s1679-49742021000100030 . Brasil. Ministério da Saúde. Saúde Brasil 2020/2021: anomalias congênitas prioritárias para a vigilância ao nascimento. Brasília: Ministério da Saúde; 2021. van der Linde D, Konings EEM, Slager MA, et al. Birth prevalence of congenital heart disease worldwide. J Am Coll Cardiol. 2011;58(21):2241–7. 10.1016/j.jacc.2011.08.025 . Brasil. Ministério da Saúde. DATASUS. Sistema de Informações sobre Mortalidade – SIM [Internet]. Brasília: Ministério da Saúde; 2023 [cited 2025 Jun 23]. Available from: https://datasus.saude.gov.br/mortalidade-desde-1979-pela-cid-10/ Amorim LFP, Pires CAB, Lana AMA, et al. Apresentação das cardiopatias congênitas diagnosticadas ao nascimento: análise de 29 770 recém-nascidos. J Pediatr. 2008;84(1):83–90. 10.1590/S0021-75572008000100014 . Huber J, Peres VC, Santos TJD, et al. Cardiopatias congênitas em um serviço de referência: evolução clínica e doenças associadas. Arq Bras Cardiol. 2010;94(3):333–8. 10.1590/S0066-782X2010000300009 . Fernandes PS, Magalhães LR, Pezzini TR, de Sousa Santos EF, Calderon MG. Congenital heart diseases trends in São Paulo State, Brazil: a national live birth data bank analysis. World J Pediatr. 2022;18(7):472–81. 10.1007/s12519-022-00543-3 . Dolk H, Loane M, Garne E. Congenital heart defects in Europe. Circulation. 2011;123(8):841–9. 10.1161/CIRCULATIONAHA.110.958405 . Pinto Júnior VC, Branco KMPC, Cavalcante RC, et al. Epidemiology of congenital heart disease in Brazil: approximation of the official Brazilian data with the literature. Rev Bras Cir Cardiovasc. 2015;30(2):213–20. 10.5935/1678-9741.20150018 . Pinheiro DO, Varisco BB, Silva MBD, et al. Accuracy of prenatal diagnosis of congenital cardiac malformations. Rev Bras Ginecol Obstet. 2019;41(1):11–6. 10.1055/s-0038-1676058 . Chowdhury D, Toms R, Brumbaugh JE, et al. Evaluation and management of noncardiac comorbidities in children with congenital heart disease. Pediatrics. 2022;150(Suppl 2):e20220564. 10.1542/peds.2022-056415e . Nakashima Y, Mori Y, Sugiura H, et al. Very low birth weight infants with congenital heart disease: a multicenter cohort study in Japan. J Cardiol. 2022;80(4):344–50. 10.1016/j.jjcc.2022.05.008 . Ayfokru A, Shewasinad S, Ahmed F, et al. Incidence and predictors of mortality among neonates with congenital heart disease in Ethiopia: a retrospective cohort study. BMC Pediatr. 2024;24(1):–. 10.1186/s12887-024-05023-3 . Brasil Ministérioda, Saúde. Secretaria de Vigilância em Saúde, Departamento de Análise em Saúde e Vigilância de Doenças não Transmissíveis. Saúde Brasil 2020/2021: uma análise da situação de saúde e da qualidade da informação. Brasília: Ministério da Saúde; 2021. Ahn D, Kim J, Kang J, Kim YH, Kim K. Congenital anomalies and maternal age: a systematic review and meta-analysis of observational studies. Acta Obstet Gynecol Scand. 2022;101(5):484–98. 10.1111/aogs.14339 . Hartman RJ, Rasmussen SA, Botto LD, et al. The contribution of chromosomal abnormalities to congenital heart defects: a population-based study. Pediatr Cardiol. 2011;32(8):1147–57. 10.1007/s00246-011-0034-5 . Kuehl KS, Loffredo C. Risk factors for heart disease associated with abnormal sidedness. Teratology. 2002;66(5):242–8. 10.1002/tera.10099 . Williams LJ, Correa A, Rasmussen S. Maternal lifestyle factors and risk for ventricular septal defects. Birth Defects Res Clin Mol Teratol. 2004;70(2):59–64. 10.1002/bdra.10145 . Meyer KD, Zhang L. Short- and long-term adverse effects of cocaine abuse during pregnancy on heart development. Ther Adv Cardiovasc Dis. 2009;3(1):7–16. 10.1177/1753944708099877 . Helle E, Priest JR. Maternal obesity and diabetes mellitus as risk factors for congenital heart disease in the offspring. J Am Heart Assoc. 2020;9(8):e011541. 10.1161/jaha.119.011541 . Ministério da Saúde (Brasil). Vigitel Brasil 2023: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico. Brasília: Ministério da Saúde; 2024. Magalhães EIS, Maia DS, Bonfim CFA, Netto MP, Lamounier JA, Rocha Dda S. Prevalência e fatores associados ao ganho de peso gestacional excessivo em unidades de saúde do sudoeste da Bahia. Rev Bras Epidemiol. 2015;18(4):858–69. 10.1590/1980-5497201500040014 . Ferreira LAP, Piccinato CA, Cordioli E, Zlotnik E. Pregestational body mass index, weight gain during pregnancy and perinatal outcome: a retrospective descriptive study. Einstein (Sao Paulo). 2019;18:eAO4851. 10.31744/einstein_journal/2020AO4851 . Nast M, Oliveira A, Rauber F, Vitolo MR. Ganho de peso excessivo na gestação é fator de risco para o excesso de peso em mulheres. Rev Bras Ginecol Obstet. 2013;35(12):536–40. 10.1590/S0100-72032013001200002 . Brasil. Ministério da Saúde, Secretaria de Vigilância em Saúde e Ambiente. Boletim Epidemiológico de Sífilis 2024. Brasília: Ministério da Saúde; 2024. Newman L, Kamb M, Hawkes S, Gomez G, Say L, Seuc A, et al. Global estimates of syphilis in pregnancy and associated adverse outcomes: analysis of multinational antenatal surveillance data. PLoS Med. 2013;10(2):e1001396. 10.1371/journal.pmed.1001396 . Patel J, Politis MD, Howley MM, et al. Fever and antibiotic use in maternal urinary tract infections during pregnancy and risk of congenital heart defects: findings from the National Birth Defects Prevention Study. Birth Defects Res. 2023;116(1). 10.1002/bdr2.2281 . Hagemann LL, Zielinsky P. Rastreamento populacional de anormalidades cardíacas fetais por ecocardiografia pré-natal em gestações de baixo risco no município de Porto Alegre. Arq Bras Cardiol. 2004;82(4). 10.1590/S0066-782X2004000400003 . Silvestri Melkan MPI, Ferreira OS, Bassan LCL, et al. Prevalence and trends of major congenital anomalies in Brazil: a study from 2011 to 2020. PLoS ONE. 2025;20(6):e0323654. 10.1371/journal.pone.0323654 . Zhang X, Sun Y, Zhu J, et al. Epidemiology, prenatal diagnosis, and neonatal outcomes of congenital heart defects in eastern China: a hospital-based multicenter study. BMC Pediatr. 2020;20:416. 10.1186/s12887-020-02313-4 . Tables Table 1 Congenital heart defects diagnosed in live births, in Rio Grande do Sul, from Nov/2021 to Feb/2024. ICD CHD iCHD N (%)* aCHD N (%)* Q211 Atrial septal defect 112 (45.7) 62 (45.6) Q210 Ventricular septal defect 77 (31.4) 33 (24.3) Q250 Patent ductus arteriosus 70 (28.6) 33 (24.3) Q221 Congenital pulmonary valve stenosis 15 (6.1) 9 (6.6) Q228 Other congenital malformations of tricuspid valve 10 (4.1) 4 (2.9) Q233 Congenital mitral insufficiency 10 (4.1) 2 (1.5) Q238 Bicuspid aortic valve 9 (3.7) 4 (2.9) Q254 Congenital malformation of aorta unspecified 8 (3.3) 2 (1.5) Q251 Coarctation of aorta 4 (1.6) 4 (2.9) Q213 Tetralogy of Fallot 2 (0.8) 3 (2.2) Q223 Other congenital malformations of pulmonary valve 2 (0.8) 2 (1.5) Q218 Other congenital malformations of cardiac septa 2 (0.8) 0 Q230 Congenital stenosis of aortic valve 2 (0.8) 0 Q232 Congenital mitral stenosis 2 (0.8) 0 Q234 Hypoplastic left heart syndrome 2 (0.8) 0 Q240 Dextrocardia 1 (0.4) 10 (7.4) Q212 Atrioventricular septal defect 1 (0.4) 8 (5.9) Q231 Congenital insufficiency of aortic valve 1 (0.4) 4 (2.9) Q208 Other congenital malformations of cardiac chambers and connections 1 (0.4) 2 (1.5) Q256 Stenosis of pulmonary artery 1 (0.4) 1 (0.7) Q222 Congenital pulmonary valve insufficiency 1 (0.4) 0 Q225 Ebstein's anomaly 1 (0.4) 0 Q229 Congenital malformation of tricuspid valve, unspecified 1 (0.4) 0 Q231 Congenital insufficiency of aortic valve 1 (0.4) 0 Q239 Congenital malformation of aortic and mitral valves, unspecified 1 (0.4) 0 Q203 Discordant ventriculoarterial connection (Transposition of the great arteries) 1 (0.4) 0 Q201 Double outlet right ventricle 0 2 (1.5) Q245 Malformation of coronary vessels 0 1 (0.7) Q248 Other specified congenital malformations of heart 0 1 (0.7) Q200 Common arterial trunk 0 1 (0.7) Q209 Congenital malformation of cardiac chambers and connections, unspecified 0 1 (0.7) Q897 Multiple congenital malformations, not elsewhere classified 0 1 (0.7) ICD : International Classification of Diseases; CHD : congenital heart defects; iCHD : isolated congenital heart defects; aCHD : associated congenital heart defects; *The total exceeds 100% as some cases had multiple CHD. Table 2 Syndromes and other congenital anomalies associated with congenital heart defects, identified in live births in Rio Grande do Sul. Syndromes (67 cases) Numerical Chromosome Syndromes N (% ) Trisomy 21 33 (49.3) Trisomy 13 4 (6.0) Trisomy 18 3 (4.5) Klinefelter Syndrome 2 (2.9) Turner Syndrome 2 (2.9) Structural Chromosomal Syndromes N (% ) Microdeletion/microduplication Syndrome 3 (4.5) Others 4 (6.0) Monogenic Syndromes 3 (4.5 ) Associations/Sequences N (% ) VACTERL Association 4 (6.0) Pierre Robin Sequence 3 (4.5) Prune Belly Sequence 2 (2.9) Others Syndromes 4 (6.0 ) Other congenital anomalies (69 cases)* N (%) Central Nervous System 17 (24.6) Genitourinary System 15 (21.7) Craniofacial Anomalies 14 (20.2) Limb Defects 13 (18.8) Congenital Diaphragmatic Hernia 11 (16.0) Musculoskeletal Anomalies 11 (16.0) Abdominal Wall Defects 10 (14.4) Neural Tube Defects 10 (14.4) Gastrointestinal Tract 7 (10.0) Peripheral Vascular System 6 (8.6) Other anomalies 5 (7.2) *The total exceeds 100% as some cases had multiple associated anomalies. Table 3 Characteristics of newborns with isolated CHD and those with associated extracardiac anomalies (univariate analysis). iCHD (N = 245) aCHD (N = 136) Sex N (%) N (%) p-value Male 127 (51.8) 66 (48.5) 0.593 Female 118 (48.2) 70 (51.5) Gestational Age N (%) N (%) p-value Preterm 85 (35.6) 52 (39.1) 0.503 Term 154 (64.4) 81 (60.9) Birth Weight N (%) N (%) p-value +2 25 (10.2) 5 (3.8) Birth Length N (%) N (%) p-value < -3 5 (2.3) 12 (10.3) -2 194 (89.8) 86 (74.2) Birth Head Circumference N (%) N (%) p-value +3 32 (15.0) 17 (14.7) Death N (%) N (%) p-value Yes 9 (3.7) 24 (17.8) < 0.001* No 234 (96.3) 111 (82.2) Fetal Echocardiogram N (%) N (%) p-value Normal 14 (7.5) 17 (15.9) 0.082 Altered 29 (15.5) 16 (15.0) Not performed 144 (77.0) 74 (69.1) Postnatal Checklist N (%) N (%) p-value Normal Pulse Oximetry Screening 92 (44.9) 22 (22.7) < 0.001* Altered Pulse Oximetry Screening 29 (14.1) 14 (14.4) Not performed Pulse Oximetry Screening 40 (19.5) 24 (24.7) Echocardiogram 245 (100) 136 (100) iCHD : isolated congenital heart defects; aCHD : associated congenital heart defects; birth weight, length and, head circumference: Z score value; *p < 0.05. Table 4 Maternal characteristics of newborns presenting isolated CHD and those with associated extracardiac anomalies (univariate analysis). iCHD (N = 245) aCHD (N = 136) Age (years) N (%) N (%) p-value ≤ 20 31 (13.0) 17 (12.9) 0.004* 21 a 34 155 (65.1) 65 (49.2) ≥ 35 52 (21.8) 50 (37.9) Skin Color N (%) N (%) p-value White 164 (76.6) 81 (77.9) 0.562 Black/Brown 49 (22.9) 20 (19.2) Others 1 (0.5) 3 (2.9) Educational Level N (%) N (%) p-value Elementary School 66 (31.9) 32 (31.3) 1.000 High School 107 (51.7) 53 (52.0) University School 34 (16.4) 17 (16.7) Gravidity N (%) N (%) p-value Primigravida 64 (29.9) 31 (27.4) 1.000 Multigravida 150 (70.1) 82 (72.6) Prenatal care visits N (%) N (%) p-value ≤ 6 consultas 70 (33.3) 31 (27.4) 0.315 ≥ 7 consultas 140 (66.7) 82 (72.6) BMI (Pre-pregnancy) N (%) N (%) p-value Underweight 4 (3.8) 0 0.432 Normal weight 16 (15.4) 8 (16.0) Overweight/Obesity 84 (80.8) 42 (84.0) Hypertension (Pre-pregnancy) N (%) N (%) p-value Yes 52 (28.3) 23 (23.0) 0.398 Hypothyroidism (Pre-pregnancy) N (%) N (%) p-value Yes 15 (9.0) 16 (16.8) 0.073 Diabetes (Pre-pregnancy) N (%) N (%) p-value Yes 23 (13.1) 13 (12.9) 1.000 GDM N (%) N (%) p-value Yes 59 (32.2) 28 (27.2) 0.423 Alcohol Consumption N (%) N (%) p-value Yes 23 (13.1) 8 (7.9) 0.237 Smoking N (%) N (%) p-value Yes 32 (17.2) 22 (21.0) 0.436 Drugs Consumption N (%) N (%) p-value Yes 18 (10.1) 3 (3.0) 0.033* Medication Consumption N (%) (N = 143) N (%) (N = 82) p-value Antibiotics 60 (24.5) 22 (16.2) 0.568 Vitamins 53 (21.6) 37 (27.2) Hormones 40 (16.3) 26 (19.1) Antihypertensives 36 (14.7) 16 (11.8) Analgesics 28 (11.4) 17 (12.5) Psychotropics 17 (6.9) 13 (9.6) Others 21 (8.6) 9 (6.6) Infections during pregnancy N (%) (N = 111) N (%) (N = 50) p-value Streptococcus infections 46 (41.4) 12 (24.0) 0.057 UTI 33 (29.7) 22 (44.0) Syphilis 26 (23.4) 4 (8.0) Toxoplasmosis 7 (6.3) 3 (6.0) Herpes 7 (6.3) 3 (6.0) Covid − 19 6 (5.4) 4 (8.0) Others 24 (21.6) 13 (26.0) Other maternal health conditions N (%) (N = 31) N (%) (N = 13) p-value Preeclampsia 11 (35.5) 3 (23.1) 0.407 Psychiatric disorders 7 (22.6) 6 (46.2) Others 19 (41.9) 6 (30.8) iCHD : isolated congenital heart defects; aCHD : associated congenital heart defects; BMI : Body Mass Index; GDM : Gestational diabetes mellitus; UTI : Urinary tract infection; *p < 0.05. Table 5 Multivariate Poisson regression analysis for factors associated with isolated congenital heart defects (iCHD), according to newborns and maternal characteristics. Model I: Newborns characteristics (Adjustments: Sex) Variable PR 95% CI p-value Birth weight ( > + 2) 1.245 1.053–1.473 0.011 Birth length ( <-3) 0.778 0.534–1.132 0.189 Birth length (-3 e ≤ -2) 0.466 0.210–1.036 0.061 Death 0.302 0.136–0.667 0.003 Model II: Maternal characteristics Variable PR 95% CI p-value Age (≥ 35 anos) 0.692 0.497–0.964 0.030 Underweight (BMI) 0.623 (0.433–0.896) 0.011 Overweight/obesity (BMI) 0.687 0.570–0.829 < 0.001 Illicit drug use (Yes) 1.476 1.224–1.781 < 0.001 Infections (Yes) 0.949 0.746–1.208 0.672 PR : Prevalence Ratio; CI : Confidence Interval; BMI : Body Mass Index; iCHD : isolated congenital heart defects; p < 0.05. Additional Declarations No competing interests reported. 