• Je něco špatně v tomto záznamu ?

Pregnancy Termination and Postnatal Major Congenital Heart Defect Prevalence After Introduction of Prenatal Cardiac Screening

V. Tomek, H. Jicínská, J. Pavlícek, J. Kovanda, P. Jehlicka, E. Klásková, J. Mrázek, D. Cutka, D. Smetanová, M. Brešták, P. Vlašín, M. Pavlíková, V. Chaloupecký, J. Janoušek, J. Marek

. 2023 ; 6 (9) : e2334069. [pub] 20230905

Jazyk angličtina Země Spojené státy americké

Typ dokumentu časopisecké články, práce podpořená grantem

Perzistentní odkaz   https://www.medvik.cz/link/bmc23016276

IMPORTANCE: Prenatal cardiac screening of the first and second trimesters has had a major impact on postnatal prevalence of congenital heart defects (CHDs), rates of termination of pregnancy (TOP), and outcomes among children born alive with CHDs. OBJECTIVE: To examine the prenatal and postnatal incidence of major CHDs (ie, necessitating intervention within the first year of life), detection rate trends, rates of TOP, and the association of cardiac screening with postnatal outcomes. DESIGN, SETTINGS, AND PARTICIPANTS: In this cross-sectional study, 3827 fetuses with antenatally diagnosed major CHDs in the Czech Republic (population 10.7 million) between 1991 and 2021 were prospectively evaluated with known outcomes and associated comorbidities. Prenatal and postnatal prevalence of CHD in an unselected population was assessed by comparison with a retrospective analysis of all children born alive with major CHDs in the same period (5454 children), using national data registry. Data analysis was conducted from January 1991 to December 2021. MAIN OUTCOMES AND MEASURES: Prenatal detection and postnatal prevalence of major CHDs and rate of TOPs in a setting with a centralized health care system over 31 years. RESULTS: A total of 3 300 068 children were born alive during the study period. Major CHD was diagnosed in 3827 fetuses, of whom 1646 (43.0%) were born, 2069 (54.1%) resulted in TOP, and 112 (2.9%) died prenatally. The prenatal detection rate increased from 6.2% in 1991 to 82.8% in 2021 (P < .001). Termination of pregnancy decreased from 70% in 1991 to 43% (P < .001) in 2021. Of 627 fetuses diagnosed in the first trimester (introduced in 2007), 460 were terminated (73.3%). Since 2007, of 2066 fetuses diagnosed in the second trimester, 880 (42.6%) were terminated, resulting in an odds ratio of 3.6 (95% CI, 2.8-4.6; P < .001) for TOP in the first trimester compared with the second trimester. Postnatal prevalence of major CHDs declined from 0.21% to 0.14% (P < .001). The total incidence (combining prenatal detection of terminated fetuses with postnatal prevalence) of major CHD remained at 0.23% during the study period. CONCLUSIONS AND RELEVANCE: In this cross-sectional study, the total incidence of major CHD did not change significantly during the 31-year study period. The prenatal detection of major CHD approached 83% in the current era. Postnatal prevalence of major CHD decreased significantly due to early TOPs and intrauterine deaths. The introduction of first trimester screening resulted in a higher termination rate in the first trimester but did not revert the overall decreasing trend of termination for CHDs in general.

