Hostname: page-component-76fb5796d-wq484 Total loading time: 0 Render date: 2024-04-28T09:35:37.670Z Has data issue: false hasContentIssue false

Epidemiology of cardiovascular malformations: The state of the art

Published online by Cambridge University Press:  19 August 2008

Charlotte Ferencz*
Affiliation:
From the Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore
Adolofo Correa Villasenñor*
Affiliation:
Department of Epidemiology, Johns Hopkins School of Hygiene and Public Health, Baltimore
*
Charlotte Ferencz, M.D., M.P.H., Deptartment of Epidemiology and Preventive Medicine, University of Maiyland School of Medicine, Room 146-D, Howard Hall, 660W. Redwood Street, Baltimore, MD 21201 USA. Tel. (301) 328-7864, Fax. (301) 328-8013
Charlotte Ferencz, M.D., M.P.H., Deptartment of Epidemiology and Preventive Medicine, University of Maiyland School of Medicine, Room 146-D, Howard Hall, 660W. Redwood Street, Baltimore, MD 21201 USA. Tel. (301) 328-7864, Fax. (301) 328-8013

Summary

A historical review highlights an interest in the etiology of birth defects over the course of several centuries and recalls specific hypotheses on the origin of cardiovascular defects postulated 60 years ago. The “State of the Art” of the epidemiology of cardiovascular malformations is characterized by an expanding base of knowledge which holds promise for eventual preventive interventions. Epidemiologic investigations conducted in the past decade have led to an increased understanding of the benefits and problems of studies of populations and of methodologic issues in surveillance of disease and study of risk factors. Comparative evaluations of reported studies to an ongoing population-based case-control investigation (the Baltimore-Washington Infant Study) demonstrate variations in prevalence by time and place, evidence for a strong genetic predisposition to cardiac maldevelopment and new hypotheses regarding environmental risks in the home and place of occupation.

Type
Special Article
Copyright
Copyright © Cambridge University Press 1991

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

MacDermot, HE. Maude Abbott: A Memoir. MacMillan Co, Toronto, 1941, pp 7485.Google Scholar
Ferencz, C. Maude Elizabeth Abbott: Pioneer in congenital heart disease. In: Arntzenius, AC, Dunning, AJ, Snellen, HA (eds). Fourth Einthoven Meeting on Past and Present Cardiology. Van Gorcum, Wolfeboro, New Hampshire, 1986, pp 918.Google Scholar
Abbott, ME, Dawson, WT.The Clinical Classification of Congenital Cardiac Disease. International Clinics, 1924; 4: 156188.Google Scholar
McNamara, DG, Manning,, JA, Engle, MA, Whirtemore, R, Neill, CA, Ferencz, C.Helen Brooke Taussig: 1898 to 1986. J Am Coil Cardiol 1987; 10: 662671.CrossRefGoogle ScholarPubMed
Blalock, A, Taussig, HB. The surgical treatment of malforma tions of the heart in which there is pulmonary stenosis or pulmonary atresia. J Am Med Assn 1945; 128: 189202.CrossRefGoogle Scholar
Warkany, J. Congenital Malformations: Notes and Comments. Year Book Medical Publishers, Chicago, 1971, pp 620.Google Scholar
Schwalbe, E.Allgemeine Missbildungslehre. Verlagvon Gustav Fischer, Jena, 1906, pp 521.Google Scholar
O'Rahilly, R. One hundred years of human embryology. In: Kalter, H (ed). Issues and Reviews in Teratology, Vol. 4. Plenum Press, New York, 1988, pp 8182.CrossRefGoogle Scholar
Warkany, J.Production of congenital malformations by dietary measures: Experiments in mammals. J Am Med Assn 1958; 168: 20202023.CrossRefGoogle ScholarPubMed
