title: Risk Factors for Coarctation of the Aorta on Prenatal Ultrasound: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Prenatal diagnosis of coarctation of the aorta (CoA) is still challenging and affected by high rates of false-positive diagnoses. The aim of this study was to ascertain the strength of association and to quantify the diagnostic accuracy of different ultrasound signs in predicting CoA prenatally.
  
  
  METHODS
  Medline, Embase, CINAHL, and Cochrane databases were searched. Random-effects and hierarchical summary receiver operating characteristic model meta-analyses were used to analyze the data.
  
  
  RESULTS
  Seven hundred ninety-four articles were identified, and 12 (922 fetuses at risk for CoA) articles were included. Mean mitral valve diameterzscore was lower (P<0.001) and the mean tricuspid valve diameterzscore was higher in fetuses with CoA than in those without CoA (P=0.01). Mean aortic valve diameterzscore was lower in fetuses with CoA than in healthy fetuses (P≤0.001), but the ascending aorta diameter, expressed aszscore or millimeters, was similar between groups (P=0.07 and 0.47, respectively). Mean aortic isthmus diameterzscores measured either in sagittal (P=0.02) or in 3-vessel trachea view (P<0.001) were lower in fetuses with CoA. Conversely, the mean pulmonary artery diameterzscore, the right/left ventricular and pulmonary artery/ascending aorta diameter ratios were higher (P<0.001,P=0.02, andP=0.02, respectively) in fetuses with CoA in comparison with controls, although aortic isthmus/arterial duct diameter ratio was lower in fetuses with CoA than in those without CoA (P<0.001). The presence of coarctation shelf and aortic arch hypoplasia were more common in fetuses with CoA than in controls (odds ratio, 26.0; 95% confidence interval, 4.42-153;P<0.001 and odds ratio, 38.2; 95% confidence interval, 3.01-486;P=0.005), whereas persistent left superior vena cava (P=0.85), ventricular septal defect (P=0.12), and bicuspid aortic valve (P=0.14) did not carry an increased risk for this anomaly. Multiparametric diagnostic models integrating different ultrasound signs for the detection of CoA were associated with an increased detection rate.
  
  
  CONCLUSIONS
  The detection rate of CoA may improve when a multiple-criteria prediction model is adopted. Further large multicenter studies sharing the same imaging protocols are needed to develop objective models for risk assessment in these fetuses.
authors.affiliation: From Department of Maternal-Fetal Medicine, Catholic University of the Sacred Heart, Rome, Italy (A.F., G.D.S., C.V., A.L., G.S.); Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Italy (M.M.); Fetal Medicine Unit, Saint George's Hospital, London, United Kingdom (A.K.); Pediatric Cardiology Unit, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden (S.S.-E.); Department of Obstetrics and Gynecology, IRCCS San Martino Hospital University of Genoa, Italy (C.S.); Department of Obstetrics and Gynaecology, University of TorVergata, Rome, Italy (G.R.); Department of Medicine and Aging Sciences, University of Chieti-Pescara, Italy (M.E.F.); Department of Medical Sciences, University of Ferrara, Italy (L.M.); Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden (G.A.); and Department of Clinical Medicine, UiT- The Arctic University of Norway and Department of Obstetrics and Gynecology, University Hospital of Northern Norway, Tromsø (F.D.A.).
authors.forename: Alessandra
authors.initials: A
authors.lastname: Familiari
authors.affiliation: From Department of Maternal-Fetal Medicine, Catholic University of the Sacred Heart, Rome, Italy (A.F., G.D.S., C.V., A.L., G.S.); Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Italy (M.M.); Fetal Medicine Unit, Saint George's Hospital, London, United Kingdom (A.K.); Pediatric Cardiology Unit, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden (S.S.-E.); Department of Obstetrics and Gynecology, IRCCS San Martino Hospital University of Genoa, Italy (C.S.); Department of Obstetrics and Gynaecology, University of TorVergata, Rome, Italy (G.R.); Department of Medicine and Aging Sciences, University of Chieti-Pescara, Italy (M.E.F.); Department of Medical Sciences, University of Ferrara, Italy (L.M.); Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden (G.A.); and Department of Clinical Medicine, UiT- The Arctic University of Norway and Department of Obstetrics and Gynecology, University Hospital of Northern Norway, Tromsø (F.D.A.).