Citace poskytuje Crossref.org

000      
00000naa a2200000 a 4500
001      
bmc23016276
003      
CZ-PrNML
005      
20231026110053.0
007      
ta
008      
231013s2023 xxu f 000 0|eng||
009      
AR
024    7_
$a 10.1001/jamanetworkopen.2023.34069 $2 doi
035    __
$a (PubMed)37713196
040    __
$a ABA008 $b cze $d ABA008 $e AACR2
041    0_
$a eng
044    __
$a xxu
100    1_
$a Tomek, Viktor $u Children's Heart Centre, Second Faculty of Medicine, Motol University Hospital, Charles University, Prague, the Czech Republic
245    10
$a Pregnancy Termination and Postnatal Major Congenital Heart Defect Prevalence After Introduction of Prenatal Cardiac Screening / $c V. Tomek, H. Jicínská, J. Pavlícek, J. Kovanda, P. Jehlicka, E. Klásková, J. Mrázek, D. Cutka, D. Smetanová, M. Brešták, P. Vlašín, M. Pavlíková, V. Chaloupecký, J. Janoušek, J. Marek
520    9_
$a IMPORTANCE: Prenatal cardiac screening of the first and second trimesters has had a major impact on postnatal prevalence of congenital heart defects (CHDs), rates of termination of pregnancy (TOP), and outcomes among children born alive with CHDs. OBJECTIVE: To examine the prenatal and postnatal incidence of major CHDs (ie, necessitating intervention within the first year of life), detection rate trends, rates of TOP, and the association of cardiac screening with postnatal outcomes. DESIGN, SETTINGS, AND PARTICIPANTS: In this cross-sectional study, 3827 fetuses with antenatally diagnosed major CHDs in the Czech Republic (population 10.7 million) between 1991 and 2021 were prospectively evaluated with known outcomes and associated comorbidities. Prenatal and postnatal prevalence of CHD in an unselected population was assessed by comparison with a retrospective analysis of all children born alive with major CHDs in the same period (5454 children), using national data registry. Data analysis was conducted from January 1991 to December 2021. MAIN OUTCOMES AND MEASURES: Prenatal detection and postnatal prevalence of major CHDs and rate of TOPs in a setting with a centralized health care system over 31 years. RESULTS: A total of 3 300 068 children were born alive during the study period. Major CHD was diagnosed in 3827 fetuses, of whom 1646 (43.0%) were born, 2069 (54.1%) resulted in TOP, and 112 (2.9%) died prenatally. The prenatal detection rate increased from 6.2% in 1991 to 82.8% in 2021 (P < .001). Termination of pregnancy decreased from 70% in 1991 to 43% (P < .001) in 2021. Of 627 fetuses diagnosed in the first trimester (introduced in 2007), 460 were terminated (73.3%). Since 2007, of 2066 fetuses diagnosed in the second trimester, 880 (42.6%) were terminated, resulting in an odds ratio of 3.6 (95% CI, 2.8-4.6; P < .001) for TOP in the first trimester compared with the second trimester. Postnatal prevalence of major CHDs declined from 0.21% to 0.14% (P < .001). The total incidence (combining prenatal detection of terminated fetuses with postnatal prevalence) of major CHD remained at 0.23% during the study period. CONCLUSIONS AND RELEVANCE: In this cross-sectional study, the total incidence of major CHD did not change significantly during the 31-year study period. The prenatal detection of major CHD approached 83% in the current era. Postnatal prevalence of major CHD decreased significantly due to early TOPs and intrauterine deaths. The introduction of first trimester screening resulted in a higher termination rate in the first trimester but did not revert the overall decreasing trend of termination for CHDs in general.
650    _2
$a dítě $7 D002648
650    _2
$a ženské pohlaví $7 D005260
650    _2
$a těhotenství $7 D011247
650    _2
$a lidé $7 D006801
650    _2
$a průřezové studie $7 D003430
650    _2
$a prevalence $7 D015995
650    _2
$a retrospektivní studie $7 D012189
650    12
$a vrozené srdeční vady $x diagnóza $x epidemiologie $7 D006330
650    12
$a indukovaný potrat $7 D000028
655    _2
$a časopisecké články $7 D016428
655    _2
$a práce podpořená grantem $7 D013485
700    1_
$a Jicínská, Hana $u Department of Pediatric Cardiology, The University Hospital Brno, Faculty of Medicine of Masaryk University, Brno, the Czech Republic
700    1_
$a Pavlícek, Jan $u Department of Pediatrics and Prenatal Cardiology, University Hospital Ostrava, Ostrava, the Czech Republic
700    1_
$a Kovanda, Jan $u Children's Heart Centre, Second Faculty of Medicine, Motol University Hospital, Charles University, Prague, the Czech Republic
700    1_
$a Jehlicka, Petr $u Department of Pediatrics, University Hospital in Pilsen, Charles University, Pilsen, the Czech Republic
700    1_
$a Klásková, Eva $u Department of Pediatrics, Olomouc University Hospital and Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, the Czech Republic
700    1_
$a Mrázek, Jirí $u Department of Pediatrics, Masaryk Hospital, Ústí nad Labem, the Czech Republic
700    1_
$a Cutka, David $u Centre for Medical Genetics, České Budějovice, the Czech Republic
700    1_
$a Smetanová, Dagmar $u Gennet, Centre for Fetal Medicine and Reproductive Genetics, Prague, the Czech Republic
700    1_
$a Brešták, Miroslav $u Department of Obstetrics and Gynecology of the First Faculty of Medicine, Charles University and General University Hospital, Prague, the Czech Republic
700    1_
$a Vlašín, Pavel $u Fetal Medicine Center, Brno, the Czech Republic
700    1_
$a Pavlíková, Markéta $u Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University, Prague, the Czech Republic
700    1_
$a Chaloupecký, Václav $u Children's Heart Centre, Second Faculty of Medicine, Motol University Hospital, Charles University, Prague, the Czech Republic
700    1_
$a Janoušek, Jan $u Children's Heart Centre, Second Faculty of Medicine, Motol University Hospital, Charles University, Prague, the Czech Republic
700    1_
$a Marek, Jan $u Great Ormond Street Hospital for Children and Institute of Cardiovascular Sciences UCL, London, United Kingdom
773    0_
$w MED00205674 $t JAMA network open $x 2574-3805 $g Roč. 6, č. 9 (2023), s. e2334069
856    41
$u https://pubmed.ncbi.nlm.nih.gov/37713196 $y Pubmed
910    __
$a ABA008 $b sig $c sign $y - $z 0
990    __
$a 20231013 $b ABA008
991    __
$a 20231026110047 $b ABA008
999    __
$a ok $b bmc $g 2000034 $s 1202638
BAS    __
$a 3
BAS    __
$a PreBMC-MEDLINE
BMC    __
$a 2023 $b 6 $c 9 $d e2334069 $e 20230905 $i 2574-3805 $m JAMA network open $n JAMA Netw Open $x MED00205674
LZP    __
$a Pubmed-20231013

Najít záznam

Citační ukazatele

Možnosti archivace