Background: Congenital heart disease (CHD) is the commonest congenital anomaly, affecting 9 in every 1,000 births globally. CHD may significantly impact fetal, neonatal and long-term health. Emerging evidence suggests that there may be increased risks of adverse pregnancy outcomes in the setting of fetal CHD, which may be mediated by placental dysfunction rather than CHD severity. This systematic review aims to assess the risk of adverse pregnancy outcomes in fetal CHD cohort to help identify at risk populations.
Methods: A systematic review of the literature was performed in Embase, MEDLINE, CINAHL, Web of Science and clinicaltrials.gov. Studies reporting adverse pregnancy outcomes from the year 2000 were included to ensure current clinical relevance. Only structural fetal CHD was included. Studies were excluded if they included patent ductus arteriosus, patent foramen ovale or arrhythmias as the only CHD diagnosis.
Results: 8,148 studies were retrieved and screened, with 129 studies included in the pooled analyses. Pregnancies with fetal CHD had higher odds ratio (95% CI) of preeclampsia (1.70 [1.38,2.09]), preterm birth (PTB) <37 weeks (2.2 [1.84,2.65]), and small for gestational age (birthweight <10th percentile) (2.31 [2.07,2.58]) when compared with pregnancies without fetal CHD.
Conclusion: This review demonstrates that there are increased odds of adverse outcomes with pregnancies affected by fetal CHD when compared with pregnancies without fetal CHD. Understanding the risk profile of these pregnancies is needed to ensure that they have adequate management and surveillance, in order to improve fetal and maternal outcomes.