Spatial Distribution and Birth Prevalence of Congenital Heart Disease in Iran: A Systematic Review and Hierarchical Bayesian Meta-analysis

Document Type : Review Article


1 Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran

2 School of Public Health, University of Queensland, Brisbane, Queensland, Australia

3 Department of Clinical Biochemistry, Kermanshah University of Medical Sciences, Kermanshah, Iran

4 Department of Statistics, Razi University, Kermanshah, Iran

5 Department of Statistics, Ludwig-Maximilians-University, Munich, Germany


This study aimed to comprehensively analyze the overall congenital heart disease (CHD) prevalence in live births and children in Iran, along with evaluating the spatial distribution of CHD birth prevalence across various geographical regions within the country.
A Bayesian hierarchical meta-analysis (PROSPERO 2022: CRD42022331281) was performed to determine the pooled prevalence. A systematic search was conducted using Web of Science, ScienceDirect, PubMed, Iranian Research Institute for Information Science and Technology (IranDoc), Scientific Information Database (SID), and Magiran until October 4, 2023. Cross-sectional and cohort studies in both English and Persian languages, focusing on the age range of 0-10 years, were considered for the study population. The study quality was evaluated using the Agency for Healthcare Research and Quality (AHRQ) Risk of Bias tool. Heterogeneity was assessed by I2 and τ2 statistics, and publication bias by Egger’s and Begg’s tests.
The meta-analysis included 62 studies, revealing an overall CHD prevalence of 2.5 per 1000 births. Over time, CHD birth prevalence in Iran has consistently increased. Spatial distribution analysis, including spatial autocorrelation and local spatial autocorrelation, indicated no spatial clustering (P = .46) or aggregation (P = .65) among Iran’s provinces. Geographic disparities were significant (P = .000), with the northern and eastern regions showing the highest and lowest CHD prevalence, respectively.
The overall CHD prevalence in Iran is lower than global rates, but it continues to rise. Furthermore, there are variations in birth prevalence among different regions of Iran. Environmental, genetic, socioeconomic, and diagnostic accessibility differences are possibly involved in regional variation. The limitations like heterogeneity among studies, the potential inaccuracy of reports due to limited use of accurate diagnostic methods in some studies, and the absence of population-based models to investigate prevalence, underscore the urgent need for standardized diagnostic approaches, and the utilization of population-wide birth defect registries to accurately assess CHD prevalence in Iran.


  1. van der Linde D, Konings EE, Slager MA, et al. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol. 2011;58(21):2241-2247. doi:1016/j.jacc.2011.08.025
  2. Mitchell SC, Korones SB, Berendes HW. Congenital heart disease in 56,109 births. Incidence and natural history. Circulation. 1971;43(3):323-332. doi:1161/01.cir.43.3.323
  3. Fahed AC, Gelb BD, Seidman JG, Seidman CE. Genetics of congenital heart disease: the glass half empty. Circ Res. 2013;112(4):707-720. doi:1161/circresaha.112.300853
  4. Brickner ME, Hillis LD, Lange RA. Congenital heart disease in adults. Second of two parts. N Engl J Med. 2000;342(5):334-342. doi:1056/nejm200002033420507
  5. Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol. 2002;39(12):1890-1900. doi:1016/s0735-1097(02)01886-7
  6. Miranović V. The incidence of congenital heart defects in the world regarding the severity of the defect. Vojnosanit Pregl. 2016;73(2):159-164. doi:2298/vsp140917033m
  7. Liu Y, Chen S, Zühlke L, et al. Global birth prevalence of congenital heart defects 1970-2017: updated systematic review and meta-analysis of 260 studies. Int J Epidemiol. 2019;48(2):455-463. doi:1093/ije/dyz009
  8. Mason CA, Kirby RS, Sever LE, Langlois PH. Prevalence is the preferred measure of frequency of birth defects. Birth Defects Res A Clin Mol Teratol. 2005;73(10):690-692. doi:1002/bdra.20211
  9. Wu W, He J, Shao X. Incidence and mortality trend of congenital heart disease at the global, regional, and national level, 1990-2017. Medicine (Baltimore). 2020;99(23):e20593. doi:1097/md.0000000000020593
  10. Shahmohammadi F, Ahmadi MA. Statistical investigation of the gross congenital anomalies in alive newborns in Taleghani hospital–Arak. J Arak Uni Med Sci. 1997;1(4):23-29. [Persian].