Kalter, H, Warkany, J.Experimental production of congenital malformations in mammals by metabolic procedure. Physiol Rev 1959; 39: 69115.CrossRefGoogle ScholarPubMed
Bamberger, H.Lehrbuch der Krankheiten des Herzens. Wilhelm Braumuller, Wien, 1857, pp 377.Google Scholar
Peacock, TB.On Malformations of the Human Heart. Longwood Press, Boston, 1858, pp 115117.Google Scholar
Abbott, ME. Congenital cardiac disease. In: Osler, W, McCrae, T (eds). Modern Medicine: Its Theory and Practice. Lea & Febiger, Philadelphia, 1908, pp 323425.Google Scholar
Abbott, ME.Atlas of Congenital Cardiac Disease. American Heart Association, New York, 1936.Google Scholar
Abbott, ME. Congenital Heart Disease. In: Nelson Loose Leaf Medicine, Vol 4. Thomas Nelson & Sons, New York, 1932, pp 207321.Google Scholar
Carlgren, LE.The incidence of congenital heart disease in children born in Gothenburg, 1941–1950. Br Heart J 1959; 21: 4050.CrossRefGoogle ScholarPubMed
Polani, PE, Campbell, M.An aetiologic study of congenital heart disease. Ann Hum Genet 1955; 19: 209230.CrossRefGoogle ScholarPubMed
Nora, JJ.Multifactorial inheritance hypothesis for the etiology of congenital heart disease: The genetic-environmental interaction. Circulation 1978; 38: 604617.CrossRefGoogle Scholar
Doyle, EF, Rutkowski, M.Etiology of congenital heart disease. Cardiovascular Clinics 1970; 2: 125.Google ScholarPubMed
Mitchell, SC, Korones, SB, Berendes, HW.Congenital heart disease in 56,109 births. Circulation 1971; 43: 323332.CrossRefGoogle Scholar
Mitchell, SC, Sellman, AH, Westphal, MC, Park, J.Etiologic correlates in a study of congenital heart disease in 56,109 births. Am J Cardiol 1971; 23: 653657.CrossRefGoogle Scholar
Fyler, DC.Report of the New England Regional Infant Cardiac Program. Pediatrics 1980; 65(Supplyes): 375461.Google Scholar
Last, JM.Dictionary of Epidemiology. Oxford University Press, Oxford, 1983, p. 32.Google Scholar
Gordon, JE. Epidemiology - Old and New. In: Buck, C, Llopis, A, Najera, E, Terris, M (eds). The Challenge of Epidemiology: Issues and Selected Readings. Pan American Health Organi zation, Science Publ No 505, Washington DC, 1988, p. 135.Google Scholar
Clark, EB. Mechanisms in the pathogenesis of congenital heart defects. In: Pierpont, ME, Moller, JM (eds). The Genetics of Cardiovascular Disease. Martinus-Nijoff, Boston, 1986, pp 311.Google Scholar
McKusick, VA.Mendelian Inheritance in Man, 7th edition. Johns Hopkins University Press, Baltimore, 1986.Google Scholar
Ferencz, C, Rubin, JD, McCarter, RJ.Congenital heart disease: Prevalence at live birth. Am J Epidemiol 1985; 12: 3136.CrossRefGoogle Scholar
Rubin, JD, Ferencz, C, Brenner, JI, Neill, CA, Perry, LW.Early detection of congenital cardiovascular malformations in in fancy. Am J Dis Child 1987; 141: 12181220.Google Scholar
Ferencz, C, Rubin, JD, McCarter, RJ.Cardiac and non-cardiac malformations: Observations in a population-based study. Teratology 1987; 35: 367378.CrossRefGoogle Scholar
Ferencz, C, Neill, CA, Boughman, JA.Congenital cardiovascu lar malformations with chromosome abnormalities: An epidemiologic study. J Pediatr 1989; 114: 7986.CrossRefGoogle Scholar
Boughman, JA, Berg, KA, Astemborski, JA, Clark, EB, McCarter, RJ, Rubin, JD, Ferencz, C.Familial risks of congenital heart defect assessed in a population-based epidemiologic study. Am J Med Genet 1987; 26: 839849.CrossRefGoogle Scholar
Boughman, JA, Astemborski, JA, Berg, KA, Clark, EB, Ferencz, C. Variation in expression of congenital cardiovascular malformations within and among families. In: Woodhead, AD, Bender, MA, Leonard, RC (eds). Phenotypic Variation in Populations. Plenum Publishing, New York, 1988, pp 93103.CrossRefGoogle Scholar
