Critical congenital heart disease and maternal comorbidities: An observation

Abstract

BackgroundCritical congenital heart disease is the target of postnatal, pulse-oximetry screening; nevertheless, prenatal detection is preferable. Prenatal diagnosis allows for advanced perinatal planning, parental counseling, potential fetal cardiac intervention if indicated, and avoidance of complicated, costly, and at times, risky neonatal transport. ObjectiveThe purpose of this study was to investigate a possible association between the occurrence of critical congenital heart disease and pregnancies complicated by maternal comorbidities. MethodsWe identified all those prenatally and postnatally diagnosed with critical congenital heart disease in Nevada between July 2014 and June 2020. For each identified case of critical congenital heart disease, we assessed each mother's medical history. We divided pregnant women into two groups: 1) those with maternal comorbidities and 2) those without comorbidities. ResultsWe identified 367 cases of critical congenital heart disease. Of the 367, 229 (62%) occurred in those with maternal comorbidities. Of the 367, 321 (87%) were live-born. Of the 321 live-born, 201 (63%) occurred in those with maternal comorbidities, however, the prevalence of maternal comorbidities in the general pregnancy population is not known. The majority of patients born with critical heart disease were born to mothers with comorbidities versus those without comorbidities for both the total and live-born cohorts (p = 0.00001). Of the 321 live-born, 10 had no prenatal care. Of the 311 with prenatal care, 248 (80%) were prenatally diagnosed. During the study period, there were approximately 210,000 live births in Nevada, for a prevalence of 15.2 (321/210,000) critical congenital cardiac malformations per 10,000 live births. ConclusionIn Nevada, most of those with critical congenital heart disease are products of pregnancies complicated by maternal comorbidities. Further, the state-wide, live-born, critical congenital heart disease prenatal-detection rate was 80%.