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1","display":"","copyAsset":false,"role":"figure","size":375728,"visible":true,"origin":"","legend":"\u003cp\u003eSummary of the main findings from a hospital-based surveillance study of CHD in live births.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eiCHD:\u003c/strong\u003e isolated congenital heart defects; \u003cstrong\u003eaCHD:\u003c/strong\u003e associated congenital heart defects; \u003cstrong\u003eBMI: \u003c/strong\u003eBody Mass Index.\u003c/p\u003e","description":"","filename":"Figura1.png","url":"https://assets-eu.researchsquare.com/files/rs-7339920/v1/f821de8233f0496896c0e7bd.png"},{"id":100069982,"identity":"c8c83721-c125-48b0-bf52-8433a2642653","added_by":"auto","created_at":"2026-01-12 16:15:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1918427,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7339920/v1/781e9e0b-246f-487a-be27-8468afe458a2.pdf"},{"id":94823400,"identity":"6953a657-712c-4029-b791-e8bb458e9dd0","added_by":"auto","created_at":"2025-10-31 06:47:17","extension":"png","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":451594,"visible":true,"origin":"","legend":"","description":"","filename":"GraphicalAbstractImage.png","url":"https://assets-eu.researchsquare.com/files/rs-7339920/v1/0ede4734c89dd9e180b7338c.png"},{"id":94823957,"identity":"ac34125c-81e1-4934-a829-2b6e23119e76","added_by":"auto","created_at":"2025-10-31 06:48:19","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":285682,"visible":true,"origin":"","legend":"","description":"","filename":"TableS1Clinicalfeaturesof67syndromiccongenitalheartdefectsidentifiedinthestudy.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7339920/v1/dbf3e048e62095d0bc5e643e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Epidemiology of Congenital Heart Defects in Live Births: Findings from a Study in Southern Brazil","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCongenital heart defects (CHD) are structural abnormalities of the heart and intrathoracic great vessels present at birth. They are estimated to affect 8 to 12 per 1,000 live births and account for approximately 40% of prenatal deaths\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. About 70% of CHD occur as isolated defects with multifactorial etiology, while the remaining 30% are associated with extracardiac anomalies or form part of genetic syndromes\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. The etiology of CHD includes genetic causes\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e as well as environmental exposures such as medications (e.g., lithium)\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e, alcohol\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e, recreational drugs\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e, maternal diabetes\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e, and obesity\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. The majority of isolated CHD is of multifactorial etiology, a combination of genetic predisposition associated with environmental risk factors\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIn Brazil, CHD represents the second most prevalent group of congenital anomalies, with a reported rate of 15 per 10,000 live births in 2022\u003csup\u003e9\u003c/sup\u003e. Regional geographic and cultural diversity, combined with disparities in access to healthcare services, may influence both the diagnosis and the outcomes of children with CHD\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Early diagnosis is essential for implementing structured care pathways and enabling timely interventions. In this regard, fetal echocardiography has become a crucial tool, contributing to improved prenatal detection rates and better perinatal outcomes\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Although fetal echocardiography can identify approximately 80% of CHD, many cases remain undetected due to various maternal, social, and technical factors\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Treatment strategies depend on the severity of the condition and may involve cardiac catheterization, surgical procedures, and/or pharmacological therapy\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eDespite being among the anomalies considered priority for public health surveillance in Brazil\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e, CHD are frequently underreported in the Live Birth Information System (SINASC)\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Therefore, this study aimed to characterize the profile of live births diagnosed with CHD in three university hospitals in Rio Grande do Sul, a state in the South of Brazil, including the main types of CHD identified, the presence of associated congenital anomalies, and related maternal risk factors.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e The study included live-born infants up to one year of age with a confirmed diagnosis of congenital heart defects (CHD), born in Rio Grande do Sul state and admitted in three regional referral hospitals: Hospital de Cl\u0026iacute;nicas de Porto Alegre (HCPA/UFRGS), University Hospital FURG, and the Teaching Hospital of the Federal University of Pelotas (HE/UFPEL). Cases were searched through physical examination, echocardiogram exams, medical records, and maternal interviews. Data were collected between November 2021 and February 2024, and CHD were classified according to the 10th Revision of the International Classification of Diseases (ICD-10). Cases in which the only diagnosis was a patent ductus arteriosus in preterm infants (\u0026lt;\u0026thinsp;37 weeks of gestation) were excluded.\u003c/p\u003e\u003cp\u003eCHD were classified as (1) isolated, when the cardiac defect was the only anomaly identified, or (2) associated, when accompanied by a genetic syndrome or other extracardiac anomalies.\u003c/p\u003e\u003cp\u003eThe following maternal variables were analyzed: age, skin color, education level, number of prenatal consultations, and parity. Neonatal variables included birth weight, length, head circumference, and gestational age. Exposure to potential risk factors such as alcohol, tobacco, illicit recreational drugs, infections, diabetes, and obesity was also evaluated. Additionally, data regarding the timing of CHD diagnosis, fetal echocardiography, and pulse oximetry screening were assessed.\u003c/p\u003e\u003cp\u003eGestational age was categorized as preterm (\u0026lt;\u0026thinsp;37 weeks) or at term (\u0026ge;\u0026thinsp;37 and \u0026lt;\u0026thinsp;42 weeks). Birth weight, length, and head circumference were corrected for gestational age and sex using the INTERGROWTH-21st standards (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://intergrowth21.tghn.org/\u003c/span\u003e\u003cspan address=\"https://intergrowth21.tghn.org/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAssociations between CHD with maternal risk factors during pregnancy, and neonatal variables were assessed using Fisher\u0026rsquo;s exact test. Multivariate analysis was performed using Poisson regression with robust variance only for isolated congenital heart defects (iCHD). Two separate models were constructed. The first model included neonatal variables that were statistically significant in the univariate analysis (birth length and death), or considered relevant (birth weight), and adjusted for the newborn\u0026rsquo;s sex. The second model included maternal variables that were either statistically significant (maternal age and illicit drug use) or considered relevant (obesity and infections). A significance level of 5% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) was adopted. Statistical analyses were conducted using the \u003cem\u003eStatistical Package for the Social Sciences (SPSS), version 18.0.\u003c/em\u003e\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eEthics statement\u003c/h2\u003e\u003cp\u003e\u003cem\u003eThe study was approved by the Research Ethics Committee of Hospital de Clinicas de Porto Alegre (#\u003c/em\u003eCAAE: 30886520.9.1001.5327) \u003cem\u003eand was conducted according to the principles expressed in the Declaration of Helsinki. A\u003c/em\u003e written informed consent was obtained from the parents or legal guardians of all participating children to participate in the study and to publish results.\u003c/p\u003e\u003c/div\u003e\n\u003cp\u003eClínical Trial Number: not applicable\u003c/p\u003e\n"},{"header":"Results","content":"\u003cp\u003eDuring the study period, 547 live births with selected priority congenital anomalies\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e were registered through the active surveillance system in the three reference hospitals. Among them, 381 were diagnosed with CHD (HCPA: n\u0026thinsp;=\u0026thinsp;315, 82.6%; HE-UFPEL and FURG: n\u0026thinsp;=\u0026thinsp;66, 17.3%). Two cases were excluded because the births occurred outside the state. Most newborns were from the metropolitan region of Porto Alegre, the capital of Rio Grande do Sul (n\u0026thinsp;=\u0026thinsp;269, 70.6%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eiCHD\u003c/b\u003e: isolated congenital heart defects; \u003cb\u003eaCHD\u003c/b\u003e: associated congenital heart defects; \u003cb\u003eBMI\u003c/b\u003e: Body Mass Index.\u003c/p\u003e\u003cp\u003eOf the 381 CHD cases, 254 (64.3%) were classified as isolated (iCHD), and 136 (35.7%) were associated with genetic syndromes or other congenital anomalies (aCHD). The most frequently diagnosed CHD was atrial septal defect (n\u0026thinsp;=\u0026thinsp;174; 45.6%), followed by ventricular septal defect (n\u0026thinsp;=\u0026thinsp;110; 28.8%). Other congenital malformations of the great arteries were also identified, such as patent ductus arteriosus (n\u0026thinsp;=\u0026thinsp;103; 27.0%) and other malformations of the aorta (n\u0026thinsp;=\u0026thinsp;10; 2.7%). Among the valvular anomalies, the most frequent were pulmonary valve stenosis (n\u0026thinsp;=\u0026thinsp;24, 6.2%) and other tricuspid valve malformations (n\u0026thinsp;=\u0026thinsp;14, 3.6%). Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the distribution of CHD types between the iCHD and aCHD groups.\u003c/p\u003e\u003cp\u003eAmong the aCHD cases, 67 (49.2%) were part of known genetic syndromes, and 69 (50.8%) had other extracardiac congenital anomalies. Trisomy 21 was the most frequent (n\u0026thinsp;=\u0026thinsp;33; 48.5%), followed by Trisomy 13 (n\u0026thinsp;=\u0026thinsp;4; 5.9%) and the VACTERL association (n\u0026thinsp;=\u0026thinsp;4; 5.9%). The most frequent extracardiac anomalies involved the central nervous system (n\u0026thinsp;=\u0026thinsp;17; 25.0%), genitourinary system (n\u0026thinsp;=\u0026thinsp;15; 22.0%), and craniofacial anomalies (n\u0026thinsp;=\u0026thinsp;14; 20.0%). Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarizes the genetic syndromes and extracardiac anomalies associated with CHD. Cases diagnosed as syndromes, associations, or sequences were further characterized based on clinical profile and are presented in detail in Table Supplementary 1.