Wilson, JG. The evolution of teratologic testing. Teratology 1979; 20: 205212.CrossRefGoogle ScholarPubMed
Castillo, E, Czeizel, A, Källén, B, Mastrolacovo, P, Oakley, GP Jr, Takeshita, K, De Wals, P, Kulieve, AM.Methodology for birth defects monitoring. Birth Defects 1986; Original Article Series 22: 12, 3941.Google Scholar
Källén, B, Hay, S, Kleinberg, M. Birth defects monitoring systems. In: Kalter, H (ed). Issues and Review of Teratology Vol 2. Plenum Press, New York, 1984, pp 122.Google Scholar
Borman, B, Chapman, C, Howard, K, Buckfield, P, Findlay, J. Using a national register for the epidemiological study of congenital heart defects. NZ Med J 1987; 100: 404406.Google ScholarPubMed
Ferencz, C, Czeizel, A, Lys, F.The problem of comparative analysis of birth prevalence of congenital cardiovascular malformations. Acta Paed Hung 1990; 30: 169189.Google Scholar
Stoll, C, Alemik, Y, Roth, MP, Dott, B, De Geeter, B. Eur J Epidemiol 1989; 5: 382–91.CrossRefGoogle Scholar
Fixler, DE, Pastor, P, Chamberlin, M, Sigman, E, Eifler, CW.Trends in congenital heart disease in Dallas County births, 1971– 1984. Circulation 1990; 81: 137142.CrossRefGoogle ScholarPubMed
Samánek, M, Voriskova, M. Infants with critical heart disease in a territory with centralized care. Internatl J Cardiol 1987; 16: 7591.CrossRefGoogle Scholar
Carlgren, LE, Ericson, A, Källén, B.Monitoring of congenital cardiac defects. Pediatr Cardiol 1987; 8: 247256.CrossRefGoogle ScholarPubMed
Grabitz, RG, Joffre, MR, Collins-Nakai, RL.Congenital heart disease: Incidence in the first year of life. Am J Epidemiol 1988; 128: 381388.CrossRefGoogle ScholarPubMed
Centers for Disease Control. Congenital Malformations Surveillance Jan 1982-Dec 1985. US Dept Health Human Services, PHS, Atlanta, 1988.Google Scholar
Martin, GR, Perry, LW, Ferencz, C.Increased prevalence of ventricular septal defect: Epidemic or improved diagnosis? Pediatrics 1989; 83: 200203.CrossRefGoogle ScholarPubMed
Newman, TB. Etiology of ventricular septal defects: An epidemiologic approach. Pediatrics 1985; 76: 741749.CrossRefGoogle ScholarPubMed
D'Orsogna, L, Sandor, GGS, Patterson, MWH, Ashmore, PG, LeBlanc, J, Culham, JAG.Influence of echocardiography in pre-operative cardiac catheterization in congenital heart dis ease. Int J Cardiol 1989; 24: 1926.CrossRefGoogle Scholar
Källén, B.Population surveillance of multimalformed infants experience with the Swedish Registry of Congenital Malformations (First Part). J Genet Hum 1987; 35: 205213.Google ScholarPubMed
Källén, B.Population surveillance of multimalformed infants experience with the Swedish Registry of Congenital Malformations (Second Part). J Genet Hum 1987; 35: 321338.Google ScholarPubMed
Swan, SH, Shaw, G, Harris, JA, Neutra, RR.Congenital cardiac anomalies in relation to water contamination, Santa Clara County, California, 1981–1983. Am J Epidemiol 1989; 129: 885893.CrossRefGoogle Scholar
Goldberg, SJ, Lebowita, MD, Graver, EJ, Hicks, S.An association of human congenital cardiac malformations and drinking water contaminants. J Am Coll Cardiol 1990; 16: 155164.CrossRefGoogle ScholarPubMed
Källén, B. Surveillance of adverse reproductive outcomes. In: Epidemiology of Human Reproduction. CRC Press, Boca Raton, 1988, pp 7487.Google Scholar
Ferenca, C.On the birth prevalence ofcongenital heart disease. J Am Coil Cardiol 1990; 16: 17011702. [Editorial]CrossRefGoogle Scholar
Wilson, PD.Sample size and power in case-control studies: Response to the Drs. Nora. Teratology 1984; 29: 137138. [Letter]CrossRefGoogle Scholar