authors.forename: Maddalena
authors.initials: M
authors.lastname: Morlando
authors.affiliation: From Department of Maternal-Fetal Medicine, Catholic University of the Sacred Heart, Rome, Italy (A.F., G.D.S., C.V., A.L., G.S.); Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Italy (M.M.); Fetal Medicine Unit, Saint George's Hospital, London, United Kingdom (A.K.); Pediatric Cardiology Unit, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden (S.S.-E.); Department of Obstetrics and Gynecology, IRCCS San Martino Hospital University of Genoa, Italy (C.S.); Department of Obstetrics and Gynaecology, University of TorVergata, Rome, Italy (G.R.); Department of Medicine and Aging Sciences, University of Chieti-Pescara, Italy (M.E.F.); Department of Medical Sciences, University of Ferrara, Italy (L.M.); Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden (G.A.); and Department of Clinical Medicine, UiT- The Arctic University of Norway and Department of Obstetrics and Gynecology, University Hospital of Northern Norway, Tromsø (F.D.A.).
authors.forename: Asma
authors.initials: A
authors.lastname: Khalil
authors.affiliation: From Department of Maternal-Fetal Medicine, Catholic University of the Sacred Heart, Rome, Italy (A.F., G.D.S., C.V., A.L., G.S.); Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Italy (M.M.); Fetal Medicine Unit, Saint George's Hospital, London, United Kingdom (A.K.); Pediatric Cardiology Unit, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden (S.S.-E.); Department of Obstetrics and Gynecology, IRCCS San Martino Hospital University of Genoa, Italy (C.S.); Department of Obstetrics and Gynaecology, University of TorVergata, Rome, Italy (G.R.); Department of Medicine and Aging Sciences, University of Chieti-Pescara, Italy (M.E.F.); Department of Medical Sciences, University of Ferrara, Italy (L.M.); Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden (G.A.); and Department of Clinical Medicine, UiT- The Arctic University of Norway and Department of Obstetrics and Gynecology, University Hospital of Northern Norway, Tromsø (F.D.A.).
authors.forename: Sven-Erik
authors.initials: SE
authors.lastname: Sonesson
authors.affiliation: From Department of Maternal-Fetal Medicine, Catholic University of the Sacred Heart, Rome, Italy (A.F., G.D.S., C.V., A.L., G.S.); Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Italy (M.M.); Fetal Medicine Unit, Saint George's Hospital, London, United Kingdom (A.K.); Pediatric Cardiology Unit, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden (S.S.-E.); Department of Obstetrics and Gynecology, IRCCS San Martino Hospital University of Genoa, Italy (C.S.); Department of Obstetrics and Gynaecology, University of TorVergata, Rome, Italy (G.R.); Department of Medicine and Aging Sciences, University of Chieti-Pescara, Italy (M.E.F.); Department of Medical Sciences, University of Ferrara, Italy (L.M.); Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden (G.A.); and Department of Clinical Medicine, UiT- The Arctic University of Norway and Department of Obstetrics and Gynecology, University Hospital of Northern Norway, Tromsø (F.D.A.).
authors.forename: Carolina
authors.initials: C
authors.lastname: Scala
authors.affiliation: From Department of Maternal-Fetal Medicine, Catholic University of the Sacred Heart, Rome, Italy (A.F., G.D.S., C.V., A.L., G.S.); Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Italy (M.M.); Fetal Medicine Unit, Saint George's Hospital, London, United Kingdom (A.K.); Pediatric Cardiology Unit, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden (S.S.-E.); Department of Obstetrics and Gynecology, IRCCS San Martino Hospital University of Genoa, Italy (C.S.); Department of Obstetrics and Gynaecology, University of TorVergata, Rome, Italy (G.R.); Department of Medicine and Aging Sciences, University of Chieti-Pescara, Italy (M.E.F.); Department of Medical Sciences, University of Ferrara, Italy (L.M.); Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden (G.A.); and Department of Clinical Medicine, UiT- The Arctic University of Norway and Department of Obstetrics and Gynecology, University Hospital of Northern Norway, Tromsø (F.D.A.).