  11. Daliri S, Sayehmiri K, Asadollahi K, Rezaei N, Saroukhani D, Karimi A. Prevalence of congenital anomalies in Iran: a systematic review and meta-analysis. Iran J Neonatol. 2018;9(2):21-32. doi:22038/ijn.2018.24791.1319
  12. Irani M, Khadivzadeh T, Asghari Nekah SM, Ebrahimipour H, Tara F. The prevalence of congenital anomalies in Iran: a systematic review and meta-analysis. Iran J Obstet Gynecol Infertil. 2018;21(Suppl):29-41. doi:22038/ijogi.2018.11619
  13. Vatankhah S, Jalilvand M, Sarkhosh S, Azarmi M, Mohseni M. Prevalence of congenital anomalies in Iran: a review article. Iran J Public Health. 2017;46(6):733-743.
  14. Zahed Pasha Y, Vahedi A, Zamani M, Alizadeh-Navaei R, Zahed Pasha E. Prevalence of birth defects in Iran: a systematic review and meta-analysis. Arch Iran Med. 2017;20(6):376-385.
  15. Siabani H, Siabani S, Gholizadeh L. Epidemiology of congenital heart defects in Iran: a systematic review. Online J Cardiol Res Rep. 2019;2(3):1-5. doi:33552/ojcrr.2019.02.000537
  16. Bagheri MM, Torabi-Nezhad MH, Jamali Z, Baneshi MR. Prevalence and etiology of heart murmurs in 2-24-months-old infants Kerman, Iran. J Kerman Univ Med Sci. 2014;21(4):114-122. [Persian].
  17. Sarri G, Patorno E, Yuan H, et al. Framework for the synthesis of non-randomised studies and randomised controlled trials: a guidance on conducting a systematic review and meta-analysis for healthcare decision making. BMJ Evid Based Med. 2022;27(2):109-119. doi:1136/bmjebm-2020-111493
  18. Xu J, Ji Z, Zhang P, Chen T, Xie Y, Li J. Disease burden of COPD in the Chinese population: a systematic review. Ther Adv Respir Dis. 2023;17:17534666231218899. doi:1177/17534666231218899
  19. Zeng X, Zhang Y, Kwong JS, et al. The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline: a systematic review. J Evid Based Med. 2015;8(1):2-10. doi:1111/jebm.12141
  20. Rostom A, Dubé, Cranney A, et al. 104 Celiac disease: summary. In: AHRQ Evidence Report Summaries. Rockville, MD: Agency for Healthcare Research and Quality (US); 2004.
  21. Mamikutty R, Aly AS, Marhazlinda J. Selecting risk of bias tools for observational studies for a systematic review of anthropometric measurements and dental caries among children. Int J Environ Res Public Health. 2021;18(16):8623. doi:3390/ijerph18168623
  22. Ma LL, Wang YY, Yang ZH, Huang D, Weng H, Zeng XT. Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: what are they and which is better? Mil Med Res. 2020;7(1):7. doi:1186/s40779-020-00238-8
  23. Martel M, Negrín MA, Vázquez-Polo FJ. Bayesian heterogeneity in a meta-analysis with two studies and binary data. J Appl Stat. 2023;50(13):2760-2776. doi:1080/02664763.2022.2084719
  24. Spiegelhalter DJ, Abrams KR, Myles JP. Bayesian Approaches to Clinical Trials and Health-Care Evaluation. Vol 13. John Wiley & Sons; 2004.