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the characteristics of the newborns in both groups, and Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents the maternal characteristics. Statistically significant differences in univariate analysis were observed between the iCHD and aCHD for birth length, head circumference, and death. Low birth weight, microcephaly, and infant death were more prevalent in the aCHD group. Multivariate analysis using Poisson regression with robust variance was conducted with iCHD as the outcome. In the model evaluating neonatal characteristics, high birth weight (\u0026thinsp;\u0026gt;\u0026thinsp;+\u0026thinsp;2 SD) was observed to have statistically significant differences in iCHD (PR\u0026thinsp;=\u0026thinsp;1.245; 95% CI: 1.053\u0026ndash;1.473; p\u0026thinsp;=\u0026thinsp;0.011). A lower prevalence of death was observed among those with iCHD (PR\u0026thinsp;=\u0026thinsp;0.302; 95% CI: 0.136\u0026ndash;0.667; p\u0026thinsp;=\u0026thinsp;0.003) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn the multivariate analysis for maternal risk factors, we observed statistically significant differences for maternal age (\u0026ge;\u0026thinsp;35 anos) and BMI (underweight and overweight/obesity) for aCHD, while illicit drug use was statistically different for iCHD (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Since the proportion of overweight/obesity women was similar between the iCHD and aCHD groups in the univariate analysis, the significance observed in the multivariate analysis reflects interactions with other variables included in the adjusted model.\u003c/p\u003e\u003cp\u003eMaternal medication use during pregnancy was evaluated, with 245 (59.0%) women reporting the use of various drug classes. The most commonly used medications included antibiotics, vitamin supplements, and hormones. Regarding infections, 161 (42.2%) mothers received treatment during pregnancy. The most frequently reported infections were caused by Streptococcus (n\u0026thinsp;=\u0026thinsp;58; 36.0%), urinary tract infections (UTIs) (n\u0026thinsp;=\u0026thinsp;55; 34.1%), and syphilis (n\u0026thinsp;=\u0026thinsp;30; 18.6%). Among maternal health conditions, preeclampsia was reported in 14 (3.6%) cases, while psychiatric disorders were noted in 13 (3.4%) cases (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFetal echocardiography was performed in only 43 cases (23.0%) of the iCHD group and in 33 cases (30.9%) in the aCHD group but a normal result was accomplished in 14 (14/43 ; 32,5%) of iCHD and in 17 (17/33 ; 51,5%) of aCHD (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePulse oximetry screening was not performed in 40 infants (19,5%) of iCHD group and in 24 infants (24,7% ) of aCHD group. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides an overview of the clinical and epidemiological profile of congenital heart defects (CHD) diagnosed in live births at three referral hospitals in Rio Grande do Sul, Brazil. Through active surveillance, we identified a high proportion of CHD (69.6%) among newborns with selected priority congenital anomalies. Data recorded in SINASC registered a prevalence of 8/10,000\u003csup\u003e15\u003c/sup\u003e, which is much less than the expected 1%\u003csup\u003e16\u003c/sup\u003e. In contrast, data from the Mortality Information System (SIM)\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e showed a proportion of deaths due to CHD of 11/10,000, suggesting that this system can capture cases more accurately, while SINASC still needs improvements in the reporting and recording of CHD.\u003c/p\u003e\u003cp\u003eA predominance of iCHD was observed, accounting for 64.3% of cases, similar to previous hospital-based studies conducted in Brazil and other countries, in which iCHD represented approximately 60% to 70% of all CHD\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. Atrial septal defects (ASD, 45.6%) and ventricular septal defects (VSD, 28.8%) were the most frequently diagnosed types of CHD, followed by patent ductus arteriosus (PDA, 27.0%), reflecting the pattern commonly reported in the literature for live births\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. Amorim et al.\u003csup\u003e18\u003c/sup\u003e also observed that ASD, VSD, and PDA accounted for 62.6% of all CHDs in a hospital-based study conducted in Minas Gerais. Globally, these lesions are among the most prevalent, with VSD (34.0%), ASD (13.0%), and PDA (10.0%) being the most frequent, as reported by van der Linde et al.\u003csup\u003e16\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eHowever, when comparing our findings to those of Pinheiro et al.\u003csup\u003e23\u003c/sup\u003e which analyzed children with CHD referred to a cardiac surgery center in Rio Grande do Sul, they observed a higher prevalence of critical and complex CHDs, such as multiple cardiac malformations (21.9%), hypoplastic left heart syndrome (14.5%), and transposition of the great arteries (11.5%). These differences reflect the referral profile of the respective hospitals, while Pinheiro et al.\u003csup\u003e23\u003c/sup\u003e focused on cases requiring surgical intervention, our study captured a large spectrum of CHDs, including milder forms.\u003c/p\u003e\u003cp\u003eThis study demonstrated significant differences between CHD groups in terms of birth length and mortality. In the multivariate analysis, mortality remained significantly higher frequency among aCHD cases, as well as low birth weight. Neonatal outcomes in CHD cases may be influenced by multiple non-cardiac and genetic factors, including adverse neonatal conditions such as low birth weight and the presence of extracardiac anomalies or genetic syndromes\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. Low birth weight is recognized as an important predictor of neonatal morbidity and mortality, especially in CHD cases requiring early surgical intervention\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. In our study, the higher prevalence of low birth weight among aCHD cases reinforces the need for interdisciplinary care to ensure adequate growth and development of these patients.\u003c/p\u003e\u003cp\u003eRegarding neonatal mortality, the lower number of deaths observed among iCHD compared with an increased number in aCHD cases indicates that the presence of extracardiac anomalies or syndromic conditions plays a critical role in increasing the risk of mortality, as also reported in previous studies\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. However, when analyzing the characteristics of the children with iCHD who died, we found that none had received a prenatal diagnosis. At birth, CHD was identified as ASD in five cases (55.5%) and other cardiac anomalies in eight cases (88.8%). Among these neonates, three (33.3%) presented extreme prematurity, two (22.2%) had short length for gestational age, and one (11.1%) had low birth weight for gestational age. Seven (77.8%) deaths occurred in the neonatal period, and two (22.2%) in the postneonatal period. In Brazil, neonatal and postneonatal mortality are strongly associated with prematurity and birth defects\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. Therefore, adequate prenatal care, including access to diagnostic tools such as morphological ultrasound and fetal echocardiography is essential to enable timely referral to specialized services and ensure proper management of newborns.\u003c/p\u003e\u003cp\u003eIn addition to neonatal characteristics, maternal factors also showed significant differences between iCHD and aCHD groups, particularly maternal age and illicit drug use. Maternal age is a well-recognized factor in the literature for its impact on CHD risk, especially in syndromic cases, which is related to the increased occurrence of aneuploidies with advancing maternal age, such as trisomies 21, 18, and 13\u003csup\u003e28,29\u003c/sup\u003e. Conversely, in iCHD cases, this effect of advanced maternal age is not commonly observed\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eExposure to illicit drugs during pregnancy has also been suggested as a potential risk factor for CHD development, with associations described for defects such as dextrocardia (cocaine)\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e and septal defects (marijuana)\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. However, the mechanisms by which these substances may influence cardiac development are not yet fully understood and are better documented in experimental animal studies\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. Mersereau et al.\u003csup\u003e6\u003c/sup\u003e used a zebrafish model to investigate the effects of embryonic pre-exposure to cocaine on development and cardiovascular physiology. Their findings demonstrated that the primary developmental effects of cocaine are mediated by elevated monoamine levels, especially dopamine, which sensitize both the cardiovascular and behavioral responses to the drug, persisting into adulthood. Although fetal cocaine exposure may not lead to structural cardiac defects, it induces cellular signaling alterations that can increase the long-term risk of cardiovascular disease in both neonates and adults\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. However in our study we couldn't see association with any specific illicit drug.\u003c/p\u003e\u003cp\u003eThe association between maternal BMI and CHD risk has been described in different populations, with evidence of increased risk for left ventricle outflow tract obstruction, right ventricle outflow tract obstruction and complex defects, among offspring of obese women\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e. In the present study, we observed similar proportions of overweight and obesity between the two CHD groups. The population of Porto Alegre presented a prevalence of overweight (50.0%) and obesity (20%) for women over 18 years of age in 2023\u003csup\u003e34\u003c/sup\u003e. Therefore, this reflects the high prevalence of overweight/obese pregnant women identified in our study, considering that BMI was analyzed before pregnancy. However, the high prevalence of overweight/obese pregnant women has already been observed in other national studies\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e,\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e,\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e, demonstrating the need to promote an adequate and safe nutritious diet for these pregnant women.\u003c/p\u003e\u003cp\u003eIn this study, we also observed a high frequency of infections during pregnancy, with a particular emphasis on urinary tract infections and syphilis. In 2023, approximately 68.6% of pregnant women diagnosed with syphilis were identified in the first or second trimesters of pregnancy in Brazil, while Rio Grande do Sul, for the same period, had a prevalence of 41/1,000 pregnancy\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e. This data reflects a high notification rate and adequate screening during prenatal care, which is necessary to avoid adverse neonatal outcomes such as neonatal deaths, premature births or low birth weight, in addition to vertical transmission of the disease to the newborn\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e. Several studies have pointed out that certain maternal infections, especially during the period of cardiogenesis, may increase the risk of CHD development\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e. Although we did not assess the direct association between these factors and CHD types in this study, our findings reinforce the importance of adequate prenatal care for the identification and management of these conditions.\u003c/p\u003e\u003cp\u003eOur results also showed a low rate of prenatal diagnosis by fetal echocardiography, especially considering the high complexity of some observed cases. This result is consistent with that of Huber et al\u003csup\u003e19\u003c/sup\u003e also from Rio Grande do Sul, where reported that only 3.1% of live births referred to a specialized CHD center had a prenatal diagnosis.\u003c/p\u003e\u003cp\u003eNotably, many of the CHD cases identified in our study were not diagnosed prenatally, and were associated with important maternal risk factors, such as advanced maternal age, obesity, and diabetes. Among the 14 pregnant women with normal fetal echocardiography results in the iCHD group, nine (64.2%) were overweight/obesity, five (35.7%) had diabetes, and three (21.4%) were of advanced maternal age. In the aCHD group, eight (47.0%) were overweight/obesity, one (5.8%) had diabetes, and 11 (64.7%) were of advanced maternal age.