Pregnancy Termination and Postnatal Major Congenital Heart
Defect Prevalence After Introduction of Prenatal Cardiac
Screening

J 2023

Pregnancy Termination and Postnatal Major Congenital Heart Defect Prevalence After Introduction of Prenatal Cardiac Screening

TOMEK, Viktor, Hana JIČÍNSKÁ, Jan PAVLICEK, Jan KOVANDA, Petr JEHLICKA et. al.

Basic information

Original name

Pregnancy Termination and Postnatal Major Congenital Heart Defect Prevalence After Introduction of Prenatal Cardiac Screening

Authors

TOMEK, Viktor (203 Czech Republic, guarantor), Hana JIČÍNSKÁ (203 Czech Republic, belonging to the institution), Jan PAVLICEK (203 Czech Republic), Jan KOVANDA (203 Czech Republic), Petr JEHLICKA (203 Czech Republic), Eva KLASKOVA (203 Czech Republic), Jiri MRAZEK (203 Czech Republic), David CUTKA (203 Czech Republic), Dagmar SMETANOVA (203 Czech Republic), Miroslav BRESTAK (203 Czech Republic), Pavel VLASIN (203 Czech Republic), Marketa PAVLIKOVA (203 Czech Republic), Vaclav CHALOUPECKY (203 Czech Republic), Jan JANOUSEK (203 Czech Republic) and Jan MAREK (203 Czech Republic)

Edition

JAMA network open, CHICAGO, AMER MEDICAL ASSOC, 2023, 2574-3805

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30218 General and internal medicine

Country of publisher

United States of America

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 13.800 in 2022

RIV identification code

RIV/00216224:14110/23:00133297

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1001/jamanetworkopen.2023.34069

UT WoS

001068514300001

Keywords in English

Pregnancy Termination; Postnatal Major Congenital Heart Defect; Prenatal Cardiac Screening

Abstract

V originále

IMPORTANCE Prenatal cardiac screening of the first and second trimesters has had a major impact on postnatal prevalence of congenital heart defects (CHDs), rates of termination of pregnancy (TOP), and outcomes among children born alive with CHDs.OBJECTIVE To examine the prenatal and postnatal incidence of major CHDs (ie, necessitating intervention within the first year of life), detection rate trends, rates of TOP, and the association of cardiac screening with postnatal outcomes.DESIGN, SETTINGS, AND PARTICIPANTS In this cross-sectional study, 3827 fetuses with antenatally diagnosed major CHDs in the Czech Republic (population 10.7 million) between 1991 and 2021 were prospectively evaluated with known outcomes and associated comorbidities. Prenatal and postnatal prevalence of CHD in an unselected population was assessed by comparison with a retrospective analysis of all children born alive with major CHDs in the same period (5454 children), using national data registry. Data analysis was conducted from January 1991 to December 2021.MAIN OUTCOMES AND MEASURES Prenatal detection and postnatal prevalence of major CHDs and rate of TOPs in a setting with a centralized health care system over 31 years.RESULTS A total of 3 300 068 children were born alive during the study period. Major CHD was diagnosed in 3827 fetuses, of whom 1646 (43.0%) were born, 2069 (54.1%) resulted in TOP, and 112 (2.9%) died prenatally. The prenatal detection rate increased from 6.2% in 1991 to 82.8% in 2021 (P < .001). Termination of pregnancy decreased from 70% in 1991 to 43% (P < .001) in 2021. Of 627 fetuses diagnosed in the first trimester (introduced in 2007), 460 were terminated (73.3%). Since 2007, of 2066 fetuses diagnosed in the second trimester, 880 (42.6%) were terminated, resulting in an odds ratio of 3.6 (95% CI, 2.8-4.6; P < .001) for TOP in the first trimester compared with the second trimester. Postnatal prevalence of major CHDs declined from 0.21% to 0.14% (P < .001). The total incidence (combining prenatal detection of terminated fetuses with postnatal prevalence) of major CHD remained at 0.23% during the study period.CONCLUSIONS AND RELEVANCE In this cross-sectional study, the total incidence of major CHD did not change significantly during the 31-year study period. The prenatal detection of major CHD approached 83% in the current era. Postnatal prevalence of major CHD decreased significantly due to early TOPs and intrauterine deaths. The introduction of first trimester screening resulted in a higher termination rate in the first trimester but did not revert the overall decreasing trend of termination for CHDs in general.

Citovat

TOMEK, Viktor, Hana JIČÍNSKÁ, Jan PAVLICEK, Jan KOVANDA, Petr JEHLICKA, Eva KLASKOVA, Jiri MRAZEK, David CUTKA, Dagmar SMETANOVA, Miroslav BRESTAK, Pavel VLASIN, Marketa PAVLIKOVA, Vaclav CHALOUPECKY, Jan JANOUSEK and Jan MAREK. Pregnancy Termination and Postnatal Major Congenital Heart Defect Prevalence After Introduction of Prenatal Cardiac Screening. JAMA network open. CHICAGO: AMER MEDICAL ASSOC, 2023, vol. 6, No 9, p. 1-12. ISSN 2574-3805. Available from: https://dx.doi.org/10.1001/jamanetworkopen.2023.34069.

