Key result
Prenatal critical CHD diagnosis is linked to ~100% higher mortality and severe morbidity versus postnatal.
Why the study?
The prenatal detection rate of congenital heart disease has been scarcely reported in Japan, and its impact on postnatal mortality and severe morbidity remained unclear.
Does prenatal diagnosis of critical CHD impact postnatal mortality and severe morbidity compared to postnatal diagnosis?
Cohort (n=626)
Yes
Does prenatal diagnosis of critical CHD impact postnatal mortality and severe morbidity compared to postnatal diagnosis?
The prenatal detection rate of critical CHD in the Kyu-Yama region of Japan was 64%, with significant variations across prefectures and CHD types, and higher mortality/morbidity observed in prenatally diagnosed cases.
May indicate selection of severe cases; leaves open whether prenatal detection improves outcomes in critical congenital heart disease.
Background The prenatal detection rate (PDR) of congenital heart disease (CHD) has been scarcely reported in Japan. This study aimed to investigate PDR of critical CHD in a region of Japan and to evaluate the impact of prenatal diagnosis on postnatal mortality and severe morbidity. Materials and Methods We included patients diagnosed with CHD either prenatally and postnatally between January 1st 2018 and December 31st 2020, based on the institutional database. The Kyu‐Yama region comprises the seven prefectures of Kyushu island, Yamaguchi prefecture, and Okinawa prefecture. Clinical outcome was compared with prenatal versus postnatal diagnosis. Results The overall PDR of critical CHD in the region was 64% (400 of 626 cases). Fifty‐four (14%) fetuses were diagnosed within 22 weeks of gestational age. Among these cases, termination of pregnancy was selected in 5 (1%) cases. In subgroup analyses by CHD type, heterotaxy had the highest detection rate (91%), followed by hypoplastic left heart syndrome (86%). In contrast, lower detection rates were observed in transposition of the great arteries (43%) and total anomalous pulmonary venous connection (15%). Detection rates varied by prefectures, ranging from 41% to 75%. Among actively managed cases, overall, there was a significant difference in mortality and severe morbidity between prenatal and postnatal groups [66 (18%) vs. 20 (9%), p = 0.0031]. Conclusion The overall PDR in this regional cohort was favorable; however, substantial differences remained across prefectures and CHD types. Reducing these disparities may require guideline‐based education. Further research is warranted to clarify the prognostic impact of prenatal diagnosis.
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Nagata et al. (2026) conducted a cohort in Critical congenital heart disease (n=626). Prenatal diagnosis vs. Postnatal diagnosis was evaluated on Mortality and severe morbidity (p=0.0031). Prenatal diagnosis of critical congenital heart disease was associated with higher mortality and severe morbidity compared to postnatal diagnosis (18% vs. 9%, p=0.0031).
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