Prenatal Diagnosis of Congenital Heart Disease and Voluntary Termination of Pregnancy: A Population-Based Study in Qingdao, China

Xuning Lu; Guoju Li; Qin Wu; Wei Ni; Silin Pan; Quansheng Xing

doi:10.2147/RMHP.S447493

Prenatal Diagnosis of Congenital Heart Disease and Voluntary Termination of Pregnancy: A Population-Based Study in Qingdao, China

Risk Manag Healthc Policy. 2024 Jan 20:17:205-212. doi: 10.2147/RMHP.S447493. eCollection 2024.

Authors

Xuning Lu^{1

2}, Guoju Li¹, Qin Wu¹, Wei Ni¹, Silin Pan¹, Quansheng Xing¹

Affiliations

¹ Heart Center, Qingdao Women and Children's Hospital, Shandong University, Qingdao, Shandong Province, People's Republic of China.
² Heart Center, Dalian Municipal Women and Children's Medical Center (Group), Dalian, Liaoning Province, People's Republic of China.

Abstract

Objective: The outcomes of fetuses with isolated congenital heart disease (CHD) diagnosed prenatally have not been investigated in a population-based study in China. This population-based study aimed to evaluate the rate of voluntary termination of pregnancy after the prenatal diagnosis of isolated CHD in Qingdao, China.

Methods: This was a population-based retrospective study in which data were collected from all pregnant women in Qingdao (eastern China) from August 2018 to July 2020; fetal data, maternal data and data on pregnancy outcomes were extracted from medical records regarding prenatal diagnosis of CHD. The inclusion criteria were as follows: pregnant women or their husbands who had a household registration in Qingdao and who underwent regular prenatal screening in Qingdao. The exclusion criterion was the failure to sign an informed consent form. Counseling for all parents of fetuses with CHD was provided by a multidisciplinary team of experienced pediatric cardiologists, obstetricians, geneticists, etc. According to the type and severity of CHD, the pregnancy termination rate was analyzed.

Results: Among the 126,843 pregnant women, 1299 fetuses with a prenatal diagnosis of CHD were included in the study. Among the included fetuses, 1075 were diagnosed with isolated CHD, and the overall pregnancy termination rate was 22.8%. Termination rates varied according to the complexity of CHD (low complexity vs moderate complexity, P=0.000; low complexity vs high complexity, P=0.000; moderate complexity vs high complexity, P=0.000), with rates of 6.0% for low complexity, 54.2% for moderate complexity, and 99.1% for high complexity. The decision to terminate the pregnancy in cases of isolated CHD was unrelated to maternal age (P=0.091) but was related to gestational age (p=0.000).

Conclusion: In Qingdao, 99.1% of parents whose fetuses were diagnosed with isolated high-complexity CHD chose to voluntarily terminate the pregnancy. The pregnancy termination rate increased with increasing complexity of prenatally diagnosed CHD.

Keywords: congenital heart defect; fetal echocardiography; prenatal diagnosis; termination of pregnancy.

Grants and funding

This work is supported by the National Natural Science Foundation of China (NSFC) [Grant numbers 81770315, 82071583], the Taishan Scholars Program, and the China Postdoctoral Science Foundation Funded Project [Grant number 2019M662307].