Epidemiology, prenatal diagnosis, and neonatal outcomes of congenital heart defects in eastern China: a hospital-based multicenter study

Abstract

Background: Congenital heart defect is the leading malformation in China. There may have been changes in congenital heart defect incidence because of birth policy shift in China over past years. This study aimed to investigate the epidemiology, prenatal diagnosis, and outcomes of congenital heart disease to improve medical and policy decisions. Methods: Data on cases of congenital heart disease identified during 2014-2018 were taken from the Zhejiang provincial birth defects surveillance system. Chi-square test, odds ratio (OR) and 95% confidence interval (CI) were used to explore epidemiology, prenatal diagnosis, and birth outcomes of congenital heart disease. Results: The average incidence of congenital heart disease was 16.0 per 1000 births, which increased by 62.2% during 2014-2018(χ 2 trend = 181.41, P < 0.001). However, the average critical congenital heart incidence was 1.6 per 1000 births, which remained stable over time. Women aged ≤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 having babies with congenital heart disease than women aged 21-34 years. Women who gave birth in urban areas (OR 1.2, 95% CI 1.2-1.3), had a son (OR 1.3, 95% CI 1.3-1.4), or had multiple births (OR 4.0, 95% CI 3.7-4.4) were also at higher risk than those giving birth in rural areas, to girls, or single births, respectively. The three major subtypes of congenital heart disease were atrial septal defect (67.9%), patent ductus arteriosus (34.7%), and ventricular septal defect (6.4%). The prenatal detection rate of critical congenital heart disease was 90.0%, which was far higher than total congenital heart disease, at 22.2% (χ 2 = 1687.67, P < 0.001). There were 1457 (17.1%) stillbirths, 106 (1.2%) early neonatal deaths, and 6983 (81.7%) live births associated with congenital heart disease. Conclusions: The high incidence of congenital heart disease in Zhejiang might be attributable to the large proportion of mild congenital heart disease. The incidence of critical congenital heart disease, the prenatal detection rate, and perinatal deaths from congenital heart disease are comparable to those in other studies.

Effectiveness of newborn pulse oximetry screening for the identification of critical congenital heart disease in a tertiary care hospital in Sri Lanka

“…We have screened a large population of term babies using POS and have demonstrated its efficacy as well as feasibility. CCHD has a reported incidence of 1.6 to 1.7 per 1000 births 15,16 , which is comparable to our findings. Furthermore, positive predictive value and false positive rates are comparable to statistics reported in other studies 9,10 .…”

Epidemiological Aspects, Prenatal Screening and Diagnosis of Congenital Heart Defects in Beijing

“…In this study, we monitored a large sample of pregnant women in the city of Beijing for 3 years to reflect the status of CHD in this population. The incidence of total CHD increased from 10.29‰ in 2018 to 13.45‰ in 2020 and was slightly higher than the global level, i.e., 8-10 ‰ (10); however, the rate of CHD was much lower than that in other studies in China, such as in Zhejiang Province (20.57‰) in 2018 (11). The increasing trend is consistent with most previous reports in China (6) and other countries (10).…”

“…However, data concerning the effect of a younger maternal age on CHD are limited, and the age classification standard also differed. Our age division is consistent with a previously published study investigating a population from Zhejiang Province (11), but the result is inconsistent, the reason may be related to the small sample size of CHD/CCHD in younger pregnant women. Therefore, we should focus on older pregnant women as well as the younger pregnant women.…”

Two approaches for newborns with critical congenital heart disease: a comparative study

“…A study from China showed that fetal echocardiography had a high sensitivity and specificity for detecting major CHDs and had satisfactory positive and negative likelihood ratios in both the low-risk (88.2% and 100%, respectively) and high-risk (100% and 99.9%, respectively) populations [8]. However, 74.4%-88.9% of the prenatally diagnosed CHD cases were terminated [8,9]. To reduce the high abortion rate and to improve the therapeutic outcomes of CCHD, we started the "prenatal diagnosis and Fig.…”

“…With the promotion of prenatally diagnosed technology and improvement of government policy, the prenatal diagnosis rate of CCHD has increased during the past 2 decades in China, and there has been a high detection rate for major CHD in both low-and high-risk populations [8,9]. Pediatrics and fetal cardiologists understand well the pathophysiology and natural history of congenital heart disease in the developed countries.…”