Table 3.

Analysis of Factors Associated With Late Detection of CCHD Among 3746 Infants in the National Birth Defects Prevention Study, 1998–2007^a

Characteristic	No. (%) of Infants		PR (95% CI)
	Total	Late Detectionb	Crude Analysis	Adjusted Analysis
Extracardiac defectsc
No	3110	980 (31.5)	1 [Reference]	1 [Reference]
Yes	636	126 (19.8)	0.63 (0.53–0.74)	0.58(0.49–0.69)
CCHD type
Single CCHD
Pulmonary atresia	120	9 (7.5)	0.57 (0.29–1.12)	0.73 (0.37–1.43)
Tricuspid atresia	90	11 (12.2)	0.93 (0.51–1.71)	1.05 (0.56–1.97)
Hypoplastic left heart syndrome	427	56 (13.1)	1 [Reference]	1 [Reference]
Dextrotransposition of the great arteries	650	88 (13.5)	1.03 (0.76–1.41)	1.21 (0.87–1.69)
Aortic stenosis, critical	20	4 (20.0)	1.53 (0.61–3.79)	1.64 (0.46–5.86)
Ebstein anomaly	90	19 (21.1)	1.61 (1.01–2.57)	1.72(1.02–2.88)
Single ventricle	127	28 (22.0)	1.68 (1.12–2.53)	1.92(1.26–2.95)
Pulmonary stenosis, critical	101	23 (22.8)	1.74 (1.12–2.68)	1.94(1.23–3.04)
Interrupted aortic arch	43	12 (27.9)	2.13 (1.24–3.65)	1.86 (0.98–3.52)
Tetralogy of Fallot	733	204 (27.8)	2.12 (1.62–2.78)	2.42(1.81–3.24)
Double-outlet right ventricle	94	29 (30.9)	2.35 (1.59–3.47)	2.90(1.90–4.43)
Truncus arteriosus	68	21 (30.9)	2.35 (1.53–3.62)	2.60(1.64–4.12)
Total anomalous pulmonary venous return	190	78 (41.1)	3.13 (2.32–4.22)	3.38(2.44–4.68)
Coarctation of the aorta	801	497 (62.0)	4.73 (3.68–6.08)	5.26(4.02–6.89)
Multiple CCHDd	192	27 (14.1)	1.07 (0.70–1.64)	1.40 (0.90–2.17)
Estimated year of delivery
1998	261	81 (31.0)	1 [Reference]	1 [Reference]
1999	357	105 (29.4)	0.95 (0.74–1.21)	0.95 (0.75–1.2)
2000	351	121 (34.5)	1.11 (0.88–1.40)	1.07 (0.86–1.34)
2001	362	109 (30.1)	0.97 (0.76–1.23)	1.01 (0.81–1.27)
2002	330	96 (29.1)	0.94 (0.73–1.20)	0.95 (0.75–1.20)
2003	352	112 (31.8)	1.03 (0.81–1.30)	0.96 (0.76–1.22)
2004	463	131 (28.3)	0.91 (0.72–1.15)	0.88 (0.70–1.10)
2005	419	117 (27.9)	0.90 (0.71–1.14)	0.88 (0.70–1.11)
2006	444	108 (24.3)	0.78 (0.61–1.00)	0.71(0.55–0.91)
2007	407	126 (31.0)	1.00 (0.79–1.26)	0.86 (0.68–1.09)
Family history of congenital heart defects
No	3613	1072 (29.7)	1 [Reference]	1 [Reference]
Yes	133	34 (25.6)	0.86 (0.64–1.16)	0.87 (0.65–1.15)
Gestational age, wk
<32 (Very preterm)	138	51 (37.0)	1.26 (1.01–1.58)	1.20 (0.96–1.50)
32–36 (Preterm)	557	151 (27.1)	0.93 (0.80–1.07)	1.04 (0.89–1.22)
37–45 (Full term)	3020	885 (29.3)	1 [Reference]	1 [Reference]
Unknown/missing	31	19 (61.3)	NC	NC
Plurality
Singleton	3509	1029 (29.3)	1 [Reference]	1 [Reference]
Twins or higher-order birth	229	72 (31.4)	1.07 (0.88–1.31)	1.03 (0.84–1.27)
Unknown/missing	8	5 (62.5)	NC	NC
Maternal race/ethnicity
Non-Hispanic white	2285	645 (28.2)	1 [Reference]	1 [Reference]
Non-Hispanic black	368	109 (29.6)	1.05 (0.88–1.24)	1.20 (0.99–1.44)
Hispanic	840	281 (33.5)	1.19 (1.06–1.33)	1.18 (1.00–1.39)
Other/unknown	253	71 (28.1)	0.99 (0.81–1.22)	1.06 (0.85–1.32)
Maternal age at delivery, y
≤24	1151	356 (30.9)	1 [Reference]	1 [Reference]
25–34	2014	605 (30.0)	0.97 (0.87–1.08)	0.96 (0.84–1.08)
