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The changing epidemiology of Ebstein’s anomaly and its relationship with maternal mental health conditions: a European registry-based study

  • Breidge Boyle (a1), Ester Garne (a2), Maria Loane (a1), Marie-Claude Addor (a3), Larraitz Arriola (a4), Clara Cavero-Carbonell (a5), Miriam Gatt (a6), Nathalie Lelong (a7), Catherine Lynch (a8), Vera Nelen (a9), Amanda J. Neville (a10), Mary O’Mahony (a11), Anna Pierini (a12), Anke Rissmann (a13), David Tucker (a14), Natalia Zymak-Zakutnia (a15) and Helen Dolk (a1)...
Abstract
Objectives

The aim of this study was to describe the epidemiology of Ebstein’s anomaly in Europe and its association with maternal health and medication exposure during pregnancy.

Design

We carried out a descriptive epidemiological analysis of population-based data.

Setting

We included data from 15 European Surveillance of Congenital Anomalies Congenital Anomaly Registries in 12 European countries, with a population of 5.6 million births during 1982–2011.

Participants

Cases included live births, fetal deaths from 20 weeks gestation, and terminations of pregnancy for fetal anomaly.

Main outcome measures

We estimated total prevalence per 10,000 births. Odds ratios for exposure to maternal illnesses/medications in the first trimester of pregnancy were calculated by comparing Ebstein’s anomaly cases with cardiac and non-cardiac malformed controls, excluding cases with genetic syndromes and adjusting for time period and country.

Results

In total, 264 Ebstein’s anomaly cases were recorded; 81% were live births, 2% of which were diagnosed after the 1st year of life; 54% of cases with Ebstein’s anomaly or a co-existing congenital anomaly were prenatally diagnosed. Total prevalence rose over time from 0.29 (95% confidence interval (CI) 0.20–0.41) to 0.48 (95% CI 0.40–0.57) (p<0.01). In all, nine cases were exposed to maternal mental health conditions/medications (adjusted odds ratio (adjOR) 2.64, 95% CI 1.33–5.21) compared with cardiac controls. Cases were more likely to be exposed to maternal β-thalassemia (adjOR 10.5, 95% CI 3.13–35.3, n=3) and haemorrhage in early pregnancy (adjOR 1.77, 95% CI 0.93–3.38, n=11) compared with cardiac controls.

Conclusions

The increasing prevalence of Ebstein’s anomaly may be related to better and earlier diagnosis. Our data suggest that Ebstein’s anomaly is associated with maternal mental health problems generally rather than lithium or benzodiazepines specifically; therefore, changing or stopping medications may not be preventative. We found new associations requiring confirmation.

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Copyright
Corresponding author
Correspondence to: B. Boyle, Room 12L14, School of Nursing, Ulster University, Shore Road, Newtownabbey, Co. Antrim, BT37 0QB, United Kingdom. Tel: +44 28 90 366 588; Fax: +44 28 90 368 341; E-mail: b.boyle1@ulster.ac.uk
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