Introduction: Exposure to teratogens such as alcohol, drugs, tobacco, etc. before or during pregnancy is a well-established risk factor for adverse birth outcomes, including low birth weight, preterm birth, and congenital heart disease (CHD). While maternal exposure has been extensively studied, the impact of paternal addictions on CHD risk in offspring remains underexplored, despite their potential effects on sperm quality and maternal health. This study investigates the role of paternal teratogen exposure in CHD development, with a focus on its correlation with socio-demographic and socio-economic factors.

Methods: A retrospective case–control study was conducted on children screened for CHD during 2022-2024. Data were analyzed using SPSS and MS Excel, employing ꭓ2 test, Fisher’s exact test, and multivariate logistic regression.

Results: Of the 8798 children screened, 7626 (86.7 %) were diagnosed with CHD, and 1172 were controls. Paternal addictions included alcohol (10.9 %), chewable tobacco (18.1 %), and pan-masala/supari (4.9 %). Alcohol consumption, prevalent in northeast India (p = 0.055; OR = 3.92) and among nuclear families (p < 0.001; OR = 1.76) in urban areas (p < 0.001; OR = 1.54), was linked to a reduced risk of total anomalous pulmonary venous connection [p = 0.03; OR (95 % CI) = 0.55 (0.32-0.94)]. Tobacco and pan-masala consumption was associated with nearly double the risk of cyanotic CHD (p < 0.001) and complex CHD manifestations (p < 0.05), particularly in families from eastern and central India (p < 0.05) with low socio-economic status (p = 0.04; OR = 19.43), and contributed to low birth weight (p = 0.003; OR = 1.25).

Conclusion: Our study highlights the significant role of paternal addiction in CHD prognosis, revealing critical socio-economic and regional risk factors. It underscores the need for targeted preventive strategies and further research on paternal teratogen exposure and its impact on offspring health.