Pediatric Cardiology

, Volume 34, Issue 3, pp 597–605

Prenatal Diagnosis of Congenital Heart Disease and Birth Outcomes

  • Benjamin J. Landis
  • Allison Levey
  • Stephanie M. Levasseur
  • Julie S. Glickstein
  • Charles S. Kleinman
  • Lynn L. Simpson
  • Ismee A. Williams
Original Article


This study was undertaken to examine the impact that prenatal diagnosis of congenital heart disease (CHD) has on birth and early neonatal outcomes. The prevalence of prenatally diagnosed CHD has risen over the past decade, but the effect that prenatal diagnosis of CHD has on peripartum decisions remains unclear. No consensus exists on the effect of prenatal diagnosis on neonatal outcomes. Between January 2004 and July 2009, a retrospective chart review of all neonates with CHD admitted to our institution’s neonatal intensive care unit was conducted. Obstetric and postnatal variables were collected. Among the 993 subjects, 678 (68.3 %) had a prenatal diagnosis. A prenatal diagnosis increased the odds of a scheduled delivery [odds ratio (OR) 4.1, 95 % confidence interval (CI) 3.0–5.6] and induction of labor (OR 11.5, 95 % CI 6.6–20.1). Prenatal diagnosis was not significantly associated with cesarean delivery when control was used for maternal age, multiple gestation, and presence of extracardiac anomaly. Mean gestational age had no impact on prenatal diagnosis, but prenatal diagnosis was associated with increased odds of delivery before a gestational age of 39 weeks (OR 1.5, 95 % CI 1.1–1.9) and decreased odds of preoperative intubation (OR 0.5, 95 % CI 0.3–0.6). Prenatal diagnosis did not have an impact on preoperative or predischarge mortality. Prenatal diagnosis was associated with increased odds of a scheduled delivery, birth before a gestational age of 39 weeks, and a decreased need for invasive respiratory support. Prenatal diagnosis of CHD was not associated with preoperative or predischarge mortality.


