Background
Many prenatal factors are reported to be associated with congenital heart defects (CHD) in offspring. However, these associations have not been adequately examined using large‐scale birth cohorts.

Methods and Results
We evaluated a data set of the Japan Environmental and Children's Study. The primary outcome was a diagnosis of CHD by age 2 years. We defined the following variables as exposures: maternal baseline characteristics, fertilization treatment, maternal history of diseases, socioeconomic status, maternal alcohol intake, smoking, tea consumption, maternal dietary intake, and maternal medications and supplements up to 12 weeks of gestation. We used multivariable logistic regression analysis to assess the associations between various exposures and CHD in offspring. A total of 91 664 singletons were included, among which 1264 (1.38%) had CHD. In multivariable analysis, vitamin A supplements (adjusted odds ratio [aOR], 5.78 [95% CI, 2.30–14.51]), maternal use of valproic acid (aOR, 4.86 [95% CI, 1.51–15.64]), maternal use of antihypertensive agents (aOR, 3.80 [95% CI, 1.74–8.29]), maternal age ≥40 years (aOR, 1.59 [95% CI, 1.14–2.20]), and high maternal hemoglobin concentration in the second trimester (aOR, 1.10 per g/dL [95% CI, 1.03–1.17]) were associated with CHD in offspring.

Conclusions
Using a Japanese large‐scale birth cohort study, we found 6 maternal factors to be associated with CHD in offspring.