Epidemiology, Prenatal Diagnosis, and Neonatal Outcomes of Congenital Heart Defects in Eastern China: A Hospital-Based Multicenter Study

Abstract

Background : Congenital heart disease (CHD) is one of the most common birth defect. Currently, the reported occurrence of CHD continues to increase at global or regional level. In 2013, Chinese government announced to end 1-child birth policy. We aimed to update the incidence, prenatal diagnosis, and neonatal outcomes of CHD since the ending of 1-child policy, in eastern China. Study design : Data were obtained from the Zhejiang provincial birth defects surveillance system. CHD identified during 2014-2018 were analyzed. Chi-square test, odds ratio (OR) and 95% confidence interval (CI) were used to explore incidence trends, prenatal diagnosis, birth outcomes and associated risk factors with CHD. Results : Overall, 8,546 of 534,002 births were identified with CHD. During the period, the overall incidence of CHD increased significantly, giving an average incidence as 16.0 per 1000 births (95% CI 15.69-16.32). However, the incidence of critical CHD (CCHD) remained stable over time (1.6 per 1000 births, 95% CI 1.47-1.69).Women aged less than 20 years (OR2.1, 95%CI 1.9-2.3) or ≥35 years (OR 1.2, 95% CI 1.2-1.3) were at higher risk of CHD than women aged 21-34 years. Births in urban areas (OR 1.2, 95% CI 1.2-1.3), male sex (OR 1.3, 95% CI 1.3-1.4), and multiple births (OR 4.0, 95% CI 3.7-4.4) had a higher risk of CHD than births in rural areas, female sex, and singletons, respectively. The three major subtypes of CHD were atrial septal defect (ASD, 68.0%), patent ductus arteriosus (PDA, 34.7%), and ventricular septal defect (VSD, 6.4%). A total of 22.2% of CHD was detected prenatally. Regarding to perinatal outcomes, there were 1457 (17.1%) stillbirths, 106 (1.2%) early neonatal deaths, and 6983 (81.7%) live births. Conclusion : The high incidence of CHD might be attributable to the large proportion of mild CHD. Pregnancies in urban areas, male births, and younger or older women were the risk factors for CHD. The prenatal detection rate for overall CHD was low, whereas the rate for CCHD was similar or even higher than other studies. The neonatal outcomes were comparable to previous literatures.