{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T06:41:09Z","timestamp":1794033669363,"version":"4.8.0"},"reference-count":35,"publisher":"BMJ","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Heart"],"accepted":{"date-parts":[[2011,11,17]]},"published-print":{"date-parts":[[2012,3,15]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To study the influence of a possible interaction between maternal smoking and high body mass index (BMI) on the occurrence of specific congenital heart anomalies (CHA) in offspring.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Case-control study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Data from a population-based birth defects registry in the Netherlands.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Patients<\/jats:title>\n                  <jats:p>Cases were 797 children and fetuses born between 1997 and 2008 with isolated non-syndromic CHA. They were classified into five cardiac subgroups: septal defects (n=349), right ventricular outflow tract obstructive anomalies (n=126), left ventricular outflow tract obstructive anomalies (n=139), conotruncal defects (n=115) and other CHA (n=68). Controls were 322 children and fetuses with chromosomal anomalies without cardiac anomalies.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main outcome measures<\/jats:title>\n                  <jats:p>Investigation of whether an interaction between maternal smoking and high BMI influences the occurrence of CHA in offspring by calculation of the synergy factors and 95% CIs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>As opposed to smoking or high BMI alone, the risk for CHA in the offspring of women with high BMI (\u226525\u2005kg\/m<jats:sup>2<\/jats:sup>) who also smoked was significantly increased. The adjusted OR was 2.65 (95% CI 1.20 to 5.87) for all CHA, 2.60 (95% CI 1.05 to 6.47) for septal defects and 3.58 (95% CI 1.46 to 8.79) for outflow tract anomalies. The interaction between maternal high BMI and smoking contributed significantly to the occurrence of all offspring-CHA combined, and to the occurrence of all cardiac subgroup anomalies except right ventricular outflow tract obstructive anomalies.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Maternal overweight and smoking may have a synergistic adverse effect on the development of the fetal heart. Overweight women who wish to become pregnant should be strongly encouraged to stop smoking and to lose weight.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/heartjnl-2011-300822","type":"journal-article","created":{"date-parts":[[2012,1,31]],"date-time":"2012-01-31T20:33:50Z","timestamp":1328042030000},"page":"474-479","source":"Crossref","is-referenced-by-count":38,"title":["Combined adverse effects of maternal smoking and high body mass index on heart development in offspring: evidence for interaction?"],"prefix":"10.1136","volume":"98","author":[{"given":"Maria E","family":"Baardman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilhelmina S","family":"Kerstjens-Frederikse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Corpeleijn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hermien E K","family":"de Walle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M W","family":"Hofstra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rolf M F","family":"Berger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marian K","family":"Bakker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2012,1,30]]},"reference":[{"key":"2025092006340746000_98.6.474.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2008.05.059"},{"key":"2025092006340746000_98.6.474.2","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/S1058-9813(03)00084-5","article-title":"Decreasing the burden of congenital heart anomalies: an epidemiological evaluation of risk factors and survival","volume":"2003","author":"Botto","year":"2003","journal-title":"Pediatr Cardiol"},{"key":"2025092006340746000_98.6.474.3","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.183216"},{"key":"2025092006340746000_98.6.474.4","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehp479"},{"key":"2025092006340746000_98.6.474.5","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1038\/oby.2003.146","article-title":"Maternal obesity and infant heart defects","volume":"11","author":"Cedergren","year":"2003","journal-title":"Obes Res"},{"key":"2025092006340746000_98.6.474.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2009.08.005"},{"key":"2025092006340746000_98.6.474.7","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.2009.28865"},{"key":"2025092006340746000_98.6.474.8","doi-asserted-by":"publisher","DOI":"10.1097\/00001648-200107000-00014"},{"key":"2025092006340746000_98.6.474.9","doi-asserted-by":"publisher","DOI":"10.1080\/14622200802238944"},{"key":"2025092006340746000_98.6.474.10","unstructured":"Statistics Netherlands. http:\/\/www.cbs.nl (accessed Jul 2011)."},{"key":"2025092006340746000_98.6.474.11","doi-asserted-by":"publisher","DOI":"10.1097\/01.hjr.0000214613.29608.f5"},{"key":"2025092006340746000_98.6.474.12","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1161\/01.ATV.17.1.95","article-title":"Effects of serum lipoproteins and smoking on atherosclerosis in young men and women. 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