title: Timing and Mode of Delivery in Prenatally Diagnosed Congenital Heart Disease- an Analysis of Practices within the University of California Fetal Consortium (UCfC).
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.
authors.affiliation: 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@ucsf.edu.
authors.forename: Shabnam
authors.initials: S
authors.lastname: Peyvandi
authors.affiliation: Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors.forename: Tina Ahn Thu Thi
authors.initials: TA
authors.lastname: Nguyen
authors.affiliation: Division of Cardiology, University of California Irvine and Children's Hospital of Orange County, Orange, CA, USA.
authors.forename: Myriam
authors.initials: M
authors.lastname: Almeida-Jones
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetric and Gynecology, University of California, Davis, CA, USA.
authors.forename: Nina
authors.initials: N
authors.lastname: Boe
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetric and Gynecology, University of California, Davis, CA, USA.
authors.forename: Laila
authors.initials: L
authors.lastname: Rhee
authors.affiliation: Division of Maternal Fetal Medicine, Department of Reproductive Medicine, University of California, San Diego, CA, USA.
authors.forename: Tracy
authors.initials: T
authors.lastname: Anton
authors.affiliation: Division of Cardiology, Mattel Children's Hospital and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Sklansky
authors.affiliation: Division of Maternal Fetal Medicine, Department of Reproductive Medicine, University of California, San Diego, CA, USA.
authors.forename: Maryam
authors.initials: M
authors.lastname: Tarsa
authors.affiliation: Division of Cardiology, Mattel Children's Hospital and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
authors.forename: Gary
authors.initials: G
authors.lastname: Satou
authors.affiliation: 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.
authors.forename: Anita J
authors.initials: AJ
authors.lastname: Moon-Grady
mesh_terms: D000328:Adult; D001724:Birth Weight; D002140:California; D036861:Delivery, Obstetric / Q000379:methods*; D004452:Echocardiography; D005260:Female; D005333:Fetus / Q000000981:diagnostic imaging; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000175:diagnosis*; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011296:Prenatal Diagnosis; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Congenital heart disease; Outcomes; Prenatal diagnosis