Stillbirth and neonatal mortality in pregnancies complicated by major congenital anomalies: findings from a large European cohort

ObjectiveTo provide prognostic information to help parents to reach an informed decision about termination or continuation of the pregnancy and to shape peripartum policy based on a large European cohort.MethodThirteen registries from the European Surveillance of Congenital Anomalies (EUROCAT) network contributed data from January 1, 1998 to December 31, 2011. Terminations for fetal anomalies were excluded. Chromosomal anomalies, syndromes and isolated anomaly groups were distinguished according to EUROCAT guidelines. Perinatal mortality, stillbirths, and early and late neonatal mortality rates (NMR)were analyzed by anomaly group and gestational age.ResultsAmong 73,337 cases, perinatal mortality associated with congenital anomaly was 1.27 per 1,000 births (95% CI 1.23–1.31). Average stillbirth rate was 2.68%, (range 0–51.2%). Early and late NMR were 2.75% (range 0–46.7%) and 0.97% (range 0-17.9%), respectively. Chromosomal anomalies and syndromes, and most isolated anomalies, had significant differences regarding timing of fetal demise compared to the general population. Chromosomal and central nervous system anomalies had higher term stillbirth rates.ConclusionsWe found relevant differences between anomalies regarding rates of stillbirth, NMR and timing by gestational age. Our data can help parents to decide about their unborn child with a congenital anomaly and help inform maternal-fetal medicine specialists regarding peripartum management.