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rizzo
authors.affiliation: From Department of Maternal-Fetal Medicine, Catholic University of the Sacred Heart, Rome, Italy (A.F., G.D.S., C.V., A.L., G.S.); Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Italy (M.M.); Fetal Medicine Unit, Saint George's Hospital, London, United Kingdom (A.K.); Pediatric Cardiology Unit, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden (S.S.-E.); Department of Obstetrics and Gynecology, IRCCS San Martino Hospital University of Genoa, Italy (C.S.); Department of Obstetrics and Gynaecology, University of TorVergata, Rome, Italy (G.R.); Department of Medicine and Aging Sciences, University of Chieti-Pescara, Italy (M.E.F.); Department of Medical Sciences, University of Ferrara, Italy (L.M.); Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden (G.A.); and Department of Clinical Medicine, UiT- The Arctic University of Norway and Department of Obstetrics and Gynecology, University Hospital of Northern Norway, Tromsø (F.D.A.).
authors.forename: Gelsomina
authors.initials: G
authors.lastname: Del Sordo
authors.affiliation: From Department of Maternal-Fetal Medicine, Catholic University of the Sacred Heart, Rome, Italy (A.F., G.D.S., C.V., A.L., G.S.); Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Italy (M.M.); Fetal Medicine Unit, Saint George's Hospital, London, United Kingdom (A.K.); Pediatric Cardiology Unit, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden (S.S.-E.); Department of Obstetrics and Gynecology, IRCCS San Martino Hospital University of Genoa, Italy (C.S.); Department of Obstetrics and Gynaecology, University of TorVergata, Rome, Italy (G.R.); Department of Medicine and Aging Sciences, University of Chieti-Pescara, Italy (M.E.F.); Department of Medical Sciences, University of Ferrara, Italy (L.M.); Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden (G.A.); and Department of Clinical Medicine, UiT- The Arctic University of Norway and Department of Obstetrics and Gynecology, University Hospital of Northern Norway, Tromsø (F.D.A.).
authors.forename: Chiara
authors.initials: C
authors.lastname: Vassallo
authors.affiliation: From Department of Maternal-Fetal Medicine, Catholic University of the Sacred Heart, Rome, Italy (A.F., G.D.S., C.V., A.L., G.S.); Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Italy (M.M.); Fetal Medicine Unit, Saint George's Hospital, London, United Kingdom (A.K.); Pediatric Cardiology Unit, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden (S.S.-E.); Department of Obstetrics and Gynecology, IRCCS San Martino Hospital University of Genoa, Italy (C.S.); Department of Obstetrics and Gynaecology, University of TorVergata, Rome, Italy (G.R.); Department of Medicine and Aging Sciences, University of Chieti-Pescara, Italy (M.E.F.); Department of Medical Sciences, University of Ferrara, Italy (L.M.); Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden (G.A.); and Department of Clinical Medicine, UiT- The Arctic University of Norway and Department of Obstetrics and Gynecology, University Hospital of Northern Norway, Tromsø (F.D.A.).
authors.forename: Maria
authors.initials: M
authors.lastname: Elena Flacco
authors.affiliation: From Department of Maternal-Fetal Medicine, Catholic University of the Sacred Heart, Rome, Italy (A.F., G.D.S., C.V., A.L., G.S.); Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Italy (M.M.); Fetal Medicine Unit, Saint George's Hospital, London, United Kingdom (A.K.); Pediatric Cardiology Unit, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden (S.S.-E.); Department of Obstetrics and Gynecology, IRCCS San Martino Hospital University of Genoa, Italy (C.S.); Department of Obstetrics and Gynaecology, University of TorVergata, Rome, Italy (G.R.); Department of Medicine and Aging Sciences, University of Chieti-Pescara, Italy (M.E.F.); Department of Medical Sciences, University of Ferrara, Italy (L.M.); Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden (G.A.); and Department of Clinical Medicine, UiT- The Arctic University of Norway and Department of Obstetrics and Gynecology, University Hospital of Northern Norway, Tromsø (F.D.A.).
