Mortality and morbidity of major congenital heart disease related to general prenatal screening for malformations

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  • Rebekka Lytzen, Copenhagen University Hospital, Copenhagen
  • ,
  • Niels Vejlstrup, Copenhagen University Hospital, Copenhagen
  • ,
  • Jesper Bjerre
  • Olav Bjørn Petersen
  • Stine Leenskjold, Aalborg University
  • ,
  • James Keith Dodd, Hvidovre Universitets Hospital, Hvidovre
  • ,
  • Finn Stener Jørgensen, Hvidovre Universitets Hospital, Hvidovre
  • ,
  • Lars Søndergaard, Department of Cardiology, Copenhagen University Hospital, Copenhagen

Background: Major congenital heart diseases (CHD) often demand intervention in the neonatal period. Prenatal diagnosis may improve mortality by eliminating the diagnostic delay; however, there is controversy concerning its true effect. We aimed to evaluate the effect of general prenatal screening on prognosis by comparing a period without general prenatal screening to a period with general prenatal screening. Methods: We conducted a nationwide retrospective study including live born children and terminated fetuses diagnosed with major CHD. Prenatal screening was recommended only in high risk pregnancies between 1996 and 2004, whereas general prenatal screening was recommended between 2005 and 2013. We assessed the influence of general prenatal screening on all-cause mortality, cardiac death, preoperative and postoperative 30-day mortality and complication rate. Results: 1-year mortality decreased over both periods, but the decrease was greater in the screening period (Odds ratio 0.92 (CI 0.83–1.00), p = 0.047). Prenatal detection of major CHD was associated with cardiac death in the period without general screening (Hazard Ratio 2.40 (CI 1.72–3.33), p < 0.001), whereas there was no significant association once general screening was implemented. Similarly, the association between prenatal diagnosis and pre- and postoperative mortality found in the period without general screening was insignificant after the implementation of general screening. Conclusion: Mortality in major CHD decreased throughout the study, especially in the period with general prenatal screening. However, comparing a prenatally diagnosed group with a postnatally diagnosed group is vulnerable to selection bias and proper interpretation is difficult.

Original languageEnglish
JournalInternational Journal of Cardiology
Volume290
Pages (from-to)93-99
Number of pages7
ISSN0167-5273
DOIs
Publication statusPublished - 1 Sep 2019

    Research areas

  • Congenital heart disease, Fetal echocardiography, Prenatal diagnosis, Prenatal malformation screening, Prognosis

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