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

Objective To 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. Method Thirteen 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 (NMRs) were analyzed by anomaly group and gestational age. Results Among 73 337 cases, perinatal mortality associated with congenital anomaly was 1.27 per 1000 births (95% confidence interval, 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. Conclusions We 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. What's already known on this topic? There are no large‐size studies regarding natural course of pregnancy in cases with congenital anomalies. Most studies concern small single center series with limited generalizability. What does this study add? By using the EUROCAT Network, representing a large number of European registries and a wide range of anomalies, we were able to perform detailed analyses of the course of pregnancy in terms of stillbirth, early or late neonatal mortality for categories of anomalies, by gestational age and for a large number of isolated anomalies. Our data show that the course of these pregnancies differs significantly according to type of congenital anomaly.