Rothman, KJ.No adjustments are needed for multiple comparisons. Epidemiol 1990; 1: 4346.CrossRefGoogle ScholarPubMed
Gregg, NM.Congenital cataract following German measles in the mother. Trans Opthal Soc of Australia 1941; 3: 3546.Google Scholar
Wagner, HR.Cardiac disease in congenital infection. Clin Perinatol 1981; 8: 481497.CrossRefGoogle Scholar
Rowe, RD, Freedom, RM, Mehrizi, A. The neonate with congenital heart disease, 2nd ed. In: Major Problems in Clinical Pediatrics, Vol. 5. WB Saunders, Philadelphia, 1981, pp 675680.Google Scholar
Pederson, LM, Tygstrup, I, Pedetson, J.Congenital malformations in newborn infants of diabetic women: Correlation with maternal diabetic complications. Lancet 1964; 1: 11241126.CrossRefGoogle Scholar
Rowland, TW, Hubbell, JP, Nadas, AS.Congenital heart disease in infants ofdiabetic mothers. J Pediatr 1973; 83: 815820.CrossRefGoogle Scholar
Mills, JL, Knopp, RH, Simpson, JL, Jovanovic-Pederson, L, Metager, BE, Holmes, LE, Arons, JH, Brown, Z, Reed, GF, Bieber, FR, Van Allen, M, Holtzman, I, Ober, C, Peterson, CM, Withiam, MJ, Duckles, A, Mueller-Heubach, E, Polk, BFThe National Institute of Child Health and Human Develop ment Early Pregnancy Study. Lack of relation of increased malformation rates in infants of diabetic mothers to glycemic control during organogenesis. N Engl J Med 1988; 381: 671676.CrossRefGoogle Scholar
Ferencz, C, Rubin, JD, McCarter, RJ, Clark, EB.Maternal diabetes and cardiovascular malformations: Predominance of double outlet right ventricle and truncus arteriosus. Teratology 1990; 41: 319326.CrossRefGoogle ScholarPubMed
Kirby, ML, Waldo, KL.Role of neural crest in congenital heart disease. Circulation 1990; 82: 332340.CrossRefGoogle ScholarPubMed
Ferencz, C, Rubin, JD, McCarter, RJ, Wilson, PD, Brenner, JI, Neill, CA, Perry, LW, Hepner, SI, Downing, JW.Associationof hereditary blood disorders and congenital heart disease. Teratology 1984; 29: 313. [Letter]CrossRefGoogle Scholar
Ferencz, C, Rubin, JD, McCarter, RJ, Wilson, PD.Hematologic disorders and congenital cardiovascular malformations: Converging lines of research. J Med 1984; 15: 337353.Google ScholarPubMed
Ferencz, C.The etiology of congenital cardiovascular malformations: observations on genetic risks with implications for further birth defects research. J Med 1985; 16: 497508.Google ScholarPubMed
Ferencz, C, Boughman, JA, Berg, KA:Genetic alterations of endothelial cells as determinants of cardiovascular maldevelopment. Teratology 1987; 35: 33A34A.Google Scholar
Ferencz, C, Boughman, JA, Neill, CA, Brenner, JI, Perry, LW and the Baltimore-Washington Infant Study Group: Congenital cardiovascular malformations: Questions on inheritance. J Am Coil Cardiol 1989; 14: 756763.CrossRefGoogle Scholar
Kitchens, CS, Alexander, JA.Partial deficiency of coagulation factor XI as a newly recognized feature of Noonan Syndrome. J Pediatr 1983; 102: 224227.CrossRefGoogle ScholarPubMed
Witt, DR, McGillivray, BC, Allanson, JE, Hughes, HE, Hathaway, WE, Zipursky, A, Hall, JG.Bleeding diathesis in Noonan syndrome: A common association. Am J Med Genet 1988; 31: 305317.CrossRefGoogle ScholarPubMed
Sharland, M, Patton, M, Chittolie, A, Talbot, S, Bevan, D: Coagulation factor abnormalities in Noonan syndrome. J Med Genet 1990; 27: 646655.Google Scholar
Jedell, KB, Michels, VV, Gordon, H, Gilchrist, GS: Frequency of congenital heart defects in patients with hemophilia. Am J Med Genet 1990; 6: 333335.CrossRefGoogle Scholar
Ardinger, RH, Murray, JC, Bell, GI, Lauer, RM.Endocardial cushion defects are associated with allele of transforming growth factor alpha. Am J Cardiol. 1988; 62: 500508.Google Scholar
