{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T12:17:08Z","timestamp":1772021828138,"version":"3.50.1"},"reference-count":41,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T00:00:00Z","timestamp":1771977600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Center for Health Outcomes Research"},{"name":"Delivery Science (CHORDS) of Children\u2019s National Research Institute, Children\u2019s National Hospital"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Etiologies of congenital heart disease (CHD) are multifactorial. The role of maternal nutrition and environmental factors among these CHD etiologies remain insufficiently understood. This pilot study evaluated the potential association between maternal diet quality, nutrient intake, and food security to fetal CHD in a cohort of 100 pregnant individuals, including 20 with CHD-affected pregnancies identified in a fetal cardiology clinic at an urban tertiary care hospital. A Diet Quality Photo Navigation (DQPN) tool assessed dietary quality and nutrient intake, while a survey collected data on demographics, health history, and food security. Comparison tests assessed for differences between CHD- and non-CHD-affected pregnancies. CHD-affected pregnancies demonstrated descriptively lower Healthy Eating Index scores, reduced prenatal multivitamin use, and lower intake of iron, manganese, fiber, and vitamin C. The non-CHD group demonstrated a significantly higher consumption of healthier snacks (p = 0.03), plant-based meat alternatives (p = 0.05), and unsweetened beverages (p = 0.05), while descriptively showing greater fruit and vegetable intake as compared to the CHD-affected group. No statistically significant differences in food security or socioeconomic indicators were identified. These findings demonstrate the feasibility of applying a DQPN tool in fetal health research and describe maternal dietary patterns that may inform the design of future hypothesis-driven studies. Continued investigation into maternal diet quality is critical to understand its potential role in mitigating CHD risk through targeted nutritional interventions.<\/jats:p>","DOI":"10.3390\/jcdd13030107","type":"journal-article","created":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T10:59:16Z","timestamp":1772017156000},"page":"107","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Identifying Inadequate Maternal Nutrition in Pregnancies Affected by Fetal Heart Defects: A Feasibility Pilot Study Using Photo-Based Diet Quality Assessment"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6070-0864","authenticated-orcid":false,"given":"Carson","family":"Flamm","sequence":"first","affiliation":[{"name":"School of Medicine and Health Sciences, The George Washington University, Washington, DC 20037, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle","family":"Udine","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Children\u2019s National Hospital, Washington, DC 20010, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Clauss","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Children\u2019s National Hospital, Washington, DC 20010, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8662-7810","authenticated-orcid":false,"given":"Anita","family":"Krishnan","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Children\u2019s National Hospital, Washington, DC 20010, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0942-5481","authenticated-orcid":false,"given":"Mary T.","family":"Donofrio","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Children\u2019s National Hospital, Washington, DC 20010, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2791-9896","authenticated-orcid":false,"given":"Michele","family":"Mietus-Snyder","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Children\u2019s National Hospital, Washington, DC 20010, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gary M.","family":"Shaw","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Stanford University, Palo Alto, CA 94305, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2629-1905","authenticated-orcid":false,"given":"Jennifer","family":"Klein","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Children\u2019s National Hospital, Washington, DC 20010, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"141","DOI":"10.5830\/CVJA-2013-028","article-title":"The global burden of congenital heart disease","volume":"24","author":"Hoffman","year":"2013","journal-title":"Cardiovasc. J. Afr."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Miao, Q., Dunn, S., Wen, S.W., Lougheed, J., Reszel, J., Venegas, C.L., and Walker, M. (2021). Neighbourhood maternal socioeconomic status indicators and risk of congenital heart disease. BMC Pregnancy Childbirth, 21.","DOI":"10.1186\/s12884-020-03512-8"},{"key":"ref_3","first-page":"1","article-title":"Deaths: Final Data for 2014","volume":"65","author":"Kochanek","year":"2016","journal-title":"Natl. Vital. Stat. Rep."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"155","DOI":"10.5694\/mja12.10811","article-title":"Congenital heart disease: Current knowledge about causes and inheritance","volume":"197","author":"Blue","year":"2012","journal-title":"Med. J. Aust."