  25. Harrer M, Cuijpers P, Furukawa TA, Ebert DD. Doing Meta-Analysis with R: A Hands-On Guide. 1st ed. Boca Raton, FL: Chapman & Hall, CRC Press; 2021. doi:1201/9781003107347
  26. Huedo-Medina TB, Sánchez-Meca J, Marín-Martínez F, Botella J. Assessing heterogeneity in meta-analysis: Q statistic or I2 index? Psychol Methods. 2006;11(2):193-206. doi:1037/1082-989x.11.2.193
  27. Mostafaei S, Keshavarz M, Sadri Nahand J, et al. Viral infections and risk of thyroid cancer: a systematic review and empirical Bayesian meta-analysis. Pathol Res Pract. 2020;216(4):152855. doi:1016/j.prp.2020.152855
  28. Gelman A, Carlin JB, Stern HS, Rubin DB. Bayesian Data Analysis. Chapman & Hall, CRC Press; 1995.
  29. Ejigu BA, Wencheko E, Berhane K. Spatial pattern and determinants of anaemia in Ethiopia. PLoS One. 2018;13(5):e0197171. doi:1371/journal.pone.0197171
  30. Ma J, Gao X, Liu B, Chen H, Xiao J, Wang H. Epidemiology and spatial distribution of bluetongue virus in Xinjiang, China. PeerJ. 2019;7:e6514. doi:7717/peerj.6514
  31. Salima BA, Bellefon MD. Spatial autocorrelation indices. In: Handbook of Spatial Analysis: Theory Aplication with R. European Statistical System (ESS); 2018:51-68.
  32. Zhao L, Chen L, Yang T, et al. Birth prevalence of congenital heart disease in China, 1980-2019: a systematic review and meta-analysis of 617 studies. Eur J Epidemiol. 2020;35(7):631-642. doi:1007/s10654-020-00653-0
  33. Albert J, Hu J. Probability and Bayesian Modeling. CRC Press; 2019.
  34. Röver C. Bayesian random-effects meta-analysis using the bayesmeta R package. ArXiv [Preprint]. November 23, 2017. Available from:
  35. Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Softw. 2010;36(3):1-48. doi:18637/jss.v036.i03
  36. Zamani A, Amini E, Kaveh M, Aminzadeh V. Prevalence of congenital malformations in neonate born in Imam Khomeini and Shariati hospitals. Sci J Forensic Med. 2000;6(20):19-25. [Persian].
  37. Akbari M, Sobhani A, Ragerdi Kashani I, Amini E, Rezai Z, Shajari H. Incidence of observable congenital abnormalities among births: Mirza Kochak-Khan, Imam Khomeini and Shariati hospitals (November 2000 to September 2001). Tehran Univ Med J. 2003;61(3):212-216. [Persian].
  38. Shajari H, Mohammadi N, Karbalai Aghai M. Prevalence of congenital malformations observed in neonates in Shariati hospital (1381-1383). Iran J Pediatr. 2006;16(3):308-312. [Persian].
  39. Mirzarahimi M, Saadati H, Doustkami H, Alipoor R, Isazadehfar K, Enteshari A. Heart murmur in neonates: how often is it caused by congenital heart disease? Iran J Pediatr. 2011;21(1):103-106.
  40. Alijahan R, Mirzarahimi M, Ahmadi Hadi P, Hazrati S. Prevalence of congenital abnormalities and its related risk factors in Ardabil, Iran, 2011. Iran J Obstet Gynecol Infertil. 2013;16(54):16-25. doi:22038/ijogi.2013.1086
  41. Pouladfar G, Mallahzadeh A. The prevalence of minor congenital anomalies and normal variations in neonates in Bushehr port. Iran South Med J. 2005;8(1):43-52. [Persian].
