Diet and Nutrition in the Periconception Period of a Subsequent Pregnancy Following a Congenital Heart Defect-affected Pregnancy

Aim This study aimed to examine whether women who have had a former pregnancy affected by a congenital heart defect (CHD) seek to improve their overall nutritional status in the periconceptional period of a subsequent pregnancy.

Methods Eight women with a previous pregnancy affected by a congenital heart defect (cases) and five women with previously healthy pregnancies (controls), who were either currently pregnant again or had given birth to a subsequent baby in the past year, completed a questionnaire by telephone interview or self-administered by email. The questionnaire examined nutritional intake in the periconceptional period of a subsequent pregnancy and the extent to which nutritional advice and information was sought and/or received. Nutritional intake and advice or information sought and received were compared between case and control groups by Fisher’s Exact tests. Nutritional intake was also compared against UK Guidelines for healthy eating in pregnancy.

Results Overall, no significant differences were seen between cases and controls in any of the measures of nutritional intake, meeting guidelines or wanting and receiving information. However some associations that did not quite reach statistical significance were found. Cases ate fish, particularly oily fish, more frequently and ate high-fat foods less frequently than controls. Cases were more likely to take extra nutritional supplements before pregnancy, and to take a higher than normal (400µg) dose of folic acid. Vitamin D supplement use in pregnancy in both case and control groups was less common than folic acid use. Over 60% of both groups did not eat the recommended five or more portions of fruit and vegetables per day in early pregnancy. Cases may be more likely to meet the majority of the UK nutritional guidelines for pregnancy than controls. Cases may be more likely to want advice than controls, but controls appeared more likely to receive advice than cases. Cases were more likely to receive advice from a specialist doctor. However all these non-significant associations may be due to chance and a larger study is needed.

Conclusions Women who have had a previous CHD-affected pregnancy make little change in their nutritional intake in a subsequent pregnancy compared to women with healthy previous pregnancies, and may not be significantly more likely to meet UK recommended guidelines than the control subjects. Some women who have had a previous CHD-affected pregnancy seek and receive advice about periconceptional nutrition prior to a subsequent pregnancy, but the majority do not receive any advice specific to reducing the risk of a recurrence of a CHD in future. Recommendations include improved methodology for future similar studies, and that information on the possibility of reducing CHD recurrence by improved nutrition should be disseminated widely among health care professionals and conveyed to women who have had a baby affected by a CHD.