title: Chromosomal anomalies influence parental treatment decisions in relation to prenatally diagnosed congenital heart disease.
abstract: This study aimed to identify the variables that influence parental treatment decisions after a prenatal diagnosis of congenital heart disease (CHD). The authors reviewed all cases of prenatally diagnosed structural CHD from August 1998 to December 2006 at their center. The following variables were studied as potential predictors of parental intent to treat: maternal age, race, insurance status, obstetric history, fetal gender, univentricular versus biventricular cardiac physiology, and fetal chromosomal abnormality. Uni- and multivariable logistic regression analyses were performed. In the review, 252 consecutive cases of prenatally diagnosed CHD were identified. Of these, 204 women pursued full medical treatment, whereas 25 women sought termination of pregnancy or comfort care. Parental intent to treat was unknown for 23 cases. Multivariable logistic regression analysis identified fetal chromosomal abnormality as the only variable that influenced parental intent to treat (odds ratio [OR], 14.33; 95% confidence interval [CI], 3.28-62.66; p = 0.0006). An associated chromosomal abnormality rather than the severity of the heart defect influences the decision to choose termination of pregnancy or comfort care for a fetus with prenatally diagnosed CHD. Women were 14 times more likely to terminate a pregnancy or seek comfort care for a fetus with CHD if a chromosomal abnormality was present.
authors.affiliation: Department of Pediatric Cardiology, Medical University of South Carolina, Charleston, SC 29425, USA. chois@musc.edu
authors.forename: Sinai C
authors.initials: SC
authors.lastname: Zyblewski
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: Hill
authors.forename: Girish
authors.initials: G
authors.lastname: Shirali
authors.forename: Andrew
authors.initials: A
authors.lastname: Atz
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Forbus
authors.forename: Javier
authors.initials: J
authors.lastname: Gonzalez
authors.forename: Anthony
authors.initials: A
authors.lastname: Hlavacek
mesh_terms: D000293:Adolescent; D000328:Adult; D000649:Amniocentesis; D002309:Cardiology; D002869:Chromosome Aberrations; D016001:Confidence Intervals; D003657:Decision Making; D004452:Echocardiography / Q000379:methods; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000196:embryology / Q000235:genetics*; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D008423:Maternal Age; D015999:Multivariate Analysis; D016017:Odds Ratio; D010290:Parents / Q000523:psychology*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D016216:Ultrasonography, Prenatal; D055815:Young Adult
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