\u003c/p\u003e\u003cp\u003eThese findings suggest that, in addition to limited access to specialized prenatal care\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e, both maternal and technical factors may interfere with the effectiveness of prenatal CHD detection. Maternal obesity can reduce the image quality of fetal echocardiography\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e, while technical limitations, including the imaging protocol used, ultrasound modality (transabdominal or transvaginal), the experience of the medical professional\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e, and gestational age at the time of examination\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e, may also impact diagnostic accuracy.\u003c/p\u003e\u003cp\u003eDespite national recommendations for performing fetal echocardiography, coverage remains insufficient in many regions, especially outside major urban centers, when compared to hospitals specialized to care for CHD, where prenatal detection rates are significantly higher\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe diagnosis of congenital heart defects (CHD) is essential for ensuring proper clinical management, while the investigation of risk factors plays a key role in understanding the etiology of these conditions. In this context, there is a need for more studies addressing the various aspects of CHD, allowing for their temporal and regional monitoring in Brazil, especially considering that these anomalies remain among the most prevalent in live births in the country\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e. Fernandes et al\u003csup\u003e20\u003c/sup\u003e, through a population-based analysis of SINASC data from 2005 to 2018 in the state of S\u0026atilde;o Paulo, identified a rising trend in the prevalence of CHD (12.4 per 10,000 live births), with a higher incidence among children born to mothers aged\u0026thinsp;\u0026ge;\u0026thinsp;35 years. The increasing prevalence of CHD has been observed worldwide\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e, suggesting that this increase may be attributed to improvements in prenatal and postnatal diagnostic methods, the implementation of pulse oximetry screening in neonatal care, and improved management of high-risk pregnancies. Encouraging epidemiological studies of congenital heart disease has been essential to improve our understanding of its distribution and associated risk factors.\u003c/p\u003e\u003cp\u003eOur study was based on an active surveillance system in three tertiary referral centers, which enhances diagnostic accuracy, as all included cases had diagnoses confirmed by echocardiography. However, some limitations must be acknowledged, such as the overrepresentation of syndromic cases or high-risk pregnancies, reflecting the care profile of the participating hospitals, especially HCPA, a regional referral center for complex cases.\u003c/p\u003e\u003cp\u003eTherefore, considering that CHD has a multifactorial etiology, we emphasize the importance of expanding investigations in specialized centers, incorporating the analysis of environmental, clinical, and genetic factors. This integrated approach can contribute to a better understanding of associated risks and the improvement of diagnostic, prevention, and management strategies for these patients.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study described the clinical and epidemiological profile of congenital heart defects (CHD) diagnosed in live births at referral hospitals in Rio Grande do Sul, Brazil, based on an active surveillance system. A predominance of isolated CHD cases was observed, with atrial and ventricular septal defects and patent ductus arteriosus being the most frequently diagnosed anomalies. Neonatal factors such as low birth weight and mortality showed significant differences when comparing CHD with additional anomalies, while high birth weight was more frequent among isolated cases.\u003c/p\u003e\u003cp\u003eAmong maternal characteristics, advanced maternal age and illicit drug use showed significant differences with aCHD and iCHD, respectively, reinforcing the influence of both genetic and environmental factors in the etiology of these malformations. Furthermore, the low rate of prenatal diagnosis by fetal echocardiography highlights the need to improve access to specialized services to facilitate early detection of these conditions.\u003c/p\u003e\u003cp\u003eThese findings underscore the importance of continuous surveillance and early diagnostic strategies, as well as the need for a multidisciplinary approach in the care of pregnant women and newborns with CHD. Future studies should further investigate the genetic, environmental, and social factors associated with the development of these anomalies to strengthen prevention and management policies.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eASD\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAtrial Septal Defects\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBody Mass Index\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eCHD\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCongenital Heart Defects\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eCI\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eConfidence Interval\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eFURG\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eUniversidade Federal do Rio Grande do Sul\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eGDM\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eGestational Diabetes Mellitus\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eHCPA\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHospital de Cl\u0026iacute;nicas de Porto Alegre\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eHE/UFPEL\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eTeaching Hospital of the Federal University of Pelotas\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eICD-10\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInternational Classification of Diseases\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eiCHD\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eIsolated Congenital Heart Defects\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003ePDA\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePatent Ductus Arteriosus\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003ePR\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePrevalence Ratio\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eSIM\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMortality Information System\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eSINASC\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLive Birth Information System\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eSPSS\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStatistical Package for the Social Sciences\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eUFRGS\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eUniversidade Federal do Rio Grande do Sul\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eUTI\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eUrinary tract infection\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eVSD\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eVentricular Septal Defects\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e All authors approved the final version of the manuscript and consent to its publication.\u003c/p\u003e\u003cp\u003eClinical Trial Number : not applicable\u003c/p\u003e\u003ch2\u003e\u003cb\u003eAuthor information\u003c/b\u003e\u003c/h2\u003e\u003cp\u003e\u003cstrong\u003eAuthors and Affiliations\u003c/strong\u003e\u003cp\u003e1. Graduate Program in Genetics and Molecular Biology, Genetics Department, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.\u003c/p\u003e\u003cp\u003eFabyanne Guimar\u0026atilde;es de Oliveira, Angel Larroza de Souza, Cl\u0026aacute;udia Fernandes Lorea, Maria Teresa Vieira Sanseverino, Thayne Woycinck Kowalski and Lavinia Schuler-Faccini.\u003c/p\u003e\u003cp\u003e2. Teratogen Information System (SIAT), Medical Genetics Service, Hospital de Cl\u0026iacute;nicas de Porto Alegre (HCPA), Porto Alegre, Brazil.\u003c/p\u003e\u003cp\u003eFabyanne Guimar\u0026atilde;es de Oliveira, Maria Teresa Vieira Sanseverino, Thayne Woycinck Kowalski and Lavinia Schuler-Faccini.\u003c/p\u003e\u003cp\u003e3. Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.\u003c/p\u003e\u003cp\u003eGeorge Octavio da Costa Salecker, Carolina Sayuri Arashiro, J\u0026uacute;lia Rei Pires, Vinicius Barreto Nolibos, Rosa Maria Moreno Barbosa and Ta\u0026iacute;s Sica da Rocha.\u003c/p\u003e\u003cp\u003e4. Faculty of Medicine, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil.\u003c/p\u003e\u003cp\u003eSimone de Menezes Karam\u003c/p\u003e\u003cp\u003e5. Cardiology Service, Hospital de Cl\u0026iacute;nicas de Porto Alegre (HCPA), Porto Alegre, Brazil.\u003c/p\u003e\u003cp\u003eAndrea Tomasi Sutil\u003c/p\u003e\u003cp\u003e6. Laboratory of Genomic Medicine, Center of Experimental Research, Hospital de Cl\u0026iacute;nicas de Porto Alegre (HCPA), Porto Alegre, Brazil.\u003c/p\u003e\u003cp\u003eThayne Woycinck Kowalski\u003c/p\u003e\u003cp\u003e7. Graduate Program in Medicine: Medical Sciences, Medicine Faculty, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.\u003c/p\u003e\u003cp\u003eThayne Woycinck Kowalski\u003c/p\u003e\u003cp\u003e8. School of Medicine. Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil\u003c/p\u003e\u003cp\u003eMaria Teresa Vieira Sanseverino\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCorresponding author\u003c/h2\u003e\u003cp\u003eCorrespondence to Ta\u0026iacute;s Sica da Rocha.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthics approval:\u003c/strong\u003e\u003cp\u003e This study was approved by the Research Ethics Committee of HCPA (CAAE: 30886520.9.1001.5327).\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u003c/strong\u003e\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003e This study was funded by the Accord OPAS / Minist\u0026eacute;rio da Sa\u0026uacute;de / Funda\u0026ccedil;\u0026atilde;o M\u0026eacute;dica do RS Projeto (2178-4) SCON2020-00173 - Vigil\u0026acirc;ncia e Aten\u0026ccedil;\u0026atilde;o em Anomalias Cong\u0026ecirc;nitas no RS; Hospital de Cl\u0026iacute;nicas de Porto Alegre (HCPA) - Fundo de Incentivo \u0026agrave; Pesquisa e Eventos (FIPE), grants no. 2019\u0026thinsp;\u0026minus;\u0026thinsp;0792 and 2020\u0026thinsp;\u0026minus;\u0026thinsp;0174. The scholarships of the authors were funded by the Conselho Nacional de Desenvolvimento Cient\u0026iacute;fico e Tecnol\u0026oacute;gico (CNPq) and Funda\u0026ccedil;\u0026atilde;o M\u0026eacute;dica do RS - Vigil\u0026acirc;ncia e Aten\u0026ccedil;\u0026atilde;o em Anomalias Cong\u0026ecirc;nitas no RS. F.G.O is the recipient of a CNPq scholarship (grant no 165593/2021-0), T.W.K. is the recipient of a Funda\u0026ccedil;\u0026atilde;o M\u0026eacute;dica do RS - Vigil\u0026acirc;ncia e Aten\u0026ccedil;\u0026atilde;o em Anomalias Cong\u0026ecirc;nitas no RS.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eF.G.O., L.S.-F. and T.S.R. designed the work; G.O.C.S., C.S.A., J.R.P., V.B.N. and R.M.M.B. collected the data from the databases; F.G.O. and A.L.S. analyzed the data from the databases; F.G.O wrote the first draft of the manuscript; S.M.M., C.F.L., M.T.V.S., A.T.S., T.W.K., L.S.-F. and T.S.R. revised the manuscript. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements:\u003c/h2\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eData availability:\u003c/h2\u003e\u003cp\u003eThe data that support the findings of this study are available from the medical records department of Hospital de Cl\u0026iacute;nicas de Porto Alegre (HCPA/UFRGS), University Hospital FURG, and the Teaching Hospital of the Federal University of Pelotas (HE/UFPEL). However, restrictions apply to the availability of these data due to patient confidentiality and ethical considerations. Data are available from the corresponding author upon reasonable request and with permission from the hospital\u0026rsquo;s ethics committee.