title: Does First-Trimester Screening Modify the Natural History of Congenital Heart Disease? Analysis of Outcome of Regional Cardiac Screening at 2 Different Time Periods.
abstract: BACKGROUND
  The study analyzed the impact of first-trimester screening on the spectrum of congenital heart defects (CHDs) later in pregnancy and on the outcome of fetuses and children born alive with a CHD.
  
  
  METHODS
  The spectrum of CHDs, associated comorbidities, and outcome of fetuses, either diagnosed with a CHD in the first trimester (Group I, 127 fetuses) or only in the second-trimester screening (Group II, 344 fetuses), were analyzed retrospectively between 2007 and 2013. Second-trimester fetuses diagnosed with a CHD between 2007 and 2013 were also compared with Group III (532 fetuses diagnosed with a CHD in the second trimester from 1996 to 2001, the period before first-trimester screening was introduced).
  
  
  RESULTS
  The spectrum of CHDs diagnosed in the first and second trimesters in the same time period differed significantly, with a greater number of comorbidities (P<0.0001), CHDs with univentricular outcome (P<0.0001), intrauterine deaths (P=0.01), and terminations of pregnancy (P<0.0001) in Group I compared with Group II. In Group III, significantly more cases of CHDs with univentricular outcome (P<0.0001), intrauterine demise (P=0.036), and early termination (P<0.0001) were identified compared with fetuses diagnosed with CHDs in the second trimester between 2007 and 2013. The spectrum of CHDs seen in the second-trimester groups differed after first-trimester screening was implemented.
  
  
  CONCLUSIONS
  First-trimester screening had a significant impact on the spectrum of CHDs and the outcomes of pregnancies with CHDs diagnosed in the second trimester. Early detection of severe forms of CHDs and significant comorbidities resulted in an increased pregnancy termination rate in the first trimester.
authors.affiliation: From Department of Pediatric Cardiology, University Hospital Brno and Faculty of Medicine, Masaryk University, Czech Republic (H.J.); Fetal Medicine Center, Brno, Czech Republic (H.J., P.V., I.G.); Children's Heart Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic (M.J., V.T., J.S., J.M.); University Hospital Sv. Anny, Brno, Czech Republic (I.G.); Louisiana State University Health-New Orleans, School of Public Health (J.V.); and Great Ormond Street Hospital for Children and Institute of Cardiovascular Sciences UCL, London, UK (J.M.). hjicinska@seznam.cz.
authors.forename: Hana
authors.initials: H
authors.lastname: Jicinska
authors.affiliation: From Department of Pediatric Cardiology, University Hospital Brno and Faculty of Medicine, Masaryk University, Czech Republic (H.J.); Fetal Medicine Center, Brno, Czech Republic (H.J., P.V., I.G.); Children's Heart Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic (M.J., V.T., J.S., J.M.); University Hospital Sv. Anny, Brno, Czech Republic (I.G.); Louisiana State University Health-New Orleans, School of Public Health (J.V.); and Great Ormond Street Hospital for Children and Institute of Cardiovascular Sciences UCL, London, UK (J.M.).
authors.forename: Pavel
authors.initials: P
authors.lastname: Vlasin
authors.affiliation: From Department of Pediatric Cardiology, University Hospital Brno and Faculty of Medicine, Masaryk University, Czech Republic (H.J.); Fetal Medicine Center, Brno, Czech Republic (H.J., P.V., I.G.); Children's Heart Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic (M.J., V.T., J.S., J.M.); University Hospital Sv. Anny, Brno, Czech Republic (I.G.); Louisiana State University Health-New Orleans, School of Public Health (J.V.); and Great Ormond Street Hospital for Children and Institute of Cardiovascular Sciences UCL, London, UK (J.M.).
authors.forename: Michal
authors.initials: M
authors.lastname: Jicinsky
authors.affiliation: From Department of Pediatric Cardiology, University Hospital Brno and Faculty of Medicine, Masaryk University, Czech Republic (H.J.); Fetal Medicine Center, Brno, Czech Republic (H.J., P.V., I.G.); Children's Heart Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic (M.J., V.T., J.S., J.M.); University Hospital Sv. Anny, Brno, Czech Republic (I.G.); Louisiana State University Health-New Orleans, School of Public Health (J.V.); and Great Ormond Street Hospital for Children and Institute of Cardiovascular Sciences UCL, London, UK (J.M.).
authors.forename: Ilga
authors.initials: I
authors.lastname: Grochova
authors.affiliation: From Department of Pediatric Cardiology, University Hospital Brno and Faculty of Medicine, Masaryk University, Czech Republic (H.J.); Fetal Medicine Center, Brno, Czech Republic (H.J., P.V., I.G.); Children's Heart Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic (M.J., V.T., J.S., J.M.); University Hospital Sv. Anny, Brno, Czech Republic (I.G.); Louisiana State University Health-New Orleans, School of Public Health (J.V.); and Great Ormond Street Hospital for Children and Institute of Cardiovascular Sciences UCL, London, UK (J.M.).
authors.forename: Viktor
authors.initials: V
authors.lastname: Tomek
authors.affiliation: From Department of Pediatric Cardiology, University Hospital Brno and Faculty of Medicine, Masaryk University, Czech Republic (H.J.); Fetal Medicine Center, Brno, Czech Republic (H.J., P.V., I.G.); Children's Heart Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic (M.J., V.T., J.S., J.M.); University Hospital Sv. Anny, Brno, Czech Republic (I.G.); Louisiana State University Health-New Orleans, School of Public Health (J.V.); and Great Ormond Street Hospital for Children and Institute of Cardiovascular Sciences UCL, London, UK (J.M.).
authors.forename: Julia
authors.initials: J
authors.lastname: Volaufova
authors.affiliation: From Department of Pediatric Cardiology, University Hospital Brno and Faculty of Medicine, Masaryk University, Czech Republic (H.J.); Fetal Medicine Center, Brno, Czech Republic (H.J., P.V., I.G.); Children's Heart Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic (M.J., V.T., J.S., J.M.); University Hospital Sv. Anny, Brno, Czech Republic (I.G.); Louisiana State University Health-New Orleans, School of Public Health (J.V.); and Great Ormond Street Hospital for Children and Institute of Cardiovascular Sciences UCL, London, UK (J.M.).
authors.forename: Jan
authors.initials: J
authors.lastname: Skovranek
authors.affiliation: From Department of Pediatric Cardiology, University Hospital Brno and Faculty of Medicine, Masaryk University, Czech Republic (H.J.); Fetal Medicine Center, Brno, Czech Republic (H.J., P.V., I.G.); Children's Heart Center, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic (M.J., V.T., J.S., J.M.); University Hospital Sv. Anny, Brno, Czech Republic (I.G.); Louisiana State University Health-New Orleans, School of Public Health (J.V.); and Great Ormond Street Hospital for Children and Institute of Cardiovascular Sciences UCL, London, UK (J.M.).
authors.forename: Jan
authors.initials: J
authors.lastname: Marek
mesh_terms: D002869:Chromosome Aberrations; D015897:Comorbidity; D018153:Czech Republic; D004452:Echocardiography; D005260:Female; D005333:Fetus / Q000000981:diagnostic imaging; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics; D006801:Humans; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal
keywords: congenital heart defects; echocardiography; epidemiology; first-trimester screening; prenatal cardiology