Key result
Prenatal diagnosis of congenital heart defects was associated with a significantly increased rate of induction of labor compared to postnatal diagnosis (OR 1.59; 95% CI 1.15-2.22).
Why the study?
Delivery outcomes in neonates with congenital heart defects (CHD) and the effect of prenatal diagnosis on these outcomes remained to be assessed.
Does prenatal diagnosis of congenital heart defects influence delivery and neonatal outcomes compared to postnatal diagnosis?
Cohort (n=87,174)
Does prenatal diagnosis of congenital heart defects influence delivery and neonatal outcomes compared to postnatal diagnosis?
Odds Ratio: 1.59 (95% CI 1.15–2.22)
Prenatal diagnosis of congenital heart disease increases the rate of labor induction but does not increase the rate of cesarean delivery, while postnatal diagnosis is associated with lower 5-minute Apgar scores.
Prenatal CHD diagnosis was associated with more inductions but no change in cesarean rates or neonatal risks; leaves open whether targeted planning improves outcomes.
Objective: The objective of this study is to assess the delivery outcomes of neonates with congenital heart defects (CHD), and to explore the effect of prenatal diagnosis on these outcomes. Methods: A retrospective study including singleton deliveries between 2011 and 2020. All singleton neonates delivered at >24 weeks of gestation were included in this study. Fetuses with known prenatal anomalies other than CHD were excluded from this study. Pregnancy and neonatal outcomes were analyzed. A comparison was made between pregnancies with CHD and controls; and between pregnancies with prenatal diagnosis of CHD and postnatal diagnosis of CHD. Results: A total of 1598 neonates with CHD (688, 43.1% diagnosed prenatally) comprised the study group, compared to 85,576 singleton controls. Pregnancies with CHD had significantly increased BMI before pregnancy, suffered more from diabetes and chronic hypertension, had more inductions of labor, and had more cesarean deliveries (CD) including both elective CD and urgent CD due to non-reassuring fetal monitor (NRFHR) (OR = 1.75; 95%CI 1.45−2.14). Prenatal diagnosis of CHD is associated with a significant increased rate of induction of labor compared to postnatal diagnosis of CHD (OR = 1.59; 95% CI 1.15−2.22), but did not affect the mode of delivery including the rate of CD and CD due to non-reassuring fetal heart rate (NRFHR). Gestational age at birth and birthweight were significantly lower in pregnancies with CHD compared to controls, with no difference between prenatal to postnatal diagnosis of the anomaly. Neonates with CHD had a higher incidence of hypoxic ischemic encephalopathy and seizures compared to controls without any impact by prenatal diagnosis. Conclusion: Prenatal diagnosis of CHD is associated with an increased rate of induction of labor, with no increased rate of CD and CD due to NRFHR. The 5-min Apgar score is lower in pregnancies with postnatal diagnosis of CHD.
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Weissmann‐Brenner et al. (2022) conducted a cohort in Congenital heart defects (n=87,174). Prenatal diagnosis of CHD vs. Postnatal diagnosis of CHD was evaluated on Induction of labor (OR 1.59, 95% CI 1.15-2.22). Prenatal diagnosis of congenital heart defects was associated with a significantly increased rate of induction of labor compared to postnatal diagnosis (OR 1.59; 95% CI 1.15-2.22).
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