  42. Sereshti M, Kazemian A, Banaeian S. Prevalence of apparent major congenital malformations and some associated factors, in terminated pregnancies in Hajar hospital of Shahrekord, 2005-2006, Iran. J Shahrekord Univ Med Sci. 2008;10(1):36-43. [Persian].
  43. Dastgiri S, Imani S, Kalankesh L, Barzegar M, Heidarzadeh M. Congenital anomalies in Iran: a cross-sectional study on 1574 cases in the north-west of country. Child Care Health Dev. 2007;33(3):257-261. doi:1111/j.1365-2214.2006.00720.x
  44. Dastgiri S, Taghizadeh M, Heidarzadeh M. Early diagnosis and screening of congenital cardiac anomalies. Cardiol Young. 2011;21(2):194-196. doi:1017/s1047951110001757
  45. Samadirad B, Khamnian Z, Hosseini MB, Dastgiri S. Congenital anomalies and termination of pregnancy in Iran. J Pregnancy. 2012;2012:574513. doi:1155/2012/574513
  46. Mashhadi Abdolahi H, Kargar Maher MH, Afsharnia F, Dastgiri S. Prevalence of congenital anomalies: a community-based study in the northwest of Iran. ISRN Pediatr. 2014;2014:920940. doi:1155/2014/920940
  47. Rostamizadeh L, Bahavarnia SR, Gholami R. Alteration in incidence and pattern of congenital anomalies among newborns during one decade in Azarshahr, northwest of Iran. Int J Epidemiol Res. 2017;4(1):37-43.
  48. Stone DH, Dastgiri S, Heidarzadeh M, Mashhadi Abdolahi H, Imani S, Kargar Maher MH. Uses, limitations, and validity of a registry of congenital anomalies in Iran: a critical review. J Environ Public Health. 2017;2017:6972617. doi:1155/2017/6972617
  49. Molapour H, Dastgiri S, Davtalab Esmaeili E. Prevalence and time trend of congenital heart defects: a registry-based study in Iran. medRxiv [Preprint]. December 17, 2021. Available from:
  50. Tarighat F, Golshan E, Dastgiri S. Prevalence of congenital anomalies in the northwest of Iran. Depiction of Health. 2021;12(4):417-425. [Persian].
  51. Vafaei H, Rafeei K, Dalili M, Asadi N, Seirfar N, Akbarzadeh-Jahromi M. Prevalence of single umbilical artery, clinical outcomes and its risk factors: a cross-sectional study. Int J Reprod Biomed. 2021;19(5):441-448. doi:18502/ijrm.v19i5.9253
  52. Jalali SZ, Fakhraie SH, Afjaei SA, Kazemian M. The incidence of obvious congenital abnormalities among the neonates born in Rasht hospitals in 2011. J Kermanshah Univ Med Sci. 2015;19(2):e70711. doi:22110/jkums.v19i2.2179
  53. Golalipour MJ, Ahmadpour-Kacho M, Vakili MA. Congenital malformations at a referral hospital in Gorgan, Islamic Republic of Iran. East Mediterr Health J. 2005;11(4):707-715.
  54. Nikyar B, Sedehi M, Mirfazeli A, Qorbani M, Golalipour MJ. Prevalence and pattern of congenital heart disease among neonates in Gorgan, northern Iran (2007-2008). Iran J Pediatr. 2011;21(3):307-312.
  55. Golalipour MJ, Mirfazeli A, Mobasheri E. Incidence and pattern of congenital malformations in Gorgan-north of Iran. J Med Sci. 2013;13(8):834-838. doi:3923/jms.2013.834.838
  56. Nikyar B, Sedehi M, Qorbani M, Nikyar A, Golalipour MJ. Ethnical variations in the incidence of congenital heart defects in Gorgan, northern Iran: a single-center study. J Tehran Heart Cent. 2014;9(1):9-14.
