Prevalence of congenital heart defects among children with and without diagnosed fetal alcohol spectrum disorders, 2016-2022.

BACKGROUND

Alcohol use during pregnancy might be a risk factor for some congenital heart defects (CHDs), but CHD prevalence among children with fetal alcohol spectrum disorders (FASDs) is not well understood. We used two administrative databases to explore CHD prevalence among U.S. children with and without FASDs.

METHODS

We limited 2016-2022 Merative™ MarketScan® Multi-State Medicaid and Commercial data to children ≤ 17 years old with ≥ 1 year of continuous enrollment with complete data on mental health and substance use services. CHD prevalence was calculated by FASD status, overall and by age group, using log-binomial prevalence ratios (PRs) and 95 % confidence intervals (CIs). Analyses were repeated after matching on enrollment length, and age and year at the start of enrollment. In the Medicaid sample, we also stratified by demographic characteristics and analyzed severe and non-severe CHD diagnoses separately. Multidimensional bias analysis considered the influence of unmeasured prenatal tobacco exposure.

RESULTS

Among 8732,345 children in the Medicaid sample, 5.2 % with FASDs and 1.0 % without FASDs had CHDs (matched cohort PR = 3.4 [CI: 2.8, 4.1]). PRs were similar when stratified by sex and race and ethnicity, and when looking at exclusively severe or non-severe CHDs. Among 10,567,765 children in the commercial claims sample, 3.0 % with FASDs and 0.6 % without FASDs had CHDs (matched cohort PR= 4.6 [CI: 3.3, 6.4]).

CONCLUSION

CHDs were more common among children with FASDs compared to those without FASDs in two administrative database samples. Increased provider awareness about CHDs as a potential FASD comorbidity may improve timely CHD care.