# Perinatal deaths attributable to congenital heart defects in Hunan Province, China, 2016–2020

## TL;DR

The study found that congenital heart defects caused significant perinatal deaths in Hunan, China, with risk factors including rural residence and young maternal age.

## Contribution

This study identifies key demographic factors associated with perinatal deaths due to CHDs in Hunan Province using a large-scale surveillance dataset.

## Key findings

- Perinatal deaths due to CHDs were more common in rural areas compared to urban areas.
- Young maternal age (<20 or 20–24 years) was significantly associated with higher perinatal mortality.
- CHDs diagnosed later in pregnancy or at birth had much higher odds of perinatal death.

## Abstract

To explore the association between demographic characteristics and perinatal deaths attributable to congenital heart defects (CHDs).

Data were obtained from the Birth Defects Surveillance System of Hunan Province, China, 2016–2020. The surveillance population included fetuses and infants from 28 weeks of gestation to 7 days after birth whose mothers delivered in the surveillance hospitals. Surveillance data included demographic characteristics such as sex, residence, maternal age, and other key information, and were used to calculate the prevalence of CHDs and perinatal mortality rates (PMR) with 95% confidence intervals (CI). Multivariable logistic regression analysis (method: Forward, Wald, α = 0.05) and adjusted odds ratios (ORs) were used to identify factors associated with perinatal deaths attributable to CHDs.

This study included 847755 fetuses, and 4161 CHDs were identified, with a prevalence of 0.49% (95%CI: 0.48–0.51). A total of 976 perinatal deaths attributable to CHDs were identified, including 16 (1.64%) early neonatal deaths and 960 (98.36%) stillbirths, with a PMR of 23.46% (95%CI: 21.98–24.93). In stepwise logistic regression analysis, perinatal deaths attributable to CHDs were more common in rural areas than urban areas (OR = 2.21, 95%CI: 1.76–2.78), more common in maternal age <20 years (OR = 2.40, 95%CI: 1.05–5.47), 20–24 years (OR = 2.13, 95%CI: 1.46–3.11) than maternal age of 25–29 years, more common in 2 (OR = 1.60, 95%CI: 1.18–2.18) or 3 (OR = 1.43, 95%CI: 1.01–2.02) or 4 (OR = 1.84, 95%CI: 1.21–2.78) or > = 5 (OR = 2.02, 95%CI: 1.28–3.18) previous pregnancies than the first pregnancy, and more common in CHDs diagnosed in > = 37 gestional weeks (OR = 77.37, 95%CI: 41.37–144.67) or 33–36 gestional weeks (OR = 305.63, 95%CI: 172.61–541.15) or < = 32 gestional weeks (OR = 395.69, 95%CI: 233.23–671.33) than diagnosed in postnatal period (within 7 days), and less common in multiple births than singletons (OR = 0.48, 95%CI: 0.28–0.80).

Perinatal deaths were common in CHDs in Hunan in 2016–2020. Several demographic characteristics were associated with perinatal deaths attributable to CHDs, which may be summarized mainly as economic and medical conditions, severity of CHDs, and parental attitudes toward CHDs.