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Non-reassuring fetal heart rate patterns: Is it a risk factor for long- term pediatric cardiovascular diseases of the
Noa Leybovitz-Haleluya1, Tamar Wainstock2, Gali Pariente1
1Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Insights
Non-reassuring fetal heart rate (NRFHR) patterns during delivery do not increase the risk of long-term cardiovascular problems in children. This study found no significant difference in pediatric cardiovascular hospitalizations between NRFHR and normal fetal heart rate groups.
Area of Science:
- Obstetrics and Gynecology
- Pediatric Cardiology
- Perinatal Medicine
Background:
- Non-reassuring fetal heart rate (NRFHR) patterns are a critical indicator of potential fetal distress during labor.
- The long-term impact of NRFHR on offspring cardiovascular health remains an area of ongoing research.
- Understanding these risks is crucial for optimizing perinatal care and long-term child health outcomes.
Purpose of the Study:
- To investigate the association between NRFHR patterns and the risk of subsequent pediatric cardiovascular morbidity.
- To compare cardiovascular-related hospitalizations in offspring born via cesarean delivery due to NRFHR versus those born due to labor dystocia with normal fetal heart rate.
- To provide evidence-based insights into the long-term health consequences of intrapartum fetal monitoring findings.
Main Methods:
- Population-based cohort study including singletons born between 1999-2014.
- Comparison of cardiovascular morbidity hospitalizations between offspring born by cesarean delivery due to NRFHR and those born due to labor dystocia.
- Utilized Kaplan-Meier survival curves and Cox proportional hazards models to analyze cumulative incidence and adjust for confounders.
- Defined cardiovascular morbidity based on ICD-9 codes recorded in hospital records.
Main Results:
- The study included 9956 newborns; 5810 (58%) were born by cesarean delivery due to NRFHR, and 4146 (42%) due to labor dystocia.
- Long-term cardiovascular-related hospitalization rates were similar between the NRFHR group (0.8%) and the labor dystocia group (0.7%).
- Cox proportional hazards analysis, controlling for gestational age, found no significant association between NRFHR patterns and subsequent pediatric cardiovascular morbidity (Adjusted HR = 0.8, p=0.376).
Conclusions:
- Intrapartum non-reassuring fetal heart rate patterns, as assessed in this study, do not appear to elevate the risk for long-term pediatric cardiovascular morbidity.
- The findings suggest that cesarean delivery for NRFHR does not predispose offspring to future cardiovascular issues compared to delivery for labor dystocia.
- Further research may explore other potential long-term outcomes or specific subgroups.
Objective:
We aimed to study the long-term effect of non-reassuring fetal heart rate (NRFHR) patterns on the risk for subsequent pediatric cardiovascular morbidity of the offspring.
Study Design:
A population based cohort study, comparing total and different subtypes of cardiovascular morbidity related pediatric hospitalizations among offspring born by caesarean delivery (CD) due to NRFHR versus labor dystocia (failure of labor to progress during the 1st or 2nd stage). The analysis included all singletons born between the years 1999-2014 at a single tertiary regional medical center. Cardiovascular related morbidities included hospitalizations involving a pre-defined set of ICD-9 codes, as recorded in hospital computerized files. Infants with congenital malformations, multiple gestations, vaginal deliveries and vacuum failure were excluded from the analysis. Perinatal mortality cases were excluded from the long-term analysis. A Kaplan-Meier survival curve was used to compare the cumulative cardiovascular morbidity incidence, and a Cox proportional hazards model was used to adjust for confounders.
Results:
The study population included 9956 newborns who met inclusion criteria; among them, 5810 (58%) were born by CD due to NRFHR, and 4146 (42%) due to labor dystocia with normal FHR (comparison group). Rate of long- term cardiovascular related hospitalizations was comparable between both groups (0.8% vs. 0.7%, OR 0.9, 95% CI 0.6-1.4, p = 0.664; Kaplan-Meier survival curve p = 0.320(. Using a Cox proportional hazards model, controlling for gestational age, no association was found between NRFHR patterns and the risk for subsequent pediatric cardiovascular morbidity of the offspring (Adjusted HR = 0.8, 95% CI 0.5-1.3, p = 0.376).
Conclusion:
In our population, NRFHR patterns do not affect the risk of long- term pediatric cardiovascular morbidity of the offspring.
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