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBoyd R, McMullen H, Beqaj H, Kalfa D. Environmental exposures and congenital heart disease. Pediatrics. 2021;149(1):e20210521. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1542/peds.2021-052151\u003c/span\u003e\u003cspan address=\"10.1542/peds.2021-052151\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDigilio MC, Marino B. What is new in genetics of congenital heart defects? Front Pediatr. 2016;4:120. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fped.2016.00120\u003c/span\u003e\u003cspan address=\"10.3389/fped.2016.00120\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYasuhara J, Garg V. Genetics of congenital heart disease: a narrative review of recent advances and clinical implications. Transl Pediatr. 2021;10(9):2366\u0026ndash;86. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.21037/tp-21-297\u003c/span\u003e\u003cspan address=\"10.21037/tp-21-297\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDiav-Citrin O, Shechtman S, Tahover E, et al. Pregnancy outcome following in utero exposure to lithium: a prospective, comparative, observational study. Am J Psychiatry. 2014;171(7):785\u0026ndash;94. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1176/appi.ajp.2014.12111402\u003c/span\u003e\u003cspan address=\"10.1176/appi.ajp.2014.12111402\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWu L, Li N, Liu Y. Association between maternal factors and risk of congenital heart disease in offspring: a systematic review and meta-analysis. Matern Child Health J. 2022;27(1):29\u0026ndash;48. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10995-022-03538-8\u003c/span\u003e\u003cspan address=\"10.1007/s10995-022-03538-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMersereau E, Boyle C, Poitra S, et al. Longitudinal effects of embryonic exposure to cocaine on morphology, cardiovascular physiology, and behavior in zebrafish. Int J Mol Sci. 2016;17(6):847. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijms17060847\u003c/span\u003e\u003cspan address=\"10.3390/ijms17060847\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTurunen R, Pulakka A, Mets\u0026auml;l\u0026auml; J, et al. Maternal Diabetes and Overweight and Congenital Heart Defects in Offspring. JAMA Netw Open. 2024;7(1):e2350579. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jamanetworkopen.2023.50579\u003c/span\u003e\u003cspan address=\"10.1001/jamanetworkopen.2023.50579\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSalmeri N, Seidenari A, Cavoretto PI, Papale M, Candiani M, Farina A. Maternal prepregnancy weight as an independent risk factor for congenital heart defect: systematic review and meta-analysis stratified by subtype and severity of defect. Ultrasound Obstet Gynecol. 2024;64(3):294\u0026ndash;307. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/uog.27659\u003c/span\u003e\u003cspan address=\"10.1002/uog.27659\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMinist\u0026eacute;rio da Sa\u0026uacute;de (Brasil). Epidemiological report [Internet]. Bras\u0026iacute;lia: Minist\u0026eacute;rio da Sa\u0026uacute;de. 2024 Mar 4. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.gov.br/saude/pt-br/../boletim-epidemiologico-volume-55-no-06\u003c/span\u003e\u003cspan address=\"https://www.gov.br/saude/pt-br/../boletim-epidemiologico-volume-55-no-06\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLopez KN, Baker-Smith C, Flores G, et al. Addressing social determinants of health and mitigating health disparities across the lifespan in congenital heart disease: a scientific statement from the American Heart Association. J Am Heart Assoc. 2022;11(8):e025358. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1161/jaha.122.025358\u003c/span\u003e\u003cspan address=\"10.1161/jaha.122.025358\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePedra SRFF, Zielinsky P, Binotto CN, et al. Brazilian fetal cardiology guidelines \u0026ndash; 2019. Arq Bras Cardiol. 2019. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5935/abc.20190075\u003c/span\u003e\u003cspan address=\"10.5935/abc.20190075\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. published online.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKarim JN, Bradburn E, Roberts N, Papageorghiou AT. First-trimester ultrasound detection of fetal heart anomalies: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2022;59(1):11\u0026ndash;25. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/uog.23740\u003c/span\u003e\u003cspan address=\"10.1002/uog.23740\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSun R, Liu M, Lu L, Zheng Y, Zhang P. Congenital heart disease: causes, diagnosis, symptoms, and treatments. Cell Biochem Biophys. 2015;72(3):857\u0026ndash;60. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s12013-015-0551-6\u003c/span\u003e\u003cspan address=\"10.1007/s12013-015-0551-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCardoso-dos-Santos AC, Medeiros-de-Souza AC, Bremm JM, et al. Lista de anomalias cong\u0026ecirc;nitas priorit\u0026aacute;rias para vigil\u0026acirc;ncia no \u0026acirc;mbito do Sistema de Informa\u0026ccedil;\u0026otilde;es sobre Nascidos Vivos do Brasil. Epidemiol Serv Sa\u0026uacute;de. 2021;30(1):e20210030. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1590/s1679-49742021000100030\u003c/span\u003e\u003cspan address=\"10.1590/s1679-49742021000100030\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrasil. Minist\u0026eacute;rio da Sa\u0026uacute;de. Sa\u0026uacute;de Brasil 2020/2021: anomalias cong\u0026ecirc;nitas priorit\u0026aacute;rias para a vigil\u0026acirc;ncia ao nascimento. Bras\u0026iacute;lia: Minist\u0026eacute;rio da Sa\u0026uacute;de; 2021.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003evan der Linde D, Konings EEM, Slager MA, et al. Birth prevalence of congenital heart disease worldwide. J Am Coll Cardiol. 2011;58(21):2241\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jacc.2011.08.025\u003c/span\u003e\u003cspan address=\"10.1016/j.jacc.2011.08.025\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrasil. Minist\u0026eacute;rio da Sa\u0026uacute;de. DATASUS. Sistema de Informa\u0026ccedil;\u0026otilde;es sobre Mortalidade \u0026ndash; SIM [Internet]. Bras\u0026iacute;lia: Minist\u0026eacute;rio da Sa\u0026uacute;de; 2023 [cited 2025 Jun 23]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://datasus.saude.gov.br/mortalidade-desde-1979-pela-cid-10/\u003c/span\u003e\u003cspan address=\"https://datasus.saude.gov.br/mortalidade-desde-1979-pela-cid-10/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAmorim LFP, Pires CAB, Lana AMA, et al. Apresenta\u0026ccedil;\u0026atilde;o das cardiopatias cong\u0026ecirc;nitas diagnosticadas ao nascimento: an\u0026aacute;lise de 29 770 rec\u0026eacute;m-nascidos. J Pediatr. 2008;84(1):83\u0026ndash;90. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1590/S0021-75572008000100014\u003c/span\u003e\u003cspan address=\"10.1590/S0021-75572008000100014\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHuber J, Peres VC, Santos TJD, et al. Cardiopatias cong\u0026ecirc;nitas em um servi\u0026ccedil;o de refer\u0026ecirc;ncia: evolu\u0026ccedil;\u0026atilde;o cl\u0026iacute;nica e doen\u0026ccedil;as associadas. Arq Bras Cardiol. 2010;94(3):333\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1590/S0066-782X2010000300009\u003c/span\u003e\u003cspan address=\"10.1590/S0066-782X2010000300009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFernandes PS, Magalh\u0026atilde;es LR, Pezzini TR, de Sousa Santos EF, Calderon MG. Congenital heart diseases trends in S\u0026atilde;o Paulo State, Brazil: a national live birth data bank analysis. World J Pediatr. 2022;18(7):472\u0026ndash;81. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s12519-022-00543-3\u003c/span\u003e\u003cspan address=\"10.1007/s12519-022-00543-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDolk H, Loane M, Garne E. Congenital heart defects in Europe. Circulation. 2011;123(8):841\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1161/CIRCULATIONAHA.110.958405\u003c/span\u003e\u003cspan address=\"10.1161/CIRCULATIONAHA.110.958405\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePinto J\u0026uacute;nior VC, Branco KMPC, Cavalcante RC, et al. Epidemiology of congenital heart disease in Brazil: approximation of the official Brazilian data with the literature. Rev Bras Cir Cardiovasc. 2015;30(2):213\u0026ndash;20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5935/1678-9741.20150018\u003c/span\u003e\u003cspan address=\"10.5935/1678-9741.20150018\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePinheiro DO, Varisco BB, Silva MBD, et al. Accuracy of prenatal diagnosis of congenital cardiac malformations. Rev Bras Ginecol Obstet. 2019;41(1):11\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1055/s-0038-1676058\u003c/span\u003e\u003cspan address=\"10.1055/s-0038-1676058\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChowdhury D, Toms R, Brumbaugh JE, et al. Evaluation and management of noncardiac comorbidities in children with congenital heart disease. Pediatrics. 2022;150(Suppl 2):e20220564. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1542/peds.2022-056415e\u003c/span\u003e\u003cspan address=\"10.1542/peds.2022-056415e\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNakashima Y, Mori Y, Sugiura H, et al. Very low birth weight infants with congenital heart disease: a multicenter cohort study in Japan. J Cardiol. 2022;80(4):344\u0026ndash;50. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jjcc.2022.05.008\u003c/span\u003e\u003cspan address=\"10.1016/j.jjcc.2022.05.008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAyfokru A, Shewasinad S, Ahmed F, et al. Incidence and predictors of mortality among neonates with congenital heart disease in Ethiopia: a retrospective cohort study. BMC Pediatr. 2024;24(1):\u0026ndash;. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12887-024-05023-3\u003c/span\u003e\u003cspan address=\"10.1186/s12887-024-05023-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrasil Minist\u0026eacute;rioda, Sa\u0026uacute;de. Secretaria de Vigil\u0026acirc;ncia em Sa\u0026uacute;de, Departamento de An\u0026aacute;lise em Sa\u0026uacute;de e Vigil\u0026acirc;ncia de Doen\u0026ccedil;as n\u0026atilde;o Transmiss\u0026iacute;veis. Sa\u0026uacute;de Brasil 2020/2021: uma an\u0026aacute;lise da situa\u0026ccedil;\u0026atilde;o de sa\u0026uacute;de e da qualidade da informa\u0026ccedil;\u0026atilde;o. Bras\u0026iacute;lia: Minist\u0026eacute;rio da Sa\u0026uacute;de; 2021.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAhn D, Kim J, Kang J, Kim YH, Kim K. Congenital anomalies and maternal age: a systematic review and meta-analysis of observational studies. Acta Obstet Gynecol Scand. 2022;101(5):484\u0026ndash;98. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/aogs.14339\u003c/span\u003e\u003cspan address=\"10.1111/aogs.14339\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHartman RJ, Rasmussen SA, Botto LD, et al. The contribution of chromosomal abnormalities to congenital heart defects: a population-based study. Pediatr Cardiol. 2011;32(8):1147\u0026ndash;57. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00246-011-0034-5\u003c/span\u003e\u003cspan address=\"10.1007/s00246-011-0034-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKuehl KS, Loffredo C. Risk factors for heart disease associated with abnormal sidedness. Teratology. 2002;66(5):242\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/tera.10099\u003c/span\u003e\u003cspan address=\"10.1002/tera.10099\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWilliams LJ, Correa A, Rasmussen S. Maternal lifestyle factors and risk for ventricular septal defects. Birth Defects Res Clin Mol Teratol. 2004;70(2):59\u0026ndash;64. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/bdra.10145\u003c/span\u003e\u003cspan address=\"10.1002/bdra.10145\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMeyer KD, Zhang L. Short- and long-term adverse effects of cocaine abuse during pregnancy on heart development. Ther Adv Cardiovasc Dis. 2009;3(1):7\u0026ndash;16. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1753944708099877\u003c/span\u003e\u003cspan address=\"10.1177/1753944708099877\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHelle E, Priest JR. Maternal obesity and diabetes mellitus as risk factors for congenital heart disease in the offspring. J Am Heart Assoc. 