Date of Award

May 2014

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Nursing

First Advisor

Kathleen J. Sawin

Committee Members

Michael J. Carvan, Teresa S. Johnson, Karen H. Morin, Janette F. Strasburger

Keywords

Congenital Heart Defects, Etiology, Life Course, Maternal Risk Factors, Pre-Conception, Pregnancy

Abstract

Congenital heart defects (CHD) are the most prevalent birth defect in the world and occur in approximately 6-8 of every 1,000 live births (Hoffman & Kaplan, 2002). CHD continues to be one of the leading causes of infant morbidity and mortality today. Five to ten percent of all cases of CHD can be attributed to a chromosomal abnormality, 3%-5% are linked to single gene defects, and approximately 2% are a result of known environmental factors (Clark, 2001). With only 10%-15% of the causes of CHD are understood, the remaining 85%-90% of all CHD cases, the etiologies remain unknown. The purpose of this study was to examine the relationships of select maternal variables to the type of CHD (simple vs. complex), birth weight and gestational age in infants born with CHD participating in the Wisconsin Pediatric Cardiac Registry (WPCR). This study was a secondary analysis of 1,687 parent/child questionnaires using the data within the WPCR database from 2000-2010. A life course perspective was used to organize the maternal context variables and illustrate the relationships to the birth outcomes of the infants with CHD. The findings in this study included two maternal variables as risk factors for having a child with complex CHD. Personal maternal history of CHD (OR: 2.382; 95 % CI: 1.424-3.984) and history of serious health condition (OR: 1.537; CI: 1.085-2.178) increased the risk for complex CHD in these infants. The predictors of birth weight included; maternal history of hypertension, serious health condition six months prior/during pregnancy, CHD, obesity and income (R² = 0.049, p < 0.05). The predictors of gestational age included; maternal history of hypertension, flu, and serious health conditions 6 months prior/during pregnancy, and type of housing (R² = 0.045, p < 0.05).

Nurses and healthcare providers can identify risk factors prior to pregnancy and provide education to women and their partners in anticipation for a future pregnancy to reduce risk of complex CHD in their infant. This study reinforces the multifaceted nature of CHD and need for further investigation of maternal and paternal exposures to help identify other risk factors for complex CHD.

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