  57. Mirfazeli A, Kaviany N, Hosseinpoor K, Aryaie M, Golalipour MJ. Birth defects in northern Iran (2008-2013). Iran J Public Health. 2018;47(3):413-417.
  58. Nazemi Gheshmi A, Nikuei P, Khezri M, et al. The frequency of congenital anomalies in newborns in two maternity hospitals in Bandar Abbas: 2007-2008. Genetics in the Third Millennium. 2012;9(4):2554-9. [Persian].
  59. Sayehmiri K, Kaffashian MR, Ranaei E. Investigating the prevalence of congenital anomalies and its associated factors in Ilam city. J Basic Res Med Sci. 2016;3(2):41-45.
  60. Movahedian AH, Noorbakhsh SE, Mosaiebi Z, Mazoochi T, Moosavi SG. Prevalence of congenital heart disorders in neonates hospitalized in Shahid Beheshti hospital during the years 1996-2000. Feyz. 2001;5(2):76-80. [Persian].
  61. Mosayebi Z, Movahedian AH. Pattern of congenital malformations in consanguineous versus nonconsanguineous marriages in Kashan, Islamic Republic of Iran. East Mediterr Health J. 2007;13(4):868-875.
  62. Movahedian AH, Heidarzadeh M, Mosayebi Z, Soleimani Z, Sayyah M, Kadkhodaii J. Congenital heart disease: frequency and the need for intervention on the first year of birth. J Res Med Dent Sci. 2017;5(1):33-36.
  63. Davari HA, Javanmardi Z, Hooshangi Z, Moazem E. Major congenital anomalies and associated risk factors in Isfahan province, Iran, 2014-2015. J Isfahan Med Sch. 2019;37(513):9-15. doi:22122/jims.v37i513.10714
  64. Saberi M, Hosseinpour M, Khaleghnejad Tabari A, Soori H, Maracy M. Evaluation of incidence and main risk factors of major congenital anomalies in hospitals affiliated with Isfahan University of Medical Sciences during 1395. Iran J Epidemiol. 2020;16(1):48-56. [Persian].
  65. Masoodpoor N, Arab-Baniasad F, Jafari A. Prevalence and pattern of congenital malformations in newborn in Rafsanjan, Iran (2007-2008). J Gorgan Univ Med Sci. 2013;15(3):114-117. [Persian].
  66. Parandavar A. Investigating the Number of Congenital Anomalies in Babies Born at Imam Khomeini Hospital in Islamabad Gharb City from 2017-2022. Kermanshah: Faculty of Agricultural Payam Noor University; 2023.
  67. Ghahramani M, Moshki M, Ebadi A. A survey of causes and prevalence of congenital anomalies in live born neonates in Gonabad 22 Bahman hospital (1373-1380). Intern Med Today. 2002;8(1):1-6. [Persian].
  68. Khatami F, Mamuri GA. Survey of congenital major malformation in 10,000 newborns. Iran J Pediatr. 2005;15(4):315-320. [Persian].
  69. Ahmadzadeh A, Safikhani Z, Abdulahi M, Ahmadzadeh A. Congenital malformations among live births at Arvand hospital, Ahwaz, Iran-a prospective study. Pak J Med Sci. 2008;24(1):33-37.
  70. Rahim F, Ebadi A, Saki G, Ramezani A. Prevalence of congenital heart disease in Iran: a clinical study. J Med Sci. 2008;8(6):547-552. doi:3923/jms.2008.547.552
  71. Khoshhal-Rahdar F, Saadati H, Mohammadian M, Hafar-Rangchi M, Mohazzab-Torabi S, Khabazkhoob M. The prevalence of congenital malformations in Dezful-2012. Genetics in the Third Millennium. 2014;12(3):3622-3631. [Persian].
  72. Mohsenzadeh A, Saket S, Ahmadipour S, Baharvand B. Prevalence and types of congenital heart disease in babies born in the city of Khorramabad (2007-2011). Yafteh. 2014;15(5):23-29. [Persian].
