1. Continuation of pregnancy despite a diagnosis of severe fetal anomaly: a retrospective French study
- Author
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Eric Verspyck, Horace Roman, Amelie Madeuf, UNIROUEN - UFR Santé (UNIROUEN UFR Santé), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU), Gamétogenèse et Qualité du Gamète - ULR 4308 (GQG), Normandie Université (NU)-Normandie Université (NU)-Université de Lille, CHU Rouen, Normandie Université (NU), Service de gynécologie et obstétrique [CHU Rouen], Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, and Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN)
- Subjects
psychosocial ,medicine.medical_specialty ,Pediatrics ,Palliative care ,pregnancy outcomes ,education ,Prenatal diagnosis ,macromolecular substances ,030204 cardiovascular system & hematology ,[SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics ,neonatology ,Choice Behavior ,severe fetal anomaly ,Congenital Abnormalities ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Risk Factors ,Prenatal Diagnosis ,Intellectual disability ,medicine ,termination of pregnancy ,Humans ,Neonatology ,Registries ,Retrospective Studies ,Fetus ,030219 obstetrics & reproductive medicine ,palliative care ,Obstetrics ,business.industry ,Infant, Newborn ,Obstetrics and Gynecology ,Retrospective cohort study ,[SDV.BDLR]Life Sciences [q-bio]/Reproductive Biology ,General Medicine ,medicine.disease ,3. Good health ,Logistic Models ,Relative risk ,Female ,France ,business ,Genetic counseling - Abstract
Introduction The aim of this study was to describe diagnoses and outcomes when women choose to continue a pregnancy despite detection of severe fetal anomaly. Material and methods Retrospective study from a French national registry between 2005 and 2009. Various indication groups were classified based on a scale incorporating mortality and morbidity outcomes. Risk factors for perinatal mortality and predictors of neonatal survival were determined by multinomial logistic regression analyses. Results The overall number of pregnancies that continued after diagnosis of a severe fetal anomaly was 2266 (6.6%). The diagnoses were categorized into life-limiting conditions (34.2%), serious disability anomaly (40.8%), potential intellectual disability (8.6%), other conditions (8.8%), and failure to classify (7.4%). During the study period, there was a significant increase in the number of women who continued pregnancy after their fetus was diagnosed with a life-limiting condition (p = 0.03), and a decrease when the fetus was diagnosed with potential intellectual disability (p = 0.01). Pregnancy outcomes were intrauterine fetal death (17.4%), neonatal mortality (22.3%), neonatal survival (52.7%), or unknown (7.5%). Multinomial logistic regression analysis suggested an increased likelihood of neonatal survival among fetuses diagnosed with serious disability anomaly [59.8%, relative risk (RR) 4.1, 95% CI 3.1-5.7], potential intellectual disability (74.4%, RR 11.5, 95% CI 6.2-21.2), and other conditions (80%, RR 12.6, 95% CI 5.7-27.9) compared with life-limiting conditions (30.1%). Conclusions An increasing proportion of women chose to continue pregnancy after the fetus was diagnosed with a potentially life-limiting condition; survival of children with these diagnoses is not uncommon.
- Published
- 2015
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