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"a037234","DOI":"10.1101\/cshperspect.a037234","article-title":"Environmental Risk Factors for Congenital Heart Disease","volume":"12","author":"Ved","year":"2020","journal-title":"Cold Spring Harb. Perspect. Biol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e2021052151","DOI":"10.1542\/peds.2021-052151","article-title":"Environmental Exposures and Congenital Heart Disease","volume":"149","author":"Boyd","year":"2022","journal-title":"Pediatrics"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1007\/s11886-024-02022-9","article-title":"Understanding the Genetic and Non-genetic Interconnections in the Aetiology of Isolated Congenital Heart Disease: An Updated Review: Part 1","volume":"26","author":"Maddhesiya","year":"2024","journal-title":"Curr. Cardiol. Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1007\/s00246-013-0775-4","article-title":"Nongenetic risk factors and congenital heart defects","volume":"34","author":"Patel","year":"2013","journal-title":"Pediatr. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1002\/ajmg.a.20132","article-title":"Do multivitamin or folic acid supplements reduce the risk for congenital heart defects? Evidence and gaps","volume":"121A","author":"Botto","year":"2003","journal-title":"Am. J. Med. Genet. A"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1111\/j.1753-4887.2004.tb00070.x","article-title":"Physiology of folate and vitamin B12 in health and disease","volume":"62","author":"Stover","year":"2004","journal-title":"Nutr. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Mao, B., Qiu, J., Zhao, N., Shao, Y., Dai, W., He, X., Cui, H., Lin, X., Lv, L., and Tang, Z. (2017). Maternal folic acid supplementation and dietary folate intake and congenital heart defects. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0187996"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e23300","DOI":"10.1002\/dvg.23300","article-title":"Retinoic acid signaling in heart development","volume":"57","author":"Nakajima","year":"2019","journal-title":"Genesis"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.mod.2016.12.002","article-title":"Mechanisms of retinoic acid signaling during cardiogenesis","volume":"143","author":"Stefanovic","year":"2017","journal-title":"Mech. Dev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1056\/NEJM199511233332101","article-title":"Teratogenicity of high vitamin A intake","volume":"333","author":"Rothman","year":"1995","journal-title":"N. Engl. J. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.earlhumdev.2017.12.011","article-title":"A compromised maternal vitamin D status is associated with congenital heart defects in offspring","volume":"117","author":"Koster","year":"2018","journal-title":"Early Hum. Dev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e036273","DOI":"10.1161\/JAHA.124.036273","article-title":"Circulating 25-hydroxyvitamin D levels during pregnancy and risk of congenital heart diseases: Multivariable and Mendelian randomization analyses using 3 birth cohorts","volume":"14","author":"Walker","year":"2025","journal-title":"J. Am. Heart Assoc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1111\/j.1471-0528.2011.02984.x","article-title":"A maternal dietary pattern characterised by fish and seafood in association with the risk of congenital heart defects in the offspring","volume":"118","author":"Vujkovic","year":"2011","journal-title":"BJOG"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1093\/aje\/kwx139","article-title":"Maternal exposure to nitrogen dioxide, intake of methyl nutrients, and congenital heart defects in offspring","volume":"186","author":"Stingone","year":"2017","journal-title":"Am. J. Epidemiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1038\/s41390-020-0813-x","article-title":"Maternal dietary fat intake and the risk of congenital heart defects in offspring","volume":"88","author":"Collins","year":"2020","journal-title":"Pediatr. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"4167","DOI":"10.1080\/14767058.2019.1702955","article-title":"Socioeconomic and racial disparities in the prevalence of congenital heart disease in infants of diabetic mothers","volume":"34","author":"Chou","year":"2021","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e015255","DOI":"10.1161\/JAHA.119.015255","article-title":"Environmental and Socioeconomic Factors Influence the Live-Born Incidence of Congenital Heart Disease: A Population-Based Study in California","volume":"9","author":"Peyvandi","year":"2020","journal-title":"J. Am. Heart Assoc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.jpeds.2021.08.080","article-title":"Geographic Distribution of Congenital Heart Disease: A Single Surgical Center Experience","volume":"240","author":"Klein","year":"2022","journal-title":"J. Pediatr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1556","DOI":"10.1002\/bdr2.2231","article-title":"Neighborhood location and nutritional resources as a risk factor for congenital heart disease in the fetus","volume":"115","author":"Klein","year":"2023","journal-title":"Birth Defects Res."