Kalter, H, Warkany, J.Congenital malformations: etiologic factors and their role in prevention (first part). N Engl J Med 1983; 308: 424431.CrossRefGoogle Scholar
Kalter, H, Warkany, J.Congenital malformations: etiologic factors and their role in prevention (second part). N Engl J Med 1983; 308: 491497.CrossRefGoogle Scholar
Schardein, JL. Chemically Induced Birth Defects. Marcel Dekker, New York, 1985, pp 208, 477495.Google Scholar
Shepard, TH.Catalogue of Teratogenic Agents, 6th edition. Johns Hopkins Press, Baltimore, 1989, p. xxii.Google Scholar
Lenz, W: A short history of thalidomide embryopathy. Teratology 1988; 38: 203215.CrossRefGoogle Scholar
Persaud, TVN.Environmental Causes of Human Birth Defects. Charles C Thomas, Springfield, 1990, pp 4243.Google Scholar
Biancaniello, T, Meyer, RA, Wong, KY, Sager, C, Kaplan, S.Doxorubicin cardiotoxicity in children. J Pediatr 1980; 97: 4550.CrossRefGoogle ScholarPubMed
Abelman, WH, Lorell, BH.The Challenge of Cardiomyopathy. J Am Coll Cardiol 1989; 13: 12191239.CrossRefGoogle Scholar
Lynberg, MC, Khoury, MJ, Lammer, EJ, Wailer, KG, Cordero, JF, Erickson, JD. Sensitivity, specificity, and positive predictive value of multiple malformations in Isotretinoin embryopathy surveillance. Teratology 1990; 42: 513519.CrossRefGoogle ScholarPubMed
Wilson, JG, Brent, RL.Are female sex hormones teratogenic. Am J Obstet Gynecol 1981; 141: 567580.CrossRefGoogle ScholarPubMed
Holmes, LB.Teratogen update: Bendectin. Teratology 1983; 27: 277281.CrossRefGoogle ScholarPubMed
Brent, RL.The Bendectin saga: Another American tragedy (Brent, '80). Teratology 1983; 27: 283286.CrossRefGoogle ScholarPubMed
Warkany, J: Teratogen update: Lithium. Teratology 1988; 38: 593596.CrossRefGoogle ScholarPubMed
Mottet, NK. Biochemical mechanisms of trace element teratogenesis. In: Juchau, MR (ed). The Biochemical Basis ofChemical Teratogenesis. Elsevier/North-Holland, New York, 1981, pp 201246.Google Scholar
Källén, B.Comments on Teratogen Update: Lithium. Teratology 1988; 38: 597.CrossRefGoogle Scholar
Zalzsrein, E, Koren, G, Einarson, T, Freedom, RM.A ease control study on the association between first trimester exposure to lithium and Ebstein's anomaly. Am J Cardiol 1990; 65: 817818.CrossRefGoogle Scholar
Cunniff, CM, Sahn, DJ, Reed, KL, Chambers, CC, Johnson, KA, Jones, KL.Pregnancyourcome in women treated with Lithium. Teratology 1989; 39: 447448.Google Scholar
Warkany, J.Prevention of congenital malformations. Contr Epidem Biostatist 1979; 1: 190197.Google Scholar
Simpson, JL, Mills, JL, Morey, A, Metzger, BE, Knopp, RH, Holmes, LB, Jovanovic-Peterson, L, Aarons, JH, Brown, Z, Van Allen, M, Elias, S, NICHHD Diabetes in Early Pregnancy Study Group. Drug ingestion during pregnancy: infrequent exposure in a contemporary US sample. Am J Perinatology 1989; 6: 244251.CrossRefGoogle Scholar
Bracken, MB: Drug use in pregnancy and congenital heart disease in offspring. N Engl J Med 1986; 314: 1120. [Letter to the Editor]Google ScholarPubMed
Zierler, S, Rothman, KJ: Congenital heart disease in relation to maternal use of Bendectin and other drugs in early pregnancy. N Engl J Med 1985; 313: 347352.CrossRefGoogle ScholarPubMed
Heinonen, OP, Slone, D, Shapiro, S (eds). Birth Defects and Drugs in Pregnancy. PSG Publishing, Littleton, 1977, pp 293, 342, 361.Google Scholar
Johnson, SF, McCarter, RJ, Ferencz, C.Changes in alcohol, cigarette, and recreational drug use during pregnancy: Implications for intervention. Am J Epidemiol 1987; 126: 695702.CrossRefGoogle ScholarPubMed
