Demographic Aspects of Congenital Heart Disease in Fallujah Maternity and Children Hospital, Fallujah City, Anbar, West of Iraq

Background: Congenital heart diseases (CHD) are major global health problem .Several maternal and fetal risk factors have been mentioned to be associated with the development of CHD , though different epidemiological patterns observed in different parts of the world , our study is aiming to demonstrate the descriptive characteristics of a group of children in Fallujah Maternity and Children Hospital (FMCH) diagnosed with (CHD) .

Materials and Methods: This is a prospective study, conducted at the Birth Defect Unit in Fallujah Maternity and Children Hospital. One thousand twenty five pediatric patients for 1018 mothers (14 of them are twins) where investigated, those were admitted to the newborns and children's wards and diagnosed as cases of CHD during the period from 1/12/2018 to 30/9/2022 . All the data collected by interviewing the patients’ guardians following a registration and questionnaire form including variables and factors related to the child like name, sex, birth weight, type of the CHD ,presence of other associated anomalies, and the mother's variables like name, age and occupation , degree of consanguinity between the parents, history of previous births with congenital CHD or any other congenital anomaly, type of pregnancy (singleton or twins), presence of chronic maternal disease, history of exposure during pregnancy to fever, X-ray irradiation or harmful drug use or toxic encounter ,beside the number of previous abortions (if any), residence of the family (rural or urban).

Results: ASD had the highest encounter, accounting for 72% of the total number, followed by VSD (25%), PDA (21%), PPH (8.8%), TOF (4%), D-TGA (2.7%), and CAVC (2%). Other defects were less frequent. Of all children investigated, 47% were aged 1-28 days, 35% were 29 days -12 months old, 7% were 13 months – 5 years old at the time of diagnosis, and 11% were more than 5 years old. The male/female ratio was 1.2/1, and 0.2% of all participants had an ambiguous gender. Regarding birth weight, 58% weighed ≥ 2.5kg, while 42% weighed < 2.5kg. Only 20% had a previous family history of CHDs, and 8% had a family history of other different congenital anomalies. Of all the patients included in the study, 7% were born with other congenital abnormalities in addition to their CHD. About 15% of the total number were born with ≥ 4 or more defects, 9% were born with 3 defects, 29% with 2 defects, and 47% were diagnosed with a single heart defect. Regarding the ages of mothers at birth of the diseased children, 52% were 14 to 30 years old, while 38% were 31 to 40 years old, and only 10% of the total number of investigated mothers were more than 40 years old. Consanguineous marriage was reported in 76% of all cases. The defects were more frequently reported in the age period of 1-28 days old except for CAVC (AVSD), which had an equal incidence during the first 28 days and the first year of age.

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Conclusion: Congenital heart diseases are causing ever-increasing concern in Fallujah city. Therefore, it is necessary to implement preventive strategies for modifiable risk factors, monitor high-risk pregnancies, and raise awareness about the importance of genetic counseling, especially for those with a family history of congenital anomalies in general, and congenital heart diseases, in particular. On the other hand, the cardiology department in the hospital needs more attention from the authorities to enhance its capacity and capabilities to accommodate more patients and improve the diagnostic and therapeutic tools. Conducting more research studies is necessary to investigate the reasons behind the striking increase in the number of newborns diagnosed with congenital heart defects in the last few years.