The link between low maternal cholesterol levels and increased risk of fetal patent ductus arteriosus and septal defects: Large-scale cohort retrospective study

Abstract

Objective: To investigate whether low maternal cholesterol levels during pregnancy are associated with an increased risk of neonatal Patent Ductus Arteriosus (PDA) and Atrial or Ventricular Septal Defect (ASD/VSD).

Methodology: Medical records of 36,633 pregnant women who received care and delivered at Fujian Maternity and Child Health Hospital, China, from 2016 to 2020 were retrospectively analyzed. Maternal serum lipid levels were measured one week before delivery, and Congenital heart disease (CHD) was diagnosed by echocardiography within three days of birth. Logistic regression models were adjusted for neonatal sex, maternal age, gestational diabetes and hypertension, gravidity, parity, and preterm birth.

Results: Among 36,633 mother-child pairs, 906 (2.5%) cases of CHD were identified. Lower maternal TC, LDL-C, and HDL-C levels were significantly associated with increased CHD risk. Each 1 mmol/L increase in TC was associated with an 11% decrease in CHD risk (OR: 0.89, 95% CI 0.85, 0.95). LDL-C showed a similar protective effect (OR: 0.88, 95% CI 0.82, 0.95), while HDL-C demonstrated the strongest association (OR: 0.61, 95% CI 0.51, 0.73). The relationship between TG and CHD risk was not significant after adjustment (OR: 0.97, 95% CI 0.92, 1.02; p=0.224). For PDA specifically, TC, LDL-C, and HDL-C remained significantly protective; for ASD/VSD, only TC demonstrated significance (OR: 0.91, 95% CI 0.83, 0.99). TG showed no significant association with any CHD subtype.

Conclusion: This study indicates that lower maternal levels of TC, LDL-C, and HDL-C may be significantly associated with an increased risk of PDA, while lower TC levels could be associated with ASD/VSD risk. The relationship between maternal TG levels and CHD could not be demonstrated. Future prospective multicenter and intervention studies are needed to validate the results.