Clinical Factors Associated with Termination of Pregnancy Recommendations Following Prenatal Diagnosis of Congenital Heart Disease: A Multidisciplinary Council-Based Study

Objective: To evaluate clinical factors associated with termination of pregnancy (TOP) recommendations following prenatal diagnosis of congenital heart disease (CHD) within a multidisciplinary fetal council model. Methods: This retrospective cohort study included 146 fetuses with prenatally diagnosed CHD discussed in a tertiary referral center fetal council between October 2023 and December 2025. The primary outcome was council-issued recommendation for TOP (yes/no). Variables included gestational age (GA) at diagnosis, cardiac severity (Davey scale grouped as low, moderate, high), extracardiac anomalies, fetal growth restriction (FGR), and genetic evaluation/results. Group comparisons were performed using Mann–Whitney U and χ2 tests. Independent associations were assessed using binary logistic regression. A subgroup analysis was conducted in isolated CHD cases (no extracardiac structural anomalies). Results: A total of 146 fetuses with prenatal CHD were included in the analysis. TOP was recommended in 71 cases (48.6%). GA at diagnosis did not differ between groups when analyzed continuously; however, categorical GA showed significant differences, with earlier diagnoses more frequent among TOP-recommended cases. Cardiac severity distribution differed significantly between groups. In multivariable analysis, GA at diagnosis and cardiac severity were independently associated with TOP recommendation. Compared with <20 weeks, diagnosis at 20–23+6 weeks (OR 17.96, 95% CI 3.50–92.22) and ≥24 weeks (OR 3.92, 95% CI 1.53–10.06) increased the odds of TOP recommendation. Relative to high severity, moderate (OR 0.23, 95% CI 0.07–0.72) and low severity (OR 0.20, 95% CI 0.08–0.50) were associated with lower odds of TOP recommendation. Extracardiac anomalies, genetic findings, and FGR were not independently associated after adjustment. Similar patterns were observed in isolated CHD cases. Conclusions: In a multidisciplinary prenatal counseling setting, TOP recommendations after prenatal CHD diagnosis were primarily driven by cardiac severity and GA at diagnosis, rather than extracardiac or genetic findings alone.