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The implementation of a nationwide anomaly screening programme improves prenatal detection of major cardiac defects:
J Hautala1, M Gissler2,3, A Ritvanen4
1Department of Obstetrics and Gynaecology, Women's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Insights
A nationwide prenatal anomaly screening program significantly improved detection rates for congenital heart defects like univentricular heart (UVH) and transposition of great arteries (TGA). Maternal risk factors did not impact screening efficacy, though regional variations in detection were noted.
Area of Science:
- Cardiology
- Prenatal Diagnostics
- Public Health
Background:
- Congenital heart diseases, including univentricular heart (UVH) and transposition of great arteries (TGA), pose significant health challenges.
- Effective prenatal detection is crucial for timely intervention and improved outcomes.
Purpose of the Study:
- To assess the impact of a nationwide prenatal anomaly screening program on the detection rates of UVH and TGA.
- To investigate whether maternal risk factors influence the prenatal detection of severe fetal heart disease.
Main Methods:
- A population-based cohort study utilizing nationwide data from Finnish registries (2004-2014).
- Analysis of prenatal detection rates across three distinct time periods: prescreening, transition, and screening phases.
- Evaluation of the influence of maternal risk factors (obesity, IVF, diabetes, smoking) on screening efficacy.
Main Results:
- The prenatal detection rate for UVH increased from 50.4% to 82.8%, and for TGA from 12.3% to 41.0% (P < 0.0001).
- Maternal risk factors did not demonstrate a significant effect on prenatal detection rates.
- Substantial regional differences in detection rates were observed across the country.
Conclusions:
- The implementation of a nationwide prenatal anomaly screening program effectively enhanced the detection of UVH and TGA.
- While screening efficacy was not affected by maternal risk factors, regional disparities highlight the need for standardized implementation.
- Establishing structured guidelines and a prospective screening register is recommended to ensure consistent high-quality prenatal screening.
Objective:
To evaluate whether a nationwide prenatal anomaly screening programme improves detection rates of univentricular heart (UVH) and transposition of great arteries (TGA), and whether maternal risk factors for severe fetal heart disease affect prenatal detection.
Design:
Population-based cohort study.
Setting:
Nationwide data from Finnish registries 2004-14.
Population:
A total of 642 456 parturients and 3449 terminated pregnancies due to severe fetal anomaly.
Methods:
Prenatal detection rates were calculated in three time periods (prescreening, transition and screening phase). The effect of maternal risk factors (obesity, in vitro fertilisation, pregestational diabetes and smoking) was evaluated.
Main Outcome Measures:
Change in detection rates and impact of maternal risk factors on screening programme efficacy.
Results:
In total, 483 cases of UVH and 184 of TGA were detected. The prenatal detection rate of UVH increased from 50.4% to 82.8% and of TGA from 12.3% to 41.0% (P < 0.0001). Maternal risk factors did not affect prenatal detection rate, but detection rate differed substantially by region.
Conclusions:
A nationwide screening programme improved overall UVH and TGA detection rates, but regional differences were observed. Obesity or other maternal risk factors did not affect the screening programme efficacy. The establishment of structured guidelines and recommendations is essential when implementing the screening programme. In addition, a prospective screening register is highly recommended to ensure high quality of screening.
Tweetable Abstract:
Implementation of a nationwide prenatal anomaly screening improved detection rates of UVH and TGA.
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