  73. Mohammadzadeh I, Sorkhi H, Alizadeh-Navaei R. Prevalence of external congenital malformations in neonates born in Mehregan hospital, north of Iran. Iran J Neonatol. 2013;11(1):2990-2995.
  74. Movafagh A, Pear Zadeh Z, Hajiseyed Javadi M, et al. Occurrence of congenital anomalies and genetic diseases in a population of Ghazvin province, Iran: a study of 33380 cases. Pak J Med Sci. 2008;24(1):80-85.
  75. Farhud DD, Walizadeh GR, Kamali MS. Congenital malformations and genetic diseases in Iranian infants. Hum Genet. 1986;74(4):382-385. doi:1007/bf00280490
  76. Vakilian K, Hajian S, Sadeghian A. Frequency of congenital structural anomalies in newborns of Shahroud, Iran. Zahedan J Res Med Sci. 2013;15(9):e92887.
  77. Hosseini S, Nikravesh A, Hashemi Z, Rakhshi N. Race of apparent abnormalities in neonates born in Amir-Almomenin hospital of Sistan. J North Khorasan Uni Med Sci. 2014;6(3):573-579. doi:29252/jnkums.6.3.573
  78. Asemi-Rad A, Heidari Z, Mahmoudzadeh-Sagheb H, et al. Prevalence of congenital anomalies and related factors in live births in Zahedan, southeast of Iran: a cross-sectional study. Int J Reprod Biomed. 2023;21(8):647-656. doi:18502/ijrm.v21i8.14020
  79. Rahnama F, Hashemian M, Akbarzadeh R, Akabari A. The incidence of apparent congenital anomalies in neonates in Mobini Maternity Hospital in Sabzevar Iran in 2005-6. J Sabzevar Univ Med Sci. 2009;15(4):231-236. [Persian].
  80. Amini Nasab Z, Aminshokravi F, Moodi M, Eghbali B, Fatemimogadam F. Demographical condition of neonates with congenital abnormalities under Birjand city health centers during 2007-2012. J Birjand Univ Med Sci. 2014;21(1):96-103. [Persian].
  81. Bordbar A, Kashaki M, Vafapour M, Sepehri A. Determining the incidence of heart malformations in neonates: a novel and clinically approved solution. Front Pediatr. 2023;11:1058947. doi:3389/fped.2023.1058947
  82. Tootoonchi P. Easily identifiable congenital anomalies: prevalence and risk factors. Acta Med Iran. 2003;41(1):15-19.
  83. Hematyar M, Khajouie P. Prevalence of congenital anomalies in 1000 live births in Javaheri hospital, Tehran, 2004. Medical Sciences Journal of Islamic Azad University. 2005;15(2):75-78. [Persian].
  84. Delshad S, Khalegnejad Tabar A, Samae H, et al. The incidence of selected congenital malformations during a two-year period in Tehran, Iran. Trop Doct. 2009;39(3):156-158. doi:1258/td.2008.070434
  85. Farhangniya M, Dortaj Rabori E, Mozafari Kermani R, et al. Comparison of congenital abnormalities of infants conceived by assisted reproductive techniques versus infants with natural conception in Tehran. Int J Fertil Steril. 2013;7(3):217-224.
  86. Abdi-Rad I, Khoshkalam M, Farrokh-Islamlou HR. The prevalence at birth of overt congenital anomalies in Urmia, northwestern Iran. Arch Iran Med. 2008;11(2):148-151.
  87. Akhavan Karbasi S, Golestan M, Fallah R, Mirnaseri F, Barkhordari K, Sadr Bafghi M. Prevalence of congenital malformations in Yazd (Iran). Acta Med Iran. 2009;47(2):149-153.
