Routine prenatal screening for congenital heart disease: what can be expected? A decision-analytic approach

Am J Public Health. 1997 Jun;87(6):962-7. doi: 10.2105/ajph.87.6.962.


Objectives: This study assessed the potential impact of fetal ultrasound screening on the number of newborns affected by cardiac anomalies.

Methods: A decision model was developed that included the prevalence and history of congenital heart disease, characteristics of ultrasound, risk of abortion, and attitude toward pregnancy termination. Probabilities were obtained with a literature survey; sensitivity analysis showed their influence on expected outcomes.

Results: Presently, screening programs may prevent the birth of approximately 1300 severely affected newborns per million second-trimester pregnancies. However, over 2000 terminations of pregnancy would be required, 750 of which would have ended in intrauterine death or spontaneous abortion. Further, 9900 false-positive screening results would occur, requiring referral. Only the sensitivity of routine screening and attitude toward termination of pregnancy appeared to influence the yield substantially.

Conclusions: The impact of routine screening for congenital heart disease appeared relatively small. Further data may be required to fully assess the utility of prenatal screening.

MeSH terms

  • Abortion, Spontaneous
  • Attitude
  • Decision Support Techniques
  • Diagnostic Tests, Routine
  • Female
  • Heart Defects, Congenital / diagnosis*
  • Heart Defects, Congenital / diagnostic imaging
  • Humans
  • Mass Screening*
  • Multivariate Analysis
  • Predictive Value of Tests
  • Pregnancy
  • Pregnancy Outcome
  • Prenatal Diagnosis*
  • Sensitivity and Specificity
  • Ultrasonography, Prenatal