Down syndrome (DS) is the most common chromosomal abnormality, affecting 1 in 700 infants born yearly in the United States.1 The birth prevalence of DS varies internationally among populations, likely due to variations in maternal age, race/ethnicity, use of prenatal screening, and terminations of affected pregnancies.2,3 Approximately half of all infants born with DS also have a congenital heart defect (CHD), the most common type being atrioventricular septal defect (AVSD), with rates from 30% to 60%.4 In the era of increasing maternal age and pregnancy terminations,2 it is interesting to investigate if and how the pattern of associated CHDs among infants with DS has changed.

In this issue of Pediatrics, Bergstrom et al5 describe the pattern of CHDs among Swedish liveborn infants with DS from 1992 to 2012. In this nationwide, population-based cohort, over half had a CHD; the 3 most common...

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