authors.forename: Lamberto
authors.initials: L
authors.lastname: Manzoli
authors.affiliation: From Department of Maternal-Fetal Medicine, Catholic University of the Sacred Heart, Rome, Italy (A.F., G.D.S., C.V., A.L., G.S.); Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Italy (M.M.); Fetal Medicine Unit, Saint George's Hospital, London, United Kingdom (A.K.); Pediatric Cardiology Unit, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden (S.S.-E.); Department of Obstetrics and Gynecology, IRCCS San Martino Hospital University of Genoa, Italy (C.S.); Department of Obstetrics and Gynaecology, University of TorVergata, Rome, Italy (G.R.); Department of Medicine and Aging Sciences, University of Chieti-Pescara, Italy (M.E.F.); Department of Medical Sciences, University of Ferrara, Italy (L.M.); Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden (G.A.); and Department of Clinical Medicine, UiT- The Arctic University of Norway and Department of Obstetrics and Gynecology, University Hospital of Northern Norway, Tromsø (F.D.A.).
authors.forename: Antonio
authors.initials: A
authors.lastname: Lanzone
authors.affiliation: From Department of Maternal-Fetal Medicine, Catholic University of the Sacred Heart, Rome, Italy (A.F., G.D.S., C.V., A.L., G.S.); Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Italy (M.M.); Fetal Medicine Unit, Saint George's Hospital, London, United Kingdom (A.K.); Pediatric Cardiology Unit, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden (S.S.-E.); Department of Obstetrics and Gynecology, IRCCS San Martino Hospital University of Genoa, Italy (C.S.); Department of Obstetrics and Gynaecology, University of TorVergata, Rome, Italy (G.R.); Department of Medicine and Aging Sciences, University of Chieti-Pescara, Italy (M.E.F.); Department of Medical Sciences, University of Ferrara, Italy (L.M.); Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden (G.A.); and Department of Clinical Medicine, UiT- The Arctic University of Norway and Department of Obstetrics and Gynecology, University Hospital of Northern Norway, Tromsø (F.D.A.).
authors.forename: Giovanni
authors.initials: G
authors.lastname: Scambia
authors.affiliation: From Department of Maternal-Fetal Medicine, Catholic University of the Sacred Heart, Rome, Italy (A.F., G.D.S., C.V., A.L., G.S.); Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Italy (M.M.); Fetal Medicine Unit, Saint George's Hospital, London, United Kingdom (A.K.); Pediatric Cardiology Unit, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden (S.S.-E.); Department of Obstetrics and Gynecology, IRCCS San Martino Hospital University of Genoa, Italy (C.S.); Department of Obstetrics and Gynaecology, University of TorVergata, Rome, Italy (G.R.); Department of Medicine and Aging Sciences, University of Chieti-Pescara, Italy (M.E.F.); Department of Medical Sciences, University of Ferrara, Italy (L.M.); Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden (G.A.); and Department of Clinical Medicine, UiT- The Arctic University of Norway and Department of Obstetrics and Gynecology, University Hospital of Northern Norway, Tromsø (F.D.A.).
authors.forename: Ganesh
authors.initials: G
authors.lastname: Acharya
authors.affiliation: From Department of Maternal-Fetal Medicine, Catholic University of the Sacred Heart, Rome, Italy (A.F., G.D.S., C.V., A.L., G.S.); Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Italy (M.M.); Fetal Medicine Unit, Saint George's Hospital, London, United Kingdom (A.K.); Pediatric Cardiology Unit, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden (S.S.-E.); Department of Obstetrics and Gynecology, IRCCS San Martino Hospital University of Genoa, Italy (C.S.); Department of Obstetrics and Gynaecology, University of TorVergata, Rome, Italy (G.R.); Department of Medicine and Aging Sciences, University of Chieti-Pescara, Italy (M.E.F.); Department of Medical Sciences, University of Ferrara, Italy (L.M.); Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden (G.A.); and Department of Clinical Medicine, UiT- The Arctic University of Norway and Department of Obstetrics and Gynecology, University Hospital of Northern Norway, Tromsø (F.D.A.). francesco.dantonio@uit.no.
authors.forename: Francesco
authors.initials: F
authors.lastname: D'Antonio
mesh_terms: D001011:Aorta / Q000000981:diagnostic imaging / Q000503:physiopathology; D001017:Aortic Coarctation / Q000175:diagnosis* / Q000000981:diagnostic imaging; D016208:Databases, Factual; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D011247:Pregnancy; D011296:Prenatal Diagnosis; D012307:Risk Factors; D016216:Ultrasonography, Prenatal
keywords: aortic coarctation; fetal echocardiography; heart defects, congenital; prenatal diagnosis