Prevalence and detection rate of major congenital heart disease in twin pregnancies in Denmark

M. Bouazzi, D. E. S. Jørgensen, H. Andersen, T. Krusenstjerna-Hafstrøm, C. K. Ekelund, A. N. Jensen, P. Sandager, L. Sperling, J. Steensberg, K. Sundberg, N. G. Vejlstrup, O. B. B. Petersen, C. Vedel*

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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Abstract

Objective: To investigate the national prevalence and prenatal detection rate (DR) of major congenital heart disease (mCHD) in twin pregnancies without twin-to-twin transfusion syndrome (TTTS)-associated CHD in a Danish population following a standardized prenatal screening program.

Methods: This was a national registry-based study of data collected prospectively over a 10-year period. In Denmark, all women with a twin pregnancy are offered standardized screening and surveillance programs in addition to first- and second-trimester screening for aneuploidies and malformation, respectively: monochorionic (MC) twins every 2 weeks from gestational week 15 and dichorionic (DC) twins every 4 weeks from week 18. The data were retrieved from the Danish Fetal Medicine Database and included all twin pregnancies from 2009-2018, in which at least one fetus had a pre- and/or postnatal mCHD diagnosis. mCHD was defined as CHD requiring surgery within the first year of life, excluding ventricular septal defects. All pregnancy data were pre- and postnatally validated in the local patient files at the four tertiary centers covering the entire country.

Results: A total of 60 cases from 59 twin pregnancies were included. The prevalence of mCHD was 4.6 (95% CI, 3.5-6.0) per 1000 twin pregnancies (1.9 (95% CI, 1.3-2.5) per 1000 live births). The prevalences for DC and MC were 3.6 (95% CI, 2.6-5.0) and 9.2 (95% CI, 5.8-13.7) per 1000 twin pregnancies, respectively. The national prenatal DR of mCHD in twin pregnancies for the entire period was 68.3%. The highest DRs were in cases with univentricular hearts (100%) and the lowest with aortopulmonary window, total anomalous pulmonary venous return, Ebstein's anomaly, aortic valve stenosis and coarctation of the aorta (0-25%). Mothers of children with prenatally undetected mCHD had a significantly higher body mass index (BMI) compared to mothers of children with a prenatally detected mCHD (median, 27 kg/m2 and 23 kg/m2 , respectively; P = 0.02).

Conclusions: The prevalence of mCHD in twins was 4.6 per 1000 pregnancies and was higher in MC than DC pregnancies. The prenatal DR of mCHD in twin pregnancies was 68.3%. Maternal BMI was higher in cases of prenatally undetected mCHD. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Original languageEnglish
JournalUltrasound in Obstetrics & Gynecology
Volume62
Issue number5
Pages (from-to)681-687
Number of pages7
ISSN0960-7692
DOIs
Publication statusPublished - Nov 2023

Bibliographical note

© 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Keywords

  • Child
  • Denmark/epidemiology
  • Female
  • Gestational Age
  • Heart Defects, Congenital/diagnostic imaging
  • Humans
  • Pregnancy
  • Pregnancy, Twin
  • Prevalence
  • Retrospective Studies
  • Twins, Dizygotic
  • prenatal detection rate
  • congenital heart defect
  • twins
  • twin pregnancy
  • congenital heart disease
  • prenatal screening
  • CHD

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