胎児疾患の出生前診断後の妊娠継続：その推移と影響

To evaluate trends in continued pregnancies following a prenatal diagnosis of severe fetal conditions eligible for termination under French law, as well as the associated perinatal outcome.

We conducted a time-series analysis from 2008 to 2022 using public data from the French National Institute of Statistics and the Biomedicine Agency. Indicators, expressed per 1,000 live births, included the number of severe fetal conditions identified antenatally, authorizations for termination of pregnancy, continued pregnancies, overall neonatal mortality, and pregnancy outcomes in case of continuation.

Between 2008 and 2022, the number of severe fetal conditions identified antenatally increased from 8.70 to 12.09 per 1,000 live births. Over the same period, the rate of continued pregnancies rose from 0.60 to 2.69 per 1,000 live births. This increase was significantly less pronounced than the overall rise in severe fetal conditions diagnosed antenatally (p < 0.001).Among continued pregnancies, the proportion of neonates alive at day 28 increased. Neonatal mortality following pregnancy continuation also increased, but at a slower rate than pregnancy continuation, without a specific contribution to the overall trend in neonatal mortality.

Our findings highlight an evolution in pregnancy outcomes following prenatal diagnosis of severe fetal conditions, raising major clinical, ethical, and organizational challenges, and underscoring the need to strengthen perinatal indicators to better inform public health policies.