Maternal‐fetal comorbidities and obstetrical outcomes of fetal single ventricle cardiac defects: 10 years' experience with a multidisciplinary management protocol at a single center

Objectives To describe and compare maternal and fetal comorbidities and obstetrical outcomes in pregnancies with hypoplastic left and right heart (HLHS and HRH) single ventricle cardiac defects (SVCD) from a single center under a multidisciplinary protocol. Method A single center retrospective review of fetal SVCD from 2013 to 2022. Maternal‐fetal comorbidities, delivery, and postnatal outcomes were compared between HLHS and HRH using descriptive statistics and univariate and multivariate analyses. Results Of 181 SVCD pregnancies (131 HLHS; 50 HRH), 9% underwent termination, 4% elected comfort care, 5 died in utero and 147/152 liveborns survived to the first cardiac intervention. Cesarean delivery occurred in 57 cases (37%), planned in 36 and unplanned in 21. Comorbidities, which did not differ between HLHS and HRH, included fetal growth restriction (FGR, 17%), prematurity (14%), maternal hypertension (9%), maternal obesity (50%), fetal extracardiac anomalies and chromosome anomalies (12%, 13%). In multivariate analysis, only earlier gestational age at delivery and oligohydramnios predicted decreased odds of survival at one year. Conclusion Maternal‐fetal comorbidities are common in both HLHS and HRH. Earlier gestational age at delivery and oligohydramnios predict lower postnatal survival. FGR, even with severe early onset, did not significantly impact short‐ or long‐term neonatal survival in single ventricle conditions. Key points What's already known about this topic? With improved prenatal diagnosis and postnatal palliation, outcomes of fetal single ventricle cardiac defects have improved substantially. Little is known about maternal and fetal comorbidities and their effects on outcomes. What does this study add? Preterm birth and oligohydramnios are predictors of infant death prior to hospital discharge and at one‐year. No other maternal or fetal comorbidities, including severe fetal growth restriction, impacted survival from birth to discharge or to one year.