Risk of perinatal deaths for fetuses and early newborns with congenital heart defects

Abstract

Background Few studies assessed the perinatal death (PD) risk for congenital heart defects (CHDs). Methods Data were obtained from the Birth Defects Surveillance System in Hunan Province, China, 2016-2020. Perinatal mortality (stillbirths and early neonatal deaths per 1000 fetuses (>=28 weeks)) and 95% confidence intervals (CI) were calculated. Crude odds ratios (ORs) and 95%CI were calculated to estimate the PD risk for CHDs and to examine the association of each maternal characteristic with PD risk for CHDs. Results 847755 fetuses were registered, including 14459 (1.71%) birth defects (4161 CHDs, 0.49%) and 833296 (98.29%) cases without birth defects. 7445 PDs (6874 stillbirths and 571 early neonatal deaths) were identified, including 976 (13.11%) CHD-related deaths, and 4396 PDs for fetuses without birth defects. 97.50% (936/960) of CHD-related stillbirths were selective termination of pregnancy. The overall perinatal mortality was 0.88% (95%CI: 0.86-0.90). CHDs increased the PD risk (23.46% vs. 0.53%, OR=57.78, 95%CI: 53.47-62.44). Any specific CHD increased the PD risk (OR>1, P<0.05). Perinatal mortality for CHDs was higher in rural than urban areas (OR= 3.40, 95%CI: 2.92-3.95). And perinatal mortalities for CHDs were higher in low maternal age (<25 years old), low per-capita annual income (<4000¥), low maternal education, no birth, and premature birth compared to the reference group. (OR>1, P<0.05). Conclusions CHDs significantly increase the PD risk. Several maternal characteristics were associated with CHD-related PDs. And several mechanisms have been proposed to explain these phenomena. Our results are of immediate value for clinical care and consultation.