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Timing and Mode of Delivery in Prenatally Diagnosed Congenital Heart Disease- an Analysis of Practices within the University of California Fetal Consortium (UCfC)

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Abstract

Prenatal diagnosis of critical congenital heart disease (CHD) is associated with decreased morbidity. It is also associated with lower birth weights and earlier gestational age at delivery. The University of California Fetal Consortium (UCfC) comprises five tertiary medical centers, and was created to define treatment practices. We utilized this consortium to assess delivery patterns and outcomes in subjects with prenatal and postnatal diagnosis of CHD. A retrospective cohort study was conducted on maternal–neonatal pairs diagnosed with complex CHD prenatally (n = 186) and postnatally (n = 110) from 2011 to 2013. Outcomes were assessed between groups after adjusting for disease severity. Prenatally diagnosed subjects were born earlier (38.1 ± 0.11 vs. 39 ± 0.14 weeks, p = < 0.001), and had lower birth weights (2853 ± 49 vs. 3074 ± 58 g, p = 0.005) as compared to postnatal diagnosis. For every week increase in gestational age and 100 g increase in birth weight, length of stay decreased by 12.3 ± 2.7% (p < 0.001) and 3.9 ± 0.9% (p < 0.001). Subjects with prenatal diagnosis were more often born via cesarean both planned (35.6 vs. 26.2%, p = 0.004) and after a trial of labor (13 vs. 7.8%, p = 0.017). Neonates with cesarean delivery trended toward a longer length of stay (2.6 days longer), and were born earlier as compared to other modalities (37.7 ± 0.22 weeks, p = 0.001). Management after prenatal diagnosis of CHD appears to have modifiable disadvantages for maternal and neonatal outcomes. The UCfC provides a platform to study best practices and standardization of care for future studies.

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Acknowledgements

We would like to thank Jeffrey Gornbein, PhD (UCLA) for his assistance with statistical analysis and review of the manuscript.

Funding

Dr. Peyvandi is supported by the NIH (P01 NS082330).

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    Authors and Affiliations

    1. Division of Pediatric Cardiology and the Fetal Treatment Center, University of California San Francisco Benioff Children’s Hospital, 550 16th street, 5th floor, San Francisco, CA, 94158, USA

      Shabnam Peyvandi & Anita J. Moon-Grady

    2. Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA

      Tina Ahn Thu Thi Nguyen

    3. Division of Cardiology, Mattel Children’s Hospital and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA

      Mark Sklansky & Gary Satou

    4. Division of Cardiology, University of California Irvine and Children’s Hospital of Orange County, Orange, CA, USA

      Myriam Almeida-Jones

    5. Division of Maternal-Fetal Medicine, Department of Obstetric and Gynecology, University of California, Davis, CA, USA

      Nina Boe & Laila Rhee

    6. Division of Maternal Fetal Medicine, Department of Reproductive Medicine, University of California, San Diego, CA, USA

      Tracy Anton & Maryam Tarsa

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    Correspondence to Shabnam Peyvandi.

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    This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was not required in this study due to the d-identified and retrospective nature of the data. A multi-institutional review board reliance registry provided approval for the study (IRB #10-04093).

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    Shabnam Peyvandi and Tina Ahn Thu Thi Nguyen have contributed equally.

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    Peyvandi, S., Nguyen, T.A.T.T., Almeida-Jones, M. et al. Timing and Mode of Delivery in Prenatally Diagnosed Congenital Heart Disease- an Analysis of Practices within the University of California Fetal Consortium (UCfC). Pediatr Cardiol 38, 588–595 (2017). https://doi.org/10.1007/s00246-016-1552-y

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