Cardiovascular malformations: changes in prevalence and birth status, 1972-1990

Area of Science:

• Medical Surveillance
• Reproductive Health
• Cardiovascular Health

Background:

• Cardiovascular malformations (CVMs) are a significant concern in liveborn, stillborn infants, and fetuses.
• Traditional surveillance methods often exclude elective terminations, potentially underestimating CVM prevalence.
• Changes in prenatal screening and maternal demographics influence CVM detection and outcomes.

Purpose of the Study:

• To analyze trends in cardiovascular malformations (CVMs) over a 15-year period using active surveillance.
• To assess the impact of increasing elective terminations on CVM birth prevalence.
• To evaluate the role of prenatal screening and maternal age in CVM surveillance.

Main Methods:

• Conducted a 15-year hospital-based active surveillance program for CVMs.
• Included liveborn, stillborn infants, and fetuses from elective terminations.
• Excluded infants transferred from other institutions for anomaly care.

Main Results:

• Overall CVM prevalence increased significantly, driven by a rise in elective terminations (from 0% to 22%).
• Proportion of liveborn infants with CVMs decreased, while stillbirth frequency remained unchanged.
• Increased prenatal ultrasonography and amniocentesis use, alongside a rise in maternal age (≥35 years), were observed.

Conclusions:

• Active surveillance systems that include elective terminations are crucial for accurately tracking CVM prevalence.
• Increased elective pregnancy terminations significantly affect the overall birth prevalence of CVMs.
• Trends in prenatal diagnostics and maternal age contribute to observed changes in CVM outcomes.