2020;9(8):e011541. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1161/jaha.119.011541\u003c/span\u003e\u003cspan address=\"10.1161/jaha.119.011541\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMinist\u0026eacute;rio da Sa\u0026uacute;de (Brasil). Vigitel Brasil 2023: vigil\u0026acirc;ncia de fatores de risco e prote\u0026ccedil;\u0026atilde;o para doen\u0026ccedil;as cr\u0026ocirc;nicas por inqu\u0026eacute;rito telef\u0026ocirc;nico. Bras\u0026iacute;lia: Minist\u0026eacute;rio da Sa\u0026uacute;de; 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMagalh\u0026atilde;es EIS, Maia DS, Bonfim CFA, Netto MP, Lamounier JA, Rocha Dda S. Preval\u0026ecirc;ncia e fatores associados ao ganho de peso gestacional excessivo em unidades de sa\u0026uacute;de do sudoeste da Bahia. Rev Bras Epidemiol. 2015;18(4):858\u0026ndash;69. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1590/1980-5497201500040014\u003c/span\u003e\u003cspan address=\"10.1590/1980-5497201500040014\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFerreira LAP, Piccinato CA, Cordioli E, Zlotnik E. Pregestational body mass index, weight gain during pregnancy and perinatal outcome: a retrospective descriptive study. Einstein (Sao Paulo). 2019;18:eAO4851. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.31744/einstein_journal/2020AO4851\u003c/span\u003e\u003cspan address=\"10.31744/einstein_journal/2020AO4851\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNast M, Oliveira A, Rauber F, Vitolo MR. Ganho de peso excessivo na gesta\u0026ccedil;\u0026atilde;o \u0026eacute; fator de risco para o excesso de peso em mulheres. Rev Bras Ginecol Obstet. 2013;35(12):536\u0026ndash;40. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1590/S0100-72032013001200002\u003c/span\u003e\u003cspan address=\"10.1590/S0100-72032013001200002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrasil. Minist\u0026eacute;rio da Sa\u0026uacute;de, Secretaria de Vigil\u0026acirc;ncia em Sa\u0026uacute;de e Ambiente. Boletim Epidemiol\u0026oacute;gico de S\u0026iacute;filis 2024. Bras\u0026iacute;lia: Minist\u0026eacute;rio da Sa\u0026uacute;de; 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNewman L, Kamb M, Hawkes S, Gomez G, Say L, Seuc A, et al. Global estimates of syphilis in pregnancy and associated adverse outcomes: analysis of multinational antenatal surveillance data. PLoS Med. 2013;10(2):e1001396. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pmed.1001396\u003c/span\u003e\u003cspan address=\"10.1371/journal.pmed.1001396\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePatel J, Politis MD, Howley MM, et al. Fever and antibiotic use in maternal urinary tract infections during pregnancy and risk of congenital heart defects: findings from the National Birth Defects Prevention Study. Birth Defects Res. 2023;116(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/bdr2.2281\u003c/span\u003e\u003cspan address=\"10.1002/bdr2.2281\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHagemann LL, Zielinsky P. Rastreamento populacional de anormalidades card\u0026iacute;acas fetais por ecocardiografia pr\u0026eacute;-natal em gesta\u0026ccedil;\u0026otilde;es de baixo risco no munic\u0026iacute;pio de Porto Alegre. Arq Bras Cardiol. 2004;82(4). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1590/S0066-782X2004000400003\u003c/span\u003e\u003cspan address=\"10.1590/S0066-782X2004000400003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSilvestri Melkan MPI, Ferreira OS, Bassan LCL, et al. Prevalence and trends of major congenital anomalies in Brazil: a study from 2011 to 2020. PLoS ONE. 2025;20(6):e0323654. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0323654\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0323654\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang X, Sun Y, Zhu J, et al. Epidemiology, prenatal diagnosis, and neonatal outcomes of congenital heart defects in eastern China: a hospital-based multicenter study. BMC Pediatr. 2020;20:416. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12887-020-02313-4\u003c/span\u003e\u003cspan address=\"10.1186/s12887-020-02313-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCongenital heart defects diagnosed in live births, in Rio Grande do Sul, from Nov/2021 to Feb/2024.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eICD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCHD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eiCHD\u003c/p\u003e\u003cp\u003eN (%)*\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eaCHD\u003c/p\u003e\u003cp\u003eN (%)*\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ211\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAtrial septal defect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e112 (45.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62 (45.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ210\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVentricular septal defect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e77 (31.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33 (24.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ250\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePatent ductus arteriosus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70 (28.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33 (24.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ221\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCongenital pulmonary valve stenosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15 (6.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9 (6.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ228\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther congenital malformations of tricuspid valve\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (4.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (2.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ233\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCongenital mitral insufficiency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (4.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (1.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ238\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBicuspid aortic valve\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (3.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (2.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ254\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCongenital malformation of aorta unspecified\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (3.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (1.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ251\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCoarctation of aorta\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (1.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (2.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ213\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTetralogy of Fallot\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (0.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (2.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ223\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther congenital malformations of pulmonary valve\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (0.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (1.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ218\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther congenital malformations of cardiac septa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (0.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ230\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCongenital stenosis of aortic valve\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (0.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ232\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCongenital mitral stenosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (0.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ234\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHypoplastic left heart syndrome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (0.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ240\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDextrocardia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10 (7.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ212\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAtrioventricular septal defect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (5.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ231\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCongenital insufficiency of aortic valve\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (2.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ208\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther congenital malformations of cardiac chambers and connections\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (1.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ256\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStenosis of pulmonary artery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (0.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ222\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCongenital pulmonary valve insufficiency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ225\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEbstein's anomaly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ229\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCongenital malformation of tricuspid valve, unspecified\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ231\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCongenital insufficiency of aortic valve\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ239\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCongenital malformation of aortic and mitral valves, unspecified\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ203\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDiscordant ventriculoarterial connection (Transposition of the great arteries)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ201\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDouble outlet right ventricle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (1.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ245\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMalformation of coronary vessels\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (0.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ248\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther specified congenital malformations of heart\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (0.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCommon arterial trunk\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (0.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ209\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCongenital malformation of cardiac chambers and connections, unspecified\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (0.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ897\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMultiple congenital malformations, not elsewhere classified\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (0.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eICD\u003c/b\u003e: International Classification of Diseases; \u003cb\u003eCHD\u003c/b\u003e: congenital heart defects; \u003cb\u003eiCHD\u003c/b\u003e: isolated congenital heart defects; \u003cb\u003eaCHD\u003c/b\u003e: associated congenital heart defects; *The total exceeds 100% as some cases had multiple CHD.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSyndromes and other congenital anomalies associated with congenital heart defects, identified in live births in Rio Grande do Sul.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSyndromes (67 cases)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNumerical Chromosome Syndromes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN (%\u003c/b\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTrisomy 21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33 (49.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTrisomy 13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (6.