Impact of Maternal Obesity and Maternal Overweight on the Detection Rate of Fetal Heart Defects and the Image Quality of Prenatal Echocardiography

Zusammenfassung

Ziel: Gegenstand der Studie war es, die vorgeburtliche Entdeckung von 4 ausgewählten fetalen Herzfehlern und die Bildqualität der zugehörigen Ultraschallebenen zwischen normalgewichtigen, übergewichtigen und adipösen Schwangeren zu vergleichen. Material und Methoden: In einer retrospektiven Kohortenstudie wurden 54 846 vorgeburtliche fetale Echokardiografien der Jahre 2000 – 2007 zwischen der 18. und der 37. Schwangerschaftswoche untersucht. Die Schwangeren wurden nach dem Body-Mass-Index (BMI) vor Eintritt der Schwangerschaft in folgende Gruppen stratifiziert: normalgewichtig (BMI < 25), übergewichtig (BMI 25 – 29) und adipös (BMI ≥ 30). Die Ultraschallbildqualität und die vorgeburtliche Entdeckung des atrioventrikulären Septumdefekts (AVSD), des Double outlet right Ventricle (DORV), der Fallot’schen Tetralogie (TOF) und der Transposition der großen Arterien (TGA) wurden in den 3 BMI-Gruppen untersucht. Ergebnisse: Im Patientinnenkollektiv fanden sich 108 Fälle der berücksichtigten 4 Herzfehler. Die Prävalenz der Herzfehler in der übergewichtigen und der adipösen Gruppe war signifikant höher als bei Normalgewichtigen (Relatives Risiko = 2,04; 51 / 35,442 vs. 57 / 19,404, p < 0,0002). Insgesamt wurden 86,1 % der Herzfehler vorgeburtlich korrekt spezifiziert (93 / 108, CI: 79,6 – 92,6 %), 84,3 % (43 / 51) in der normalgewichtigen Gruppe, 88,6 % (39 / 44) bei den Übergewichtigen und 84,6 % (11 / 13) bei den Adipösen. Der Anteil insuffizienter Ultraschallbilder bei den 108 Herzfehlern stieg von 6,4 % bei normalgewichtigen auf 17,4 % bei adipösen Patientinnen an. Schlussfolgerungen: Die vorgeburtliche Ultraschalldiagnostik von fetalen AVSDs, DORVs, TOFs und TGAs war in allen 3 BMI-Gruppen zufriedenstellend, obwohl die Bildqualität mit steigendem BMI substanziell abfiel.

Abstract

Purpose: The purpose of this study was to compare the prenatal detection of four congenital heart defects (CHDs) and the image quality of five corresponding ultrasound planes among obese, overweight and normal-weight women. Materials and Methods: This was a retrospective cohort study of 54 846 pregnancies undergoing fetal echocardiography between 18 and 37 weeks of gestation in the years from 2000 to 2007. The women were categorized according to pre-pregnancy body mass index (BMI) as normal-weight (BMI < 25), overweight (BMI 25 – 29.9) and obese (BMI ≥ 30). Image quality and prenatal detection of atrioventricular septal defect (AVSD), double outlet right ventricle (DORV), tetralogy of fallot (TOF) and dextro transposition of the great arteries (D-TGA) were evaluated in the BMI strata. Results: 108 cases with one of the considered CHDs were identified. The prevalence was significantly higher (relative risk = 2.04) in overweight or obese women (57 / 19,404 vs. 51 / 35,442, p < 0.0002) than in normal-weight women. In total 86.1 % of CHDs were correctly identified prenatally (93 / 108, CI: 79.6 %–92.6 %), 84.3 % (43 / 51) in the normal weight group, 88.6 % (39 / 44) in the overweight group and 84.6 % (11 / 13) in the obese group. The rate of insufficient ultrasound images increased from 6.4 % in normal-weight patients to 17.4 % in obese women within the 108 CHD cases. Conclusion: The prenatal detection of fetal AVSD, DORV, TOF and D-TGA was also satisfactory in overweight and obese patients, but image quality substantially decreases with an increasing maternal BMI. If there is a BMI-associated difference in the detection rate, it probably will not exceed 20 %.

Key words

echocardiography - fetus - heart - pregnancy - obesity

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