Rosett, HL, Weiner, L (eds). Alcohol and the Fetus: A Clinical Perspective. Oxford University Press, New York, 1984, p. 68.Google Scholar
Manasek, FJ, Nakamura, A. Forces and deformations: Their origins and regulation in early development. In: Ferrans, , Rosenquist, , Weinstein, (eds). Cardiac Morphogenesis. Elsevier Science PubI Co., New York, 1985, pp 126133.Google Scholar
Hoyme, HE, Jones, KL, Dixon, SD, Jewert, T, Hanson, JW, Robinson, LK, Msall, ME, Allanson, JE.Prenatal cocaine exposure and fetal vascular disruption. Pediatrics 1990; 85: 743747.CrossRefGoogle ScholarPubMed
Kucera, K.Exposure to fat solvents: a possible cause of sacral agenesis in man. J Pediatr 1960;7 2: 857859.Google Scholar
Meirik, O, Källén, B, Gauffin, U, Ericson, A.Major malformations in infants born to women who worked in laboratories while pregnant. Lancer 1979; 2: 9197.CrossRefGoogle ScholarPubMed
Hansson, E, Jansa, S, Wande, H, Källén, B, Ostiund, E.Pregnancy outcome for women working in laboratories in some of the pharmaceutical industries in Sweden. Scand J Work Environ Health 1980; 6: 131134.CrossRefGoogle ScholarPubMed
Holmberg, PC, Nurminen, M.Congenital defects of the central nervous systems and occupational factors during pregnancy. A case-reference study. Am J Indus Med 1980; 1: 167176.CrossRefGoogle Scholar
Blomqvist, O, Ericson, A, Källén, B, Westerholm, P.Delivery of outcome for women working in the pulp and paper industry. Scand J Work Environ Health 1981; 7: 114118.CrossRefGoogle ScholarPubMed
Holmberg, PCHernberg, S, Kurppa, K, Rantala, K, Riala, R.Oral clefts and organic solvent exposure during pregnancy. Int Arch Occup Environ Health 1982; 50: 371376.CrossRefGoogle ScholarPubMed
Tikkanen, J, Heinonen, OP.Cardiovascular malformations and organic solvent exposure during pregnancy in Finland. Am J Indus Med 1988; 14: 18.CrossRefGoogle ScholarPubMed
Correa-Villaseñor, A, Loffredo, C, Ferencz, C, Wilson, PD.Heterogeneity of etiology and exposure, non-differential misclassification and bias in the study of birth defects. Am J Epidemiol 1990; 132: 796. [Abstract]Google Scholar
Shaw, GM, Swan, SH, Harris, JA, Malcoe, LH.Maternal water consumption during pregnancy and congenital cardiac anomalies. Epidemiol 1990; 1: 206211.CrossRefGoogle ScholarPubMed
Correa-Villaseñor, A, Loffredo, C, Ferencz, C, Wilson, PD.Lead and solvent exposure during pregnancy: possible risk of cardiovascular malformations. Teratology 1990; 41: 545. [Abstract]Google Scholar
Oller, WL, Cairns, T, Bowman, MC, Fishbein, L.A toxicological risk assessment procedure—a proposal for a surveillance index for hazardous chemicals. Arch Environ Contam Toxicol 1980; 9: 483490.CrossRefGoogle ScholarPubMed
Kurzel, RB, Cetrulo, CL.The effect of environmental pollutants on human reproduction, including birth defects. Environ Sci Technol 1981; 15: 626639.CrossRefGoogle ScholarPubMed
McDonald, AD, Mcdonald, JC, Armstrong, B, Cherry, NM, Cote, R, Lavoie, J, Noun, AD, Robert, D.Congenital defects and work in pregnancy. Br J Indus Med 1988; 45: 581588.Google ScholarPubMed
Restrepo, M, Muñoz, N, Day, NE, Parra, JE, de Romero, L, Nguyen-Dinh, X.Prevalence of adverse reproductive outcomes in a population occupationally exposed to pesticides in Colombia. Scand J Work Environ Health 1990; 16: 232238.CrossRefGoogle Scholar
Restrepo, M, Muñoz, N, Day, NE, Parra, JE, Hernández, C, Blertner, M, Giraldo, A.Birth defects amang children born to a population occupationally exposed to pesticides in Colombia. Scand J Work Environ Health 1990; 16: 239246.CrossRefGoogle Scholar