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTrisomy 18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (4.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKlinefelter Syndrome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (2.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTurner Syndrome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (2.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eStructural Chromosomal Syndromes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN (%\u003c/b\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMicrodeletion/microduplication Syndrome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (4.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (6.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMonogenic Syndromes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e3 (4.5\u003c/b\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAssociations/Sequences\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN (%\u003c/b\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVACTERL Association\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (6.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePierre Robin Sequence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (4.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrune Belly Sequence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (2.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOthers Syndromes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e4 (6.0\u003c/b\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOther congenital anomalies (69 cases)*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCentral Nervous System\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (24.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGenitourinary System\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 (21.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCraniofacial Anomalies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (20.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLimb Defects\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (18.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCongenital Diaphragmatic Hernia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (16.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMusculoskeletal Anomalies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (16.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbdominal Wall Defects\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (14.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeural Tube Defects\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (14.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGastrointestinal Tract\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (10.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePeripheral Vascular System\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (8.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther anomalies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (7.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e*The total exceeds 100% as some cases had multiple associated anomalies.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of newborns with isolated CHD and those with associated extracardiac anomalies (univariate analysis).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eiCHD (N\u0026thinsp;=\u0026thinsp;245)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eaCHD (N\u0026thinsp;=\u0026thinsp;136)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e127 (51.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66 (48.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.593\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e118 (48.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70 (51.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGestational Age\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreterm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e85 (35.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52 (39.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.503\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTerm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e154 (64.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e81 (60.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBirth Weight\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;-2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (4.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (6.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.052\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge; -2 e\u0026thinsp;\u0026ge;\u0026thinsp;+\u0026thinsp;2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e192 (84.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e116 (89.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;+2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25 (10.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (3.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBirth Length\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt; -3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (2.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (10.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e-3 e \u0026le; -2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (7.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (15.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;-2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e194 (89.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e86 (74.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBirth Head Circumference\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt; -3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (4.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.010*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e-3 e\u0026thinsp;\u0026le;\u0026thinsp;+\u0026thinsp;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e181 (85.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94 (81.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;+3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32 (15.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (14.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDeath\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (3.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24 (17.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e234 (96.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e111 (82.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFetal Echocardiogram\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNormal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (7.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (15.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.082\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAltered\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29 (15.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16 (15.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot performed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e144 (77.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e74 (69.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePostnatal Checklist\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNormal Pulse Oximetry Screening\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e92 (44.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22 (22.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAltered Pulse Oximetry Screening\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29 (14.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (14.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot performed Pulse Oximetry Screening\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40 (19.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24 (24.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEchocardiogram\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e245 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e136 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eiCHD\u003c/b\u003e: isolated congenital heart defects; \u003cb\u003eaCHD\u003c/b\u003e: associated congenital heart defects; birth weight, length and, head circumference: Z score value; *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMaternal characteristics of newborns presenting isolated CHD and those with associated extracardiac anomalies (univariate analysis).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eiCHD (N\u0026thinsp;=\u0026thinsp;245)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eaCHD (N\u0026thinsp;=\u0026thinsp;136)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31 (13.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (12.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.004*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e21 a 34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e155 (65.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65 (49.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;35\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e52 (21.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50 (37.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSkin Color\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhite\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e164 (76.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e81 (77.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.562\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlack/Brown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e49 (22.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20 (19.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (2.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducational Level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElementary School\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e66 (31.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32 (31.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh School\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e107 (51.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53 (52.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUniversity School\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34 (16.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (16.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGravidity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimigravida\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e64 (29.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31 (27.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMultigravida\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e150 (70.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e82 (72.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePrenatal care visits\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;6 consultas\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31 (27.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.315\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;7 consultas\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e140 (66.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e82 (72.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBMI (Pre-pregnancy)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnderweight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (3.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.432\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNormal weight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16 (15.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (16.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverweight/Obesity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e84 (80.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42 (84.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHypertension (Pre-pregnancy)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e52 (28.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23 (23.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.398\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHypothyroidism (Pre-pregnancy)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 (9.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16 (16.