≥35	581	145 (25.0)	0.81 (0.68–0.95)	0.87 (0.72–1.05)
Maternal education
Less than high school graduate	636	204 (32.1)	1 [Reference]	1 [Reference]
High school graduate or equivalent	908	274 (30.2)	0.94 (0.81–1.09)	1.09 (0.92–1.29)
College or university, some or graduate	2132	607 (28.5)	0.89 (0.78–1.01)	1.08 (0.92–1.28)
Unknown/missing	70	21 (30.0)	NC	NC
Maternal prepregnancy BMIe
<18.5 (Underweight)	193	47 (24.4)	0.84 (0.65–1.09)	0.79 (0.61–1.02)
18.5–24.0 (Normal weight)	1800	523 (29.1)	1 [Reference]	1 [Reference]
25.0–29.0 (Overweight)	839	257 (30.6)	1.05 (0.93–1.19)	1.07 (0.95–1.21)
≥30.0 (Obese)	733	218 (29.7)	1.02 (0.9–1.17)	1.02 (0.89–1.18)
Unknown/missing	181	61 (33.7)	NC	NC
Diabetes mellitus diagnosis before or during index pregnancyf
No	3301	977 (29.6)	1 [Reference]	1 [Reference]
Yes	420	122 (29.0)	0.98 (0.84–1.15)	0.91 (0.77–1.08)
Unknown/missing	25	7 (28.0)	NC	NC
Hypertension at any time
No	3183	908 (28.5)	1 [Reference]	1 [Reference]
Yes	554	195 (35.2)	1.23 (1.09–1.40)	1.08 (0.95–1.23)
Unknown/missing	9	3 (33.3)	NC	NC
Maternal fertility treatments
No	3493	1032 (29.5)	1 [Reference]	1 [Reference]
Yes	200	58 (29.0)	0.98 (0.79–1.23)	1.03 (0.83–1.29)
Unknown/missing	53	16 (30.2)	NC	NC
Previous pregnancy losses
None	2361	707 (29.9)	1 [Reference]	1 [Reference]
1	853	241 (28.3)	0.94 (0.83–1.07)	0.93 (0.82–1.05)
2	324	94 (29.0)	0.97 (0.81–1.16)	1.04 (0.87–1.24)
≥3	189	59 (31.2)	1.04 (0.84–1.30)	1.06 (0.85–1.31)
Unknown/missing	19	5 (26.3)	NC	NC
First prenatal care visit
First trimester	3104	909 (29.3)	1 [Reference]	1 [Reference]
Second trimester	415	127 (30.6)	1.04 (0.90–1.22)	0.93 (0.80–1.09)
Third trimester	25	7 (28.0)	0.96 (0.51–1.80)	0.94 (0.48–1.81)
Unknown/missing	202	63 (31.2)	NC	NC
Study site
A	537	117 (21.8)	1 [Reference]	1 [Reference]
B	582	146 (25.1)	1.15 (0.93–1.42)	1.17 (0.95–1.46)
C	460	123 (26.7)	1.23 (0.98–1.53)	1.18 (0.92–1.52)
D	383	105 (27.4)	1.26 (1.00–1.58)	1.32(1.05–1.67)
E	359	98 (27.3)	1.25 (0.99–1.58)	1.40(1.11–1.77)
F	229	67 (29.3)	1.34 (1.04–1.74)	1.35 (1.04–1.75)
G	329	104 (31.6)	1.45 (1.16–1.82)	1.40 (1.10–1.79)
H	465	174 (37.4)	1.72 (1.41–2.10)	1.75 (1.41–2.17)
I	402	172 (42.8)	1.96 (1.61–2.39)	2.09 (1.66–2.63)

Abbreviations: BMI, body mass index (calculated as weight in kilograms divided by height in meters squared); CCHD, critical congenital heart disease; NC, not calculated; PR, prevalence ratio.

^aAdjusted results from a Poisson regression model with robust error variance that included all listed variables and excluded infants with at least 1missing value for any included variable. Boldface indicates statistically significant (P < .05).

^bDefined as a diagnosis more than 3 days after birth via echocardiography or autopsy.

^cChromosomal abnormalities, single-gene disorders, and birth defects with known etiology are excluded from the National Birth Defects Prevention Study.

^dMultiple CCHD refers to more than 1 screening-detectable CCHD.

^eCalculated from self-reported height and weight.

^fIncludes types 1 and 2 and gestational.