title: Trends and outcomes after prenatal diagnosis of congenital cardiac malformations by fetal echocardiography in a well defined birth population, Atlanta, Georgia, 1990-1994.
abstract: OBJECTIVE
  In this study we used a population-based approach to assess the impact of fetal echocardiography on a well defined birth population with nearly complete ascertainment of cardiac defects.
  
  
  BACKGROUND
  Although fetal echocardiography is being used more frequently in the prenatal diagnosis of congenital cardiac malformations, its impact on the diagnosis and surveillance of cardiac defects has not been described in defined populations.
  
  
  METHODS
  All stillborn and live-born infants with diagnosed cardiac defects and whose mothers resided in the metropolitan Atlanta area from January 1990 through December 1994 were ascertained through an established birth defects surveillance system. All fetuses with cardiac defects diagnosed prenatally by a pediatric of cardiac defects, diagnostic trends and adverse fetal outcomes were described.
  
  
  RESULTS
  We identified 1,589 infants with congenital cardiac malformations, for a live-birth prevalence rate of 8.1/1,000 (95% confidence interval [CI] 7.8 to 8.6). Overall, 97 (6.1%) of these cases of cardiac malformations were diagnosed prenatally. The proportion of cardiac defects diagnosed prenatally rose from 2.6% in 1990 to 12.7% in 1994, a nearly fivefold increase. The proportion of cardiac defects diagnosed prenatally during the study varied by the type of defect, from a low of 4.7% for atrial septal defects to a high of 28% for hypoplastic left heart syndrome. Prenatally diagnosed cardiac malformations were associated with a high incidence of infant mortality (30.9%, 95% CI 2.4 to 5.4) and fetal wastage (17.5%, 95% CI 6.2 to 11.3).
  
  
  CONCLUSIONS
  These data show that fetal echocardiography is being used increasingly in the prenatal diagnosis of congenital cardiac malformations in metropolitan Atlanta. Few pregnancy terminations were reported as a result of such diagnoses. However, the study had limited power (10%) to detect a meaningful decrease in birth prevalence rates for congenital heart disease. In addition, survival of infants was not improved after prenatal diagnosis with fetal echocardiography.
authors.affiliation: Birth Defects and Genetic Diseases Branch, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: E
authors.initials: E
authors.lastname: Montaña
authors.forename: M J
authors.initials: MJ
authors.lastname: Khoury
authors.forename: J D
authors.initials: JD
authors.lastname: Cragan
authors.forename: S
authors.initials: S
authors.lastname: Sharma
authors.forename: P
authors.initials: P
authors.lastname: Dhar
authors.forename: D
authors.initials: D
authors.lastname: Fyfe
mesh_terms: D000328:Adult; D004452:Echocardiography / Q000706:statistics & numerical data; D005260:Female; D005318:Fetal Heart / Q000000981:diagnostic imaging*; D005845:Georgia / Q000453:epidemiology; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D016216:Ultrasonography, Prenatal / Q000706:statistics & numerical data