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.073\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDiabetes (Pre-pregnancy)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (13.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (12.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGDM\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e59 (32.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28 (27.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.423\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAlcohol Consumption\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (13.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (7.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.237\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSmoking\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32 (17.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22 (21.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.436\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDrugs Consumption\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (10.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (3.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.033*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMedication Consumption\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(N\u0026thinsp;=\u0026thinsp;143)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(N\u0026thinsp;=\u0026thinsp;82)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAntibiotics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60 (24.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22 (16.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.568\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVitamins\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e53 (21.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37 (27.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHormones\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40 (16.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26 (19.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAntihypertensives\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36 (14.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16 (11.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnalgesics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28 (11.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychotropics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (6.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (9.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21 (8.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (6.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eInfections during pregnancy\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(N\u0026thinsp;=\u0026thinsp;111)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(N\u0026thinsp;=\u0026thinsp;50)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStreptococcus infections\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46 (41.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (24.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.057\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUTI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33 (29.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22 (44.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSyphilis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26 (23.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (8.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eToxoplasmosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (6.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHerpes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (6.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCovid \u0026minus;\u0026thinsp;19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (5.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (8.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24 (21.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (26.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOther maternal health conditions\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(N\u0026thinsp;=\u0026thinsp;31)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(N\u0026thinsp;=\u0026thinsp;13)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreeclampsia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (35.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (23.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.407\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychiatric disorders\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (22.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (46.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19 (41.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (30.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eiCHD\u003c/b\u003e: isolated congenital heart defects; \u003cb\u003eaCHD\u003c/b\u003e: associated congenital heart defects; \u003cb\u003eBMI\u003c/b\u003e: Body Mass Index; \u003cb\u003eGDM\u003c/b\u003e: Gestational diabetes mellitus; \u003cb\u003eUTI\u003c/b\u003e: Urinary tract infection; *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultivariate Poisson regression analysis for factors associated with isolated congenital heart defects (iCHD), according to newborns and maternal characteristics.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eModel I: Newborns characteristics (Adjustments: Sex)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBirth weight (\u0026thinsp;\u0026gt;\u0026thinsp;+\u0026thinsp;2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.245\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.053\u0026ndash;1.473\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.011\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBirth length ( \u0026lt;-3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.778\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.534\u0026ndash;1.132\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.189\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBirth length (-3 e \u0026le; -2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.466\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.210\u0026ndash;1.036\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.061\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDeath\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.302\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.136\u0026ndash;0.667\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eModel II: Maternal characteristics\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eVariable\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003ePR\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e95% CI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (\u0026ge;\u0026thinsp;35 anos)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.692\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.497\u0026ndash;0.964\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.030\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnderweight (BMI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.623\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(0.433\u0026ndash;0.896)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.011\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverweight/obesity (BMI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.687\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.570\u0026ndash;0.829\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIllicit drug use (Yes)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.476\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.224\u0026ndash;1.781\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInfections (Yes)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.949\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.746\u0026ndash;1.208\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.672\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003ePR\u003c/b\u003e: Prevalence Ratio; \u003cb\u003eCI\u003c/b\u003e: Confidence Interval; \u003cb\u003eBMI\u003c/b\u003e: Body Mass Index; \u003cb\u003eiCHD\u003c/b\u003e: isolated congenital heart defects; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"congenital heart defects, newborns, fetal echocardiography, maternal risk factors, pregnancy, mortality","lastPublishedDoi":"10.21203/rs.3.rs-7339920/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7339920/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eCongenital heart defects (CHD) are the leading cause of infant mortality associated with birth defects in Brazil. Access to prenatal diagnosis is still considered low, and treatment is limited to referral centers, especially in large urban centers.\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e\u003cp\u003eTo characterize the profile of live births diagnosed with CHD in three university hospitals in Rio Grande do Sul, a state in southern Brazil.\u003c/p\u003e\u003ch2\u003eMethodology:\u003c/h2\u003e\u003cp\u003eThis study was based on an active surveillance system, and data were collected between November 2021 and February 2024 through medical record searches and maternal interviews. Statistical differences between CHD and maternal risk factors during pregnancy and neonatal variables were assessed using Fisher's exact test and Poisson regression with robust variance.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eFrom 381 CHD cases identified, 64.3% were classified as isolated (iCHD) and 35.7% as associated with other anomalies or syndromes (aCHD). The most frequent CHD was atrial and ventricular septal defects. Down syndrome was the most common genetic condition observed among associated cases. Maternal age, low birth weight and infant mortality were significantly more frequent in the aCHD group. Illicit drug use was more frequent in the iCHD. The rate of prenatal diagnosis by fetal echocardiography was low (15%) in both groups, and the rate of false negative results was high 14 (7.5%) iCHD and 17 (15.9%). Mortality was observed in the iCHD (n\u0026thinsp;=\u0026thinsp;9; 3.7%) and in the aCHD group (n\u0026thinsp;=\u0026thinsp;24; 17.8%).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThese findings highlight the importance of improving access to specialized prenatal care and implementing multidisciplinary strategies for managing CHD.\u003c/p\u003e","manuscriptTitle":"Epidemiology of Congenital Heart Defects in Live Births: Findings from a Study in Southern Brazil","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-30 12:04:02","doi":"10.21203/rs.3.rs-7339920/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-20T08:48:39+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-08T02:46:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-06T04:15:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"114335381833923937312974355672509495426","date":"2025-10-27T20:15:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"16281772691718091755975052593433750317","date":"2025-10-24T03:55:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"330092761000452150011875097993914967565","date":"2025-10-18T15:29:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-16T12:02:55+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-26T06:46:18+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-24T04:10:48+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-24T04:08:46+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2025-08-10T16:00:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a2cd7865-9ec0-4161-b823-403046ac69ab","owner":[],"postedDate":"October 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-12T16:08:50+00:00","versionOfRecord":{"articleIdentity":"rs-7339920","link":"https://doi.org/10.1186/s12872-025-05474-1","journal":{"identity":"bmc-cardiovascular-disorders","isVorOnly":false,"title":"BMC Cardiovascular Disorders"},"publishedOn":"2026-01-09 15:58:18","publishedOnDateReadable":"January 9th, 2026"},"versionCreatedAt":"2025-10-30 12:04:02","video":"","vorDoi":"10.1186/s12872-025-05474-1","vorDoiUrl":"https://doi.org/10.1186/s12872-025-05474-1","workflowStages":[]},"version":"v1","identity":"rs-7339920","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7339920","identity":"rs-7339920","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}