Maternal Obesity and Suboptimal Fetal Cardiac Visualization

To characterize fetal cardiac completion rates at time of anatomy ultrasound and referral patterns to fetal echocardiography in patients with BMI ≥30 kg/m2 at a tertiary care center. To determine if suboptimal fetal cardiac visualization in patients with BMI ≥30 kg/m2 at time of anatomy ultrasound is associated with increased rates of prenatally undetected congenital heart disease (CHD) through review of neonatal data. This is a retrospective cohort study of pregnant patients with BMI ≥30 kg/m2 who received prenatal care at Oregon Health & Science University from January 2013 to December 2018. All anatomic ultrasounds were evaluated by a single Maternal Fetal Medicine Division. Maternal demographic, ultrasound, fetal echocardiogram, delivery and neonatal data were collected. Statistical analysis was performed using two sample t-tests, chi-square, and multivariate logistic regression. Over the five-year time period investigated, 1532 patients met inclusion criteria (Table 1). Rates of complete fetal cardiac visualization by ultrasound were significantly different by BMI Class 1, 2 and 3 (94% vs 88% vs 71%). The relationship by multivariate analysis between ultrasound factors and rates of complete fetal cardiac visualization can be found in Table 2. Two hundred and thirty-six patients (15.4%) were referred for fetal echocardiography, and 24 patients (1.6%) were diagnosed with CHD prenatally. Twenty-one neonates (1.3%) were confirmed to have CHD. Of the forty-three patients (2.8%) who were referred to fetal echocardiography for suboptimal cardiac visualization at time of anatomy ultrasound, none were diagnosed with postnatal CHD. This is the first study comparing prenatal ultrasound findings with postnatal data. BMI class remains a significant risk factor for congenital anomalies and incomplete fetal cardiac visualization. No postnatal CHD was diagnosed among patients referred to fetal echocardiography for suboptimal visualization, thus referral to fetal echocardiography for suboptimal visualization at a skilled Maternal Fetal Medicine unit may be of low utility.View Large Image Figure ViewerDownload Hi-res image Download (PPT)