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December 20, 2024 — Copenhagen
A groundbreaking study led by the Statens Serum Institut in Copenhagen has found that pregnancies complicated by major congenital heart defects (MCHDs) face nearly three times the risk of adverse obstetric outcomes compared to those without these conditions. The study, published in JAMA Pediatrics, highlights critical concerns for maternal and fetal health, urging further research into targeted interventions and preventive care strategies.
MCHDs, which occur in approximately 1 in 100 live births, include serious conditions like univentricular heart, transposition of the great arteries (TGA), and atrioventricular septal defect. While previous studies have suggested impaired placental development may play a role in these complications, the specific obstetric risks associated with various MCHD subtypes have remained unclear—until now.
In this study, researchers analyzed data from Denmark’s Fetal Medicine Database, which covers nearly 95% of all single-baby pregnancies in the country from 2008 to 2018. They included a total of 534,170 pregnancies, of which 745 were complicated by fetal MCHDs. The study focused on a composite measure of placenta-related adverse outcomes, such as preeclampsia, preterm birth, fetal growth restriction, and placental abruption.
The results were striking: pregnancies with MCHDs had an adverse obstetric outcome rate of 22.8%, compared to 9.0% in pregnancies without MCHDs. Fetal growth restriction occurred in 6.7% of MCHD pregnancies, nearly three times the 2.3% rate observed in unaffected pregnancies. Preeclampsia was found in 6.2% of MCHD pregnancies (compared to 3.1% in non-MCHD pregnancies), while the incidence of preterm birth was significantly higher in MCHD pregnancies (15.7% vs. 4.6%). Placental abruption, though rare, also showed a higher incidence in MCHD pregnancies (0.9% vs. 0.4%).
Among the MCHD subtypes, the study found the highest risks of adverse outcomes in pregnancies with truncus arteriosus (AOR 6.35), pulmonary atresia with intact ventricular septum (AOR 5.51), and Ebstein anomaly (AOR 5.09). Interestingly, fetal TGA did not show an increased risk for preeclampsia, preterm birth, or fetal growth restriction.
The study underscores the importance of identifying specific MCHD subtypes and their associated risks in order to tailor preventative measures for affected pregnancies. These findings, which were further confirmed by a meta-analysis of 10 international studies, suggest a pressing need for healthcare providers to consider the unique challenges faced by pregnancies with MCHDs.
The researchers call for further studies to explore the mechanisms linking placental dysfunction to MCHDs, which may help guide the development of targeted interventions. With nearly triple the risk of adverse obstetric outcomes, it is clear that pregnancies with fetal congenital heart defects require more personalized and proactive care to optimize both maternal and child health.
For more details, refer to the study: “Adverse Obstetric Outcomes in Pregnancies With Major Fetal Congenital Heart Defects,” published in JAMA Pediatrics (2024). DOI: 10.1001/jamapediatrics.2024.5073.