Adams, MM, Mulinare, J, Dooley, K.Risk factors for conotruncal cardiac defects in Atlanta. J Am Coll Cardiol 1989; 14: 432442.CrossRefGoogle ScholarPubMed
Dogramaci, I, Green, H.Factors in the etiology of congenital heart disease. J Pediatr 1947; 30: 295301.CrossRefGoogle Scholar
Zierler, S, Theodore, M, Cohen, A, Rothman, KJ.Chemical quality of maternal drinking water and congenital heart disease. Int J Epidemiol 1988; 17: 589594.CrossRefGoogle ScholarPubMed
Nora, JJ. Etiologic aspects of heart disease. In: Adams, FH, Emmanoulides, GC (eds). Moss' Heart Disease in Infants, Children and Adolescents. Williams & Wilkins, Baltimore, 1983, pp 210.Google Scholar
Whittemore, R, Wells, JA, Castellsague-Pique, , Holabird, N.Cardiovascular disease in the young: epidemiology and preventive cardiology. Circulation 1989; 80(Suppl IIyes): II 82. [Abstract]Google Scholar
Burn, J. The aetiology ofcongenital heart disease. In: Anderson, RH, Macartney, FJ, Shinebourne, EA, Tynan, M (eds). Paediatric Cardiology Vol 1. Churchill Livingstone, Edinburgh, 1987, pp 1563.Google Scholar
Burn, J.Genetic advances in paediatric cardiology. Current Opinion Cardiol 1988; 3: 4349.CrossRefGoogle Scholar
Pyeritz, RE, Murphy, EA.Genetics and congenital heart disease: perspectives and prospects. Am Coll Cardiol 1989; 13: 14581468.CrossRefGoogle ScholarPubMed
Berg, KA, Astemborski, JA, Boughman, JA, Ferencz, C.Congenital cardiovascular malformations in twins and triplets from a populationbased study. Am J Dis Child 1989; 143: 14611463.Google Scholar
Berg, KA, Clark, EB, Astemborski, JA, Boughman, JA.Prenatal detection of cardiovascular malformations by echocardiography: an indication for cytogenetic evaluation. Am J Obstet Gynecol 1988; 159: 477481.CrossRefGoogle ScholarPubMed
Maestri, NE, Boughman, JA.Demographic and epidemiologi cal perspective on genetic disorders. MMJ 1989; 38: 911915.Google Scholar
Roskes, EJ, Boughman, JA, Schwartz, S, Cohen, MM.Congenital cardiovascular malformations (CCVM) and structural chromosome abnormalities: a report of 9 cases and literature review. Clin Genet 1990; 38: 198210.CrossRefGoogle ScholarPubMed
Lilienfeld, AM.Foundations of Epidemiology. Oxford University Press, New York, 1976, pp 3234.Google Scholar
Tuchmann-Duplessis, H.The teratogenic risk. Am J Indus Med 1983; 4: 245258.CrossRefGoogle ScholarPubMed
Grant, RP.The embryology of the ventricular flow pathways in man. Circulation 1962; 25: 756779.CrossRefGoogle ScholarPubMed
Clark, EB. Growth, morphogenesis, and function: The dy namics ofcardiac development. In: Moller, JH, Neal, WA (eds). Fetal, Neonatal, and Infant Cardiac Disease. Appleton & Lange, Norwalk, Connecticut 1990, pp 323.Google Scholar
Pexieder, T, Pfizenmaier Rousseil, M, Prados Frutos, JC.Spectrum of cardiac and extracardiac anomalies induced by retinoic acid in rats. Teratology 1990; 41: 584585. [Abstract]Google Scholar
Ferencz, C. A case-control study of cardiovascular malformations in liveborn infants: the morphogenetic relevance of epidemiologic findings. In: Clark, EB, Takao, A (eds). Developmental Cardiology: Morphogenesis and Function. Futura Publishing, Mt. Kisco, New York, 1990, pp 523539.Google Scholar
Pexieder, T.A common target for chemical and biophysical teratogens in cardiac malformations. Exc Med Tnt Congr Ser 1973; 297: 50.Google Scholar
Taussig, HB:Congenital Malformations of the Heart, Vol. 1: General Considerations. Harvard University Press, Cambridge, 1960, pp 1216.Google Scholar
Neill, CA.Etiology of cardiovascular heart disease. Cardiovascular Clinics 1973; 4: 138147.Google Scholar