Impact of Periconceptional Maternal Diet and Supplementation on Malnutrition in Infants with Congenital Heart Disease: A Cross-Sectional Study

Background
Maternal nutrition during the periconceptional period plays a crucial role in fetal cardiogenesis. Infants with congenital heart disease (CHD) face a dual burden of structural disease and malnutrition, which exacerbates morbidity, surgical risk, and survival. The influence of maternal dietary patterns and micronutrient supplementation on postnatal nutritional outcomes in CHD-affected infants remains underexplored.

Objective
To evaluate the association between maternal periconceptional nutrition—specifically dietary patterns, meal frequency, and micronutrient intake—and the prevalence of malnutrition in infants with CHD.

Methods
This cross-sectional study analyzed outpatient data of Indian-origin patients who underwent echocardiographic screening at a tertiary cardiac hospital (2022-2025). Maternal periconceptional dietary intake was retrospectively assessed via a validated in-house questionnaire and restricted to non-syndromic infants from singleton primigravida pregnancies to minimize recall bias. Infant’s postnatal malnutrition was classified using WHO z-scores, and associations were evaluated using SPSS.

Results
Of 17,093 screened patients, 13,972 (81.7%) were diagnosed with CHD, including 6,980 infants. After applying the inclusion criteria, 2,243 mother–infant dyads were analyzed. Malnutrition prevalence was high: 75.2% underweight, 49.6% stunted, and 73.1% wasted. Among mothers, 15.8% reported no micronutrient supplementation. Dietary patterns were 50.9% vegetarian, 44.8% non-vegetarian, 3.9% eggetarian, and 0.2% vegan. Additionally, 8% consumed ≤1 meal/day during pregnancy. The type of food showed no significant association with malnutrition. However, consuming ≥2 meals/day was protective, reducing odds of stunting by 30% (p = 0.024) and wasting by 31% (p = 0.024). Micronutrient supplementation reduced underweight by 29% (p = 0.020) and stunting by 41% (p = 0.020) among CHD infants.

Conclusion
This large cohort study underscores the impact of maternal nutrition—particularly adequate meal frequency and micronutrient supplementation—in reducing postnatal malnutrition among CHD infants, emphasizing the need for targeted nutritional interventions during early pregnancy.