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Future investigations should focus on large-scale, multicenter clinical trials, and mechanistic studies to clarify pathways of action and define clinical relevance

These may include the following: Certain medications to help prevent maternal seizures or migraine headaches (for example, topiramate [Topamax]) Certain medications that are used as cancer chemotherapy (including methotrexate [Rheumatrex, Trexall]) Smoking cigarettes (no information yet regarding e-cigarettes) Alcohol consumption Lack of folic acid supplementation before conception and throughout the pregnancy Health News Frequent Marijuana Use Linked to Higher Stress Hormone Levels Nearly 1.6 Million Dozen Eggs Pulled From Shelves Over Salmonella Concerns Back Pain

There is a left-to-right shunt at the atrial level due to increased relative right ventricular compliance leading to right atrial enlargement