OP35.02: Prenatal detection of congenital heart defects is hampered by overweight and obesity: review on 19,687 pregnant women

Abstract

In Germany as well as in other developed countries overweight and obesity have reached epidemic proportions even in adolescents. In 2009, 43% of women were overweight and 18% of them obese. During pregnancy, these patients are at higher risk for maternal and fetal complications including cardiac defects. Between 1997 and 2007 a total of 19,687 pregnant women were referred to our tertiary prenatal centre for anatomic survey including echocardiography. In our study, the women showed an average BMI of 24.83 kg/m2 and age of 30.87 years. After delivery, the fetal outcome was surveyed by reviewing paediatric charts. The results of the prenatal and postnatal examinations were compared and the frequency and detection rates, as well as false positives and false negative results were statistically analyzed with respect to maternal age, BMI levels and other maternal risk factors. In this cohort a total of 1117 heart anomalies or malformations were prenatally diagnosed and were in 81% postnatally confirmed. There was a clear positive correlation between maternal age and fetal heart malformations. Some defects showed a higher frequency in obese women (e.g. aortic stenosis and endocardial fibroelastosis). However, there was no statistically significant correlation between higher maternal BMI without any other risks like a positive family history or gestational diabetes mellitus and fetal heart disease in general. On the other hand, the detection rates for several fetal heart malformations (e.g. septal defects, Coartation of the aorta, anomalous pulmonary venous connection) was significantly lower in obese women. Performing prenatal ultrasound and precisely detecting congenital heart defects in overweight and obese women is still challenging despite improved technical skills of high-end ultrasound machines and personnel. The results show the necessity for individualised guidelines doing enhanced ultrasound in overweight or obese women.