目的:调查没有双胎对双胎输血综合征(TTTS)相关CHD的双胎妊娠中主要CHD(mCHD)的患病率和全国产前检出率(DR)。标准化产前筛查计划。
方法:除了第一和第二三个月的非整倍体和畸形筛查外,所有丹麦双胎妊娠都有标准化的筛查和监测计划,分别是:从第15周起每两周对单胎双胞胎,从第18周起每四周对双胎双胞胎。本研究采用前瞻性收集的数据进行回顾性研究。数据来自丹麦胎儿医学数据库,包括2009-2018年的所有双胎妊娠,其中至少有一个胎儿在出生前和/或出生后诊断为mCHD。mCHD被定义为在生命的第一年内需要手术的CHD,排除室间隔缺损.所有怀孕都在全国四个三级中心的当地患者档案中进行了产前和产后验证。
结果:共纳入59例妊娠60例。双胞胎中mCHD的患病率为每1,000双胎妊娠4.6例(95%置信区间(CI)3.5-6.0)(每1,000个活产儿童1.9例(95%CI1.3-2.5))。每1,000例妊娠中DC和MC的患病率分别为3.6(95%CI2.6-5.0)和9.2(95%CI5.8-13.7),分别。整个时期双胎妊娠的全国mCHDDR为68.3%。检测最高的是单室心脏(100%),最低的是肺静脉回流总异常,Ebstein的异常,主动脉瓣狭窄,和主动脉缩窄(0-25%)。与检测到mCHD的儿童的母亲相比,未检测到mCHD的儿童的母亲的BMI明显更高(中位数分别为27和23,p=0.03)。
结论:双胞胎中mCHD的患病率为每1000例妊娠4.6例,在MC双胞胎中更常见。此外,双胎妊娠mCHD的DR为68.3%.在未发现mCHD的情况下,较高的母亲BMI更为常见。本文受版权保护。保留所有权利。
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.
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.
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).
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.