Birth Congenital heart disease Neonatal Obstetrical Outcomes Prenatal diagnosis 


  1. 1.
    Abenhaim HA, Benjamin A (2011) Effect of prior cesarean delivery on neonatal outcomes. J Perinat Med 39:241–244PubMedCrossRefGoogle Scholar
  2. 2.
    Atz AM, Travison TG, Williams IA et al (2010) Prenatal diagnosis and risk factors for preoperative death in neonates with single right ventricle and systemic outflow obstruction: screening data from the Pediatric Heart Network Single Ventricle Reconstruction Trial(*). J Thorac Cardiovasc Surg 140:1245–1250PubMedCrossRefGoogle Scholar
  3. 3.
    Bonnet D, Coltri A, Butera G et al (1999) Detection of transposition of the great arteries in fetuses reduces neonatal morbidity and mortality. Circulation 99:916–918PubMedCrossRefGoogle Scholar
  4. 4.
    Brown KL, Ridout DA, Hoskote A, Verhulst L, Ricci M, Bull C (2006) Delayed diagnosis of congenital heart disease worsens preoperative condition and outcome of surgery in neonates. Heart 92:1298–1302PubMedCrossRefGoogle Scholar
  5. 5.
    Cedergren MI, Kallen BA (2006) Obstetric outcome of 6,346 pregnancies with infants affected by congenital heart defects. Eur J Obstet Gynecol Reprod Biol 125:211–216PubMedCrossRefGoogle Scholar
  6. 6.
    Chang RR, Gurvitz M, Rodriguez S (2008) Missed diagnosis of critical congenital heart disease. Arch Pediatr Adolesc Med 162:969–974PubMedCrossRefGoogle Scholar
  7. 7.
    Chew C, Halliday JL, Riley MM, Penny DJ (2007) Population-based study of antenatal detection of congenital heart disease by ultrasound examination. Ultrasound Obstet Gynecol 29:619–624PubMedCrossRefGoogle Scholar
  8. 8.
    Costello JM, Polito A, Brown DW et al (2010) Birth before 39 weeks’ gestation is associated with worse outcomes in neonates with heart disease. Pediatrics 126:277–284PubMedCrossRefGoogle Scholar
  9. 9.
    Daubeney PE, Sharland GK, Cook AC, Keeton BR, Anderson RH, Webber SA (1998) Pulmonary atresia with intact ventricular septum: impact of fetal echocardiography on incidence of birth and postnatal outcome. Circulation 98:562–566PubMedCrossRefGoogle Scholar
  10. 10.
    De Luca R, Boulvain M, Irion O, Berner M, Pfister RE (2009) Incidence of early neonatal mortality and morbidity after late preterm and term cesarean delivery. Pediatrics 123:e1064–e1071PubMedCrossRefGoogle Scholar
  11. 11.
    Eapen RS, Rowland DG, Franklin WH (1998) Effect of prenatal diagnosis of critical left heart obstruction on perinatal morbidity and mortality. Am J Perinatol 15:237–242PubMedCrossRefGoogle Scholar
  12. 12.
    Franklin O, Burch M, Manning N, Sleeman K, Gould S, Archer N (2002) Prenatal diagnosis of coarctation of the aorta improves survival and reduces morbidity. Heart 87:67–69PubMedCrossRefGoogle Scholar
  13. 13.
    Friedberg MK, Silverman NH, Moon-Grady AJ et al (2009) Prenatal detection of congenital heart disease. J Pediatr 155:26–31PubMedCrossRefGoogle Scholar
  14. 14.
    Hofbeck M, Beinder M, Kirchgessner E, Buheitel G, Singer H (1997) Perinatal management of children with prenatal diagnosis of congenital heart defects. Z Geburtshilfe Neonatal 201:49–54Google Scholar
  15. 15.
    Khoshnood B, De Vigan C, Vodovar V et al (2005) Trends in prenatal diagnosis, pregnancy termination, and perinatal mortality of newborns with congenital heart disease in France, 1983–2000: a population-based evaluation. Pediatrics 115:95–101PubMedGoogle Scholar
  16. 16.
    Kuller JA, Katz VL, Wells SR, Wright LN, McMahon MJ (1996) Cesarean delivery for fetal malformations. Obstet Gynecol Surv 51:371–375PubMedCrossRefGoogle Scholar
  17. 17.
    Kumar RK, Newburger JW, Gauvreau K, Kamenir SA, Hornberger LK (1999) Comparison of outcome when hypoplastic left heart syndrome and transposition of the great arteries are diagnosed prenatally versus when diagnosis of these two conditions is made only postnatally. Am J Cardiol 83:1649–1653PubMedCrossRefGoogle Scholar
  18. 18.
    Lee YM, D’Alton ME (2008) Cesarean delivery on maternal request: the impact on mother and newborn. Clin Perinatol 35:505–518PubMedCrossRefGoogle Scholar
  19. 19.