  88. Tayebi N, Yazdani K, Naghshin N. The prevalence of congenital malformations and its correlation with consanguineous marriages. Oman Med J. 2010;25(1):37-40. doi:5001/omj.2010.9
  89. Taheri M, Dehghani A, Noorishadkam M, Tabatabaei SM. Population attributable danger of hereditary heart breaks. Risk factors among newborns in Yazd, Iran. J Med Life. 2015;8(Spec Iss 3):212-217.
  90. Rafati S. Examining the Frequency and Types of Congenital Anomalies of Newborns Born in Hospitals in Yazd Province During the Years 2016-2022. Tehran: Faculty of Medicine, Shahed University; 2023.
  91. Safaei Nezhad A, Mahmoudi M, Kharaghani R. The prevalence of birth defects and related factors in Zanjan city (northwest, Iran) during 2015-2016. J Adv Med Biomed Res. 2018;26(118):48-53. doi:30699/jambs.26.118.48
  92. Radvar M, Zolfi A, Fakour Z, Farhadi E. Epidemiology of clinical findings and outcome in neonates with congenital heart disease. Health Sci Monit. 2022;1(2):74-80. doi:52547/hsm.1.2.74
  93. Amiri Simkouii F, Jamshidi M, Behjati Ardakani M, Toosi F, Alipour MR, Namayandeh SM. Comparative study of pulse oximetry, physical examination and echocardiography results in the diagnosis of congenital heart defects in neonates in the first 24 hours of life. J Shahid Sadoughi Univ Med Sci. 2021;29(5):3765-3774. doi:18502/ssu.v29i5.6776
  94. Reller MD, Strickland MJ, Riehle-Colarusso T, Mahle WT, Correa A. Prevalence of congenital heart defects in metropolitan Atlanta, 1998-2005. J Pediatr. 2008;153(6):807-813. doi:1016/j.jpeds.2008.05.059
  95. Jullien S. Newborn pulse oximetry screening for critical congenital heart defects. BMC Pediatr. 2021;21(Suppl 1):305. doi:1186/s12887-021-02520-7
  96. Mocumbi AO, Lameira E, Yaksh A, Paul L, Ferreira MB, Sidi D. Challenges on the management of congenital heart disease in developing countries. Int J Cardiol. 2011;148(3):285-288. doi:1016/j.ijcard.2009.11.006
  97. Li JJ, Liu Y, Xie SY, et al. Newborn screening for congenital heart disease using echocardiography and follow-up at high altitude in China. Int J Cardiol. 2019;274:106-112. doi:1016/j.ijcard.2018.08.102
  98. Sokal R, Tata LJ, Fleming KM. Sex prevalence of major congenital anomalies in the United Kingdom: a national population-based study and international comparison meta-analysis. Birth Defects Res A Clin Mol Teratol. 2014;100(2):79-91. doi:1002/bdra.23218
  99. Jenkins KJ, Correa A, Feinstein JA, et al. Noninherited risk factors and congenital cardiovascular defects: current knowledge: a scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young: endorsed by the American Academy of Pediatrics. Circulation. 2007;115(23):2995-3014. doi:1161/circulationaha.106.183216
  100. Edler I, Lindström K. The history of echocardiography. Ultrasound Med Biol. 2004;30(12):1565-1644. doi:1016/s0301-5629(99)00056-3
  101. Lunn D, Barrett J, Sweeting M, Thompson S. Fully Bayesian hierarchical modelling in two stages, with application to meta-analysis. J R Stat Soc Ser C Appl Stat. 2013;62(4):551-572. doi:1111/rssc.12007
  102. Tikkanen J, Heinonen OP. Risk factors for cardiovascular malformations in Finland. Eur J Epidemiol. 1990;6(4):348-356. doi:1007/bf00151707

Articles in Press, Corrected Proof
Available Online from 07 April 2024
  • Receive Date: 09 January 2023
  • Revise Date: 04 February 2024
  • Accept Date: 06 April 2024
  • First Publish Date: 07 April 2024