224: Trends in mode of delivery of infants with congenital heart disease

Abstract

Prenatal diagnosis of critical congenital heart disease (CCHD) has been increasing over the last two decades. While this allows care teams to plan deliveries of infants with CCHD, efforts may result in increasing rates of Cesarean-section delivery. We sought to identify trends in mode of delivery in infants with CCHD over an 18-year period in Texas and compare this to the general population in the state of Texas over the same time period. We identified live born infants with a diagnosis of CCHD from January 1999 through December 2016 using the Texas Public Use Data File, a population-based administrative database that captures nearly 100% of hospitalizations in the state of Texas. CCHD was defined as congenital heart disease likely to require intervention within the first year of life. Infants with a discharge diagnosis of a multiple gestation birth, significant birth defect or a known genetic abnormality were excluded. We evaluated the proportion of births annually that were delivered via Cesarean over the course of the time period studied. We compared this to the proportion of live births that were delivered via Cesarean in the state of Texas, using data from the Texas Department of State Health Services Vital Statistics Data over the same time period. Cesarean delivery over time in CCHD was evaluated using generalized estimating equations accounting for hospital clustering. The rates of Cesarean delivery were compared between CCHD and Texas data overall using Chi square test and Chi square test for trend. There was a total of 5,961 births fulfilling inclusion criteria. The mean percentage of cesareans performed for infants with CCHD during the study period was 46.1% compared to 32.6% in the overall infant population in Texas (p<0.001). For both groups, there appeared to be a significant yearly increase in the number of cesareans performed for both groups until 2008 (CCHD group mean annual change +1.45%, p=0.024, and Texas +1.13%, p=0.003); after this time the number of cesarean sections plateaued in CCHD and has had a mild decline overall (CCHD group mean annual change -0.06%; p=0.854, and Texas -0.13%, p=0.031). Cesarean delivery occurred more frequently in infants with CCHD than the general population in the state of Texas from 1999-2016. For both groups, the rates of Cesarean delivery increased and then appear to have plateaued. Further study to identify the reason for the higher percentage of cesarean delivery in CCHD is warranted.