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"G\u00f3mez, G., Kovalskys, I., Leme, A.C.B., Quesada, D., Rigotti, A., Cort\u00e9s Sanabria, L.Y., Y\u00e9pez Garc\u00eda, M.C., Liria-Dom\u00ednguez, M.R., Herrera-Cuenca, M., and Fisberg, R.M. (2021). Socioeconomic Status Impact on Diet Quality and Body Mass Index in Eight Latin American Countries: ELANS Study Results. Nutrients, 13.","DOI":"10.3390\/nu13072404"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e006814","DOI":"10.1136\/bmjopen-2014-006814","article-title":"Demographic and socioeconomic disparity in nutrition: Application of a novel Correlated Component Regression approach","volume":"5","author":"Alkerwi","year":"2015","journal-title":"BMJ Open"},{"key":"ref_26","first-page":"A76","article-title":"The role of race and poverty in access to foods that enable individuals to adhere to dietary guidelines","volume":"3","author":"Baker","year":"2006","journal-title":"Prev. Chronic Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3088","DOI":"10.1016\/j.tjnut.2024.07.029","article-title":"Socioeconomic Inequalities in Intakes of Ultraprocessed and Minimally Processed Foods in Nationally Representative Samples of Adults in Canada: An Analysis of Trends between 2004 and 2015","volume":"154","author":"Pozveh","year":"2024","journal-title":"J. Nutr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3165","DOI":"10.1093\/eurheartj\/ehy340","article-title":"2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy","volume":"39","author":"Bauersachs","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"102695","DOI":"10.1016\/j.cpcardiol.2024.102695","article-title":"Maternal\u2013fetal dyad beyond the phenomenology of pregnancy: From primordial cardiovascular prevention onward, do not miss this boat!","volume":"49","author":"Bucciarelli","year":"2024","journal-title":"Curr. Probl. Cardiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"109644","DOI":"10.1016\/j.mehy.2020.109644","article-title":"Dietary assessment can be based on pattern recognition rather than recall","volume":"140","author":"Katz","year":"2020","journal-title":"Med. Hypotheses"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1016\/j.jand.2023.05.015","article-title":"Healthy Eating Index-2020: Review and Update Process to Reflect the Dietary Guidelines for Americans, 2020\u20132025","volume":"123","author":"Pannucci","year":"2023","journal-title":"J. Acad. Nutr. Diet."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1177\/08901171231156513","article-title":"Rapid, Digital Dietary Assessment in Association with Cardiometabolic Biomarkers","volume":"37","author":"Dansinger","year":"2023","journal-title":"Am. J. Health Promot."},{"key":"ref_33","first-page":"360","article-title":"Comparison of the Diet ID Platform to the Automated Self-administered 24-hour (ASA24) Dietary Assessment Tool for Assessment of Dietary Intake","volume":"41","author":"Hutto","year":"2022","journal-title":"J. Am. Nutr. Assoc."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"101999","DOI":"10.1016\/j.cdnut.2023.101999","article-title":"Dietary Assessment by Pattern Recognition: A Comparative Analysis","volume":"7","author":"Bernstein","year":"2023","journal-title":"Curr. Dev. Nutr."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2241","DOI":"10.1016\/j.jacc.2011.08.025","article-title":"Birth prevalence of congenital heart disease worldwide: A systematic review and meta-analysis","volume":"58","author":"Konings","year":"2011","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"101341","DOI":"10.1016\/j.cpcardiol.2022.101341","article-title":"Geographical and socioeconomic factors influence the birth prevalence of congenital heart disease: A population-based cross-sectional study in eastern China","volume":"47","author":"Pan","year":"2022","journal-title":"Curr. Probl. Cardiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1520","DOI":"10.1016\/j.jacc.2021.01.047","article-title":"Ultra-Processed Foods and Incident Cardiovascular Disease in the Framingham Offspring Study","volume":"77","author":"Juul","year":"2021","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"l1451","DOI":"10.1136\/bmj.l1451","article-title":"Ultra-processed food intake and risk of cardiovascular disease: Prospective cohort study (NutriNet-Sant\u00e9)","volume":"365","author":"Srour","year":"2019","journal-title":"BMJ"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.ejogrb.2015.06.024","article-title":"Folic acid in pregnant women associated with reduced prevalence of severe congenital heart defects in their children: A national population-based case-control study","volume":"193","author":"Czeizel","year":"2015","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1186\/s12940-024-01150-7","article-title":"Maternal multivitamin supplementation mitigates the risk of fetal congenital heart disease associated with high indoor total volatile organic compounds exposure in east China: A case-control study","volume":"23","author":"Ruan","year":"2024","journal-title":"Environ. Health"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.ejogrb.2022.09.008","article-title":"Multivitamin intake and the risk of congenital heart defects: A cohort study","volume":"278","author":"Taagaard","year":"2022","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/3\/107\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T11:40:03Z","timestamp":1772019603000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/3\/107"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,25]]},"references-count":41,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["jcdd13030107"],"URL":"https:\/\/doi.org\/10.3390\/jcdd13030107","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,25]]}}}