The children of mothers born with heart defects face a higher risk of being developmentally vulnerable, meaning they face challenges related to physical health, emotional maturity and communication – according to a new study led by Muhammad Zakir Hossin of the Karolinska Institutet, published July 2nd in the open access journal PLOS Medicine.
Congenital heart disease, a group of structural heart defects that form before birth, affects nearly 1% of all babies. With improvements in pediatric cardiac care, more than 90% of these children now survive into adulthood and can have children of their own. Pregnancy in mothers with congenital heart disease is associated with a higher risk of premature birth and other problems, but little was known about the long-term health and developmental outcomes of the children.
In the new study, researchers looked at a cohort of more than 250,000 children born in British Columbia, Canada from 1995 to 2016, including 456 children whose mothers were born with congenital heart disease. When the children started kindergarten, teachers completed a standardized assessment of their development in five domains, such as physical health, emotional maturity and communication. Children were considered to be developmentally vulnerable if they scored in the bottom 10% in at least two of five categories. Their analysis showed that children exposed to a mother with congenital heart disease had a 28% higher risk of developmental vulnerability compared to children from mothers without congenital heart disease. Furthermore, a severe case of congenital heart disease in the mother was more strongly associated with developmental vulnerability in the child compared to a mild case.
The new findings highlight maternal congenital heart disease as an important risk factor in child development. Further research will be needed to understand why children of mothers with this condition experience a higher risk of developmental vulnerability, researchers said. But simply recognizing this association could help identify women who would benefit from prenatal counseling, perinatal care and early intervention to reduce the risk of developmental vulnerability in their children.
Author Muhammad Zakir Hossin adds, "As more women born with congenital heart disease are surviving into adulthood and becoming mothers, understanding the long-term health and development of their children is an increasing public health priority. Our study suggests that the children of mothers with congenital heart disease may experience a higher risk of developmental challenges when they start school, highlighting the importance for early developmental monitoring and support following prenatal exposure to maternal congenital heart disease."
Hossin notes, "Developmental vulnerability does not necessarily mean that a child has a clinically diagnosed developmental disorder. Rather, it refers to children who are performing less well than most of their peers in two or more areas of development, including language and learning, social competence, emotional maturity, communication skills, or physical well-being."
Senior author Neda Razaz adds, "This study is not showing that women with congenital heart disease should not have children. Rather, it highlights the importance of providing extra support and follow-up before, during, and after pregnancy, so that children and families can get any help they may need as early as possible."
In your coverage, please use this URL to provide access to the freely available paper in PLOS Medicine: https://plos.io/49RIXdf
Citation: Hossin MZ, Gadermann A, Nagy E, Gill R, Petteni MG, Faxén J, et al. (2026) Maternal congenital heart disease and risk of child developmental vulnerability in early school age: A population-based cohort study. PLoS Med 23(7): e1004890. https://doi.org/10.1371/journal.pmed.1004890
Author countries: Sweden, Canada
Funding: The study was supported by grants from the Swedish Research Council for Health, Working life and Welfare ( https://forte.se/en ; awarded to MZH; Grant No. 2023-01238), the Swedish Heart-Lung Foundation ( https://www.hjart-lungfonden.se/om-oss/in-english/ ; awarded to NR; grant No. 20240328), and Canadian Institutes of Health Research ( https://cihr-irsc.gc.ca/e/193.html ; awarded to AG). MZH received salary from the Swedish Research Council for Health, Working life and Welfare. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