@article{2367193,
   author = {Tomek, Viktor and Jičínská, Hana and Pavlicek, Jan and Kovanda, Jan and Jehlicka, Petr and Klaskova, Eva and Mrazek, Jiri and Cutka, David and Smetanova, Dagmar and Brestak, Miroslav and Vlasin, Pavel and Pavlikova, Marketa and Chaloupecky, Vaclav and Janousek, Jan and Marek, Jan},
   article_location = {CHICAGO},
   article_number = {9},
   doi = {http://dx.doi.org/10.1001/jamanetworkopen.2023.34069},
   keywords = {Pregnancy Termination; Postnatal Major Congenital Heart Defect; Prenatal Cardiac Screening},
   language = {eng},
   issn = {2574-3805},
   journal = {JAMA network open},
   title = {Pregnancy Termination and Postnatal Major Congenital Heart Defect Prevalence After Introduction of Prenatal Cardiac Screening},
   url = {https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2809603},
   volume = {6},
   year = {2023}
}

TY  - JOUR
ID  - 2367193
AU  - Tomek, Viktor - Jičínská, Hana - Pavlicek, Jan - Kovanda, Jan - Jehlicka, Petr - Klaskova, Eva - Mrazek, Jiri - Cutka, David - Smetanova, Dagmar - Brestak, Miroslav - Vlasin, Pavel - Pavlikova, Marketa - Chaloupecky, Vaclav - Janousek, Jan - Marek, Jan
PY  - 2023
TI  - Pregnancy Termination and Postnatal Major Congenital Heart Defect Prevalence After Introduction of Prenatal Cardiac Screening
JF  - JAMA network open
VL  - 6
IS  - 9
SP  - 1-12
EP  - 1-12
PB  - AMER MEDICAL ASSOC
SN  - 25743805
KW  - Pregnancy Termination
KW  - Postnatal Major Congenital Heart Defect
KW  - Prenatal Cardiac Screening
UR  - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2809603
N2  - IMPORTANCE Prenatal cardiac screening of the first and second trimesters has had a major impact on postnatal prevalence of congenital heart defects (CHDs), rates of termination of pregnancy (TOP), and outcomes among children born alive with CHDs.OBJECTIVE To examine the prenatal and postnatal incidence of major CHDs (ie, necessitating intervention within the first year of life), detection rate trends, rates of TOP, and the association of cardiac screening with postnatal outcomes.DESIGN, SETTINGS, AND PARTICIPANTS In this cross-sectional study, 3827 fetuses with antenatally diagnosed major CHDs in the Czech Republic (population 10.7 million) between 1991 and 2021 were prospectively evaluated with known outcomes and associated comorbidities. Prenatal and postnatal prevalence of CHD in an unselected population was assessed by comparison with a retrospective analysis of all children born alive with major CHDs in the same period (5454 children), using national data registry. Data analysis was conducted from January 1991 to December 2021.MAIN OUTCOMES AND MEASURES Prenatal detection and postnatal prevalence of major CHDs and rate of TOPs in a setting with a centralized health care system over 31 years.RESULTS A total of 3 300 068 children were born alive during the study period. Major CHD was diagnosed in 3827 fetuses, of whom 1646 (43.0%) were born, 2069 (54.1%) resulted in TOP, and 112 (2.9%) died prenatally. The prenatal detection rate increased from 6.2% in 1991 to 82.8% in 2021 (P < .001). Termination of pregnancy decreased from 70% in 1991 to 43% (P < .001) in 2021. Of 627 fetuses diagnosed in the first trimester (introduced in 2007), 460 were terminated (73.3%). Since 2007, of 2066 fetuses diagnosed in the second trimester, 880 (42.6%) were terminated, resulting in an odds ratio of 3.6 (95% CI, 2.8-4.6; P < .001) for TOP in the first trimester compared with the second trimester. Postnatal prevalence of major CHDs declined from 0.21% to 0.14% (P < .001). The total incidence (combining prenatal detection of terminated fetuses with postnatal prevalence) of major CHD remained at 0.23% during the study period.CONCLUSIONS AND RELEVANCE In this cross-sectional study, the total incidence of major CHD did not change significantly during the 31-year study period. The prenatal detection of major CHD approached 83% in the current era. Postnatal prevalence of major CHD decreased significantly due to early TOPs and intrauterine deaths. The introduction of first trimester screening resulted in a higher termination rate in the first trimester but did not revert the overall decreasing trend of termination for CHDs in general.
ER  -

TOMEK, Viktor, Hana JIČÍNSKÁ, Jan PAVLICEK, Jan KOVANDA, Petr JEHLICKA, Eva KLASKOVA, Jiri MRAZEK, David CUTKA, Dagmar SMETANOVA, Miroslav BRESTAK, Pavel VLASIN, Marketa PAVLIKOVA, Vaclav CHALOUPECKY, Jan JANOUSEK and Jan MAREK. Pregnancy Termination and Postnatal Major Congenital Heart Defect Prevalence After Introduction of Prenatal Cardiac Screening. \textit{JAMA network open}. CHICAGO: AMER MEDICAL ASSOC, 2023, vol.~6, No~9, p.~1-12. ISSN~2574-3805. Available from: https://dx.doi.org/10.1001/jamanetworkopen.2023.34069.

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