    Mahle WT, Clancy RR, McGaurn SP, Goin JE, Clark BJ (2001) Impact of prenatal diagnosis on survival and early neurologic morbidity in neonates with the hypoplastic left heart syndrome. Pediatrics 107:1277–1282PubMedCrossRefGoogle Scholar
  20. 20.
    Martin JA (2010) Births: final data for 2007. Natl Vital Stat Rep 58:1–85PubMedGoogle Scholar
  21. 21.
    Mellander M (2005) Perinatal management, counselling and outcome of fetuses with congenital heart disease. Semin Fetal Neonatal Med 10:586–593PubMedCrossRefGoogle Scholar
  22. 22.
    Montana E, Khoury MJ, Cragan JD et al (1996) Trends and outcomes after prenatal diagnosis of congenital cardiac malformations by fetal echocardiography in a well defined birth population, Atlanta, Georgia, 1990–1994. J Am Coll Cardiol 28:1805–1809PubMedCrossRefGoogle Scholar
  23. 23.
    Morrison JJ, Rennie JM, Milton PJ (1995) Neonatal respiratory morbidity and mode of delivery at term: influence of timing of elective cesarean section. Br J Obstet Gynaecol 102:101–106PubMedCrossRefGoogle Scholar
  24. 24.
    [No authors listed] (2006) NIH State-of-the-Science Conference Statement on cesarean delivery on maternal request. NIH Consens State Sci Statements 23:1–29Google Scholar
  25. 25.
    Rasiah SV, Ewer AK, Miller P et al (2008) Antenatal perspective of hypoplastic left heart syndrome: 5 years on. Arch Dis Child Fetal Neonatal Ed 93:F192–F197PubMedCrossRefGoogle Scholar
  26. 26.
    Reis PM, Punch MR, Bove EL, van de Ven CJ (1998) Obstetric management of 219 infants with hypoplastic left heart syndrome. Am J Obstet Gynecol 179:1150–1154PubMedCrossRefGoogle Scholar
  27. 27.
    Sharland GK, Lockhart SM, Chita SK, Allan LD (1991) Factors influencing the outcome of congenital heart disease detected prenatally. Arch Dis Child 66:284–287PubMedCrossRefGoogle Scholar
  28. 28.
    Signore C (2008) Neonatal morbidity and mortality after elective cesarean delivery. Clin Perinatol 35:361–371PubMedCrossRefGoogle Scholar
  29. 29.
    Sivarajan V, Penny DJ, Filan P, Brizard C, Shekerdemian LS (2009) Impact of antenatal diagnosis of hypoplastic left heart syndrome on the clinical presentation and surgical outcomes: the Australian experience. J Paediatr Child Health 45:112–117PubMedCrossRefGoogle Scholar
  30. 30.
    Tita AT, Landon MB, Spong CY et al (2009) Timing of elective repeat cesarean delivery at term and neonatal outcomes. N Engl J Med 360:111–120PubMedCrossRefGoogle Scholar
  31. 31.
    Tworetzky W, McElhinney DB, Reddy VM, Brook MM, Hanley FL, Silverman NH (2001) Improved surgical outcome after fetal diagnosis of hypoplastic left heart syndrome. Circulation 103:1269–1273PubMedCrossRefGoogle Scholar
  32. 32.
    Tzifa A, Barker C, Tibby SM, Simpson JM (2007) Prenatal diagnosis of pulmonary atresia: impact on clinical presentation and early outcome. Arch Dis Child Fetal Neonatal Ed 92:F199–F203PubMedCrossRefGoogle Scholar
  33. 33.
    Verheijen PM, Lisowski LA, Stoutenbeek P et al (2001) Prenatal diagnosis of congenital heart disease affects preoperative acidosis in the newborn patient. J Thorac Cardiovasc Surg 121:798–803PubMedCrossRefGoogle Scholar
  34. 34.
    Williams IA, Shaw R, Kleinman CS et al (2008) Parental understanding of neonatal congenital heart disease. Pediatr Cardiol 29:1059–1065PubMedCrossRefGoogle Scholar
  35. 35.
    Zanardo V, Simbi AK, Franzoi M, Solda G, Salvadori A, Trevisanuto D (2004) Neonatal respiratory morbidity risk and mode of delivery at term: influence of timing of elective cesarean delivery. Acta Paediatr 93:643–647PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Benjamin J. Landis
    • 1
  • Allison Levey
    • 1
  • Stephanie M. Levasseur
    • 1
  • Julie S. Glickstein
    • 1
  • Charles S. Kleinman
    • 1
  • Lynn L. Simpson
    • 2
  • Ismee A. Williams
    • 1
  1. 1.Division of Pediatric Cardiology, Department of PediatricsMorgan Stanley Children’s Hospital of New York-Presbyterian, Columbia University Medical CenterNew YorkUSA
  2. 2.Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Center for Prenatal PediatricsMorgan Stanley Children’s Hospital of New York-Presbyterian, Columbia University Medical CenterNew YorkUSA

Personalised recommendations