Maternal psychological distress, education, household income
This study shows that maternal psychological distress, socioeconomic status, and their combinations were associated with congenital heart defects (CHDs).

Researchers conducted a prospective cohort study that recruited pregnant women between 2011 and 2014. Maternal psychological distress was evaluated using the Kessler Psychological Distress Scale in the first trimester, while maternal education and household income were evaluated in the second and third trimesters. The outcome of infant CHD was determined using the medical records at 1 month of age and/or at birth. A total of 93,643 pairs of mothers and infants were analyzed, with 1.1% of infants having CHDs.

- Maternal psychological distress had a significantly higher odds ratio in the crude analysis but not in the adjusted analysis, while maternal education and household income were statistically insignificant.

- In the analysis of the combination variable of lowest education and psychological distress, the P for trend was statistically significant in the crude and multivariate model excluding anti-depressant medication, but the significance disappeared in the full model.

In particular, the combination of maternal psychological distress and lower education may be a possible indicator of infant CHD.

BMC Pregnancy and Childbirth