Key result
Maternal psychiatric and analgesic use is linked to ~0.2-mm larger neonatal LVIDd without minor CHDs.
Why the study?
Prior studies of maternal prescription medication use during pregnancy mostly assessed single drugs as binary exposures and focused on major congenital heart defects, leaving the impact of real-world, time-varying medication use patterns on newborn cardiac structure and function uncertain.
Do maternal prescription medication use patterns from 12 weeks before conception through delivery affect newborn transthoracic echocardiographic parameters and minor congenital heart defects in term newborns?
Cohort (n=24,245)
Do maternal prescription medication use patterns from 12 weeks before conception through delivery affect newborn transthoracic echocardiographic parameters and minor congenital heart defects in term newborns?
Common real-world maternal medication use patterns before and during pregnancy are not associated with clinically meaningful differences in newborn cardiac structure or function or an increased risk of minor congenital heart defects.
Answers are grounded in this paper and cite their sources.
Maternal medication patterns may subtly affect neonatal LV size; leaves open clinical relevance and need for prospective validation.
Background Maternal prescription medication use during pregnancy is common. Most studies assess use of single medications using binary exposure definitions and focus on major congenital heart defects (CHDs). Thus, the impact of real-world, time-varying maternal medication use patterns on newborn cardiac structure and function remains uncertain. Purpose To identify maternal medication use patterns from 12 weeks before conception through delivery and evaluate their associations with newborn transthoracic echocardiographic (TTE) parameters and the most frequent minor CHDs. Methods In a population-based cohort of 24,245 term newborns who underwent TTE within 60 days of birth, filled maternal prescriptions were ascertained from a national prescription registry. Unsupervised hierarchical clustering analyses identified exposure patterns based on medication class (Anatomical Therapeutic Classification codes), timing of use, and polypharmacy. Associations with 13 echocardiographic parameters were assessed using linear regression (mean differences) and quantile regression (10th, 25th, 75th, 90th percentiles). Logistic regression evaluated minor CHDs detected on neonatal TTE, including ASD, VSD, and BAV. Models were adjusted for maternal and neonatal covariates with correction for multiple testing. Results Overall, 60.7% of newborns were exposed to at least one prescription medication before or during pregnancy. Eight distinct medication-use patterns were identified. Across patterns, adjusted differences in cardiac structure and function were small and showed no consistent direction, and no pattern was associated with ASD, VSD, or BAV. One pattern characterized by sustained use of psychiatric medications, including selective serotonin reuptake inhibitors, together with analgesics was associated with small differences at the lower end of the distribution, including larger left ventricular internal diameter in diastole (25th percentile: 0.23 mm, 95% CI 0.04,0.42), larger left ventricular end-diastolic volume (25th percentile: 0.36 mL, 95% CI 0.06,0.67), and shorter mitral deceleration time (10th percentile: -5.08 ms, 95% CI -7.29, -2.88). Conclusion Common maternal medication use patterns before and during pregnancy were not associated with clinically meaningful differences in neonatal cardiac structure or function or increased risk of minor CHDs. Small differences observed at the lower end of the distribution in one medication-use pattern warrant further longitudinal evaluation.
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Ninh et al. (2026) conducted a cohort in Newborn cardiac structure and function and minor congenital heart defects (n=24,245). Maternal prescription medication use patterns (from 12 weeks pre-conception through delivery) vs. No prescription medication exposure / unexposed group was evaluated on 13 neonatal transthoracic echocardiographic parameters (e.g., left ventricular internal diameter in diastole at 25th percentile) and minor congenital heart defects (ASD, VSD, BAV) (25th percentile difference 0.23 mm (for LVIDd with sustained psychiatric + analgesic use), 95% CI 0.04-0.42). Maternal medication patterns (60.7% exposed) were not tied to minor CHDs; sustained psychiatric/analgesic use increased 25th-percentile LVIDd by 0.23 mm (95% CI 0.04-0.42).
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