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Nuchal Translucency and the Risk of Congenital Heart Disease

From Columbia University Medical Center, New York, New York, Tufts University, Boston, Massachusetts, University of Utah, Salt Lake City, Utah, Swedish Medical Center, Seattle, Washington, William Beaumont Hospital, Royal Oak, Michigan, University of Texas Medical Branch, Galveston, Texas, Mount Sinai Medical Center, New York, New York, Albert Einstein College of Medicine, New York, New York, University of Colorado Health Sciences Center, Denver, Colorado, New York University, New York, New York, Brown University, Providence, Rhode Island, University of North Carolina Medical Center, Chapel Hill, North Carolina, and DM-STAT, Boston, Massachusetts

OBJECTIVE: To estimate whether nuchal translucency assessment is a useful screening tool for major congenital heart disease (CHD) in the absence of aneuploidy.

METHODS: Unselected patients with singleton pregnancies at 10^3/7 to 13^6/7 weeks of gestation were recruited at 15 U.S. centers to undergo nuchal translucency sonography. Screening characteristics of nuchal translucency in the detection of major CHD were determined using different cutoffs (2.0 or more multiples of the median [MoM], 2.5 or more MoM, 3.0 or more MoM).

RESULTS: A total of 34,266 euploid fetuses with cardiac outcome data were available for analysis. There were 224 cases of CHD (incidence 6.5 per 1,000), of which 52 (23.2%) were major (incidence 1.5 per 1,000). The incidence of major CHD increased with increasing nuchal translucency: 14.1 per 1,000, 33.5 per 1,000, and 49.5 per 1,000 at 2.0 or more MoM, 2.5 or more MoM, and 3.0 or more MoM cutoffs, respectively. Sensitivity, specificity, and positive predictive values were 15.4%, 98.4%, and 1.4% at 2.0 or more MoM; 13.5%, 99.4%, and 3.3% at 2.5 or more MoM; and 9.6%, 99.7%, and 5.0% at 3.0 or more MoM. Nuchal translucency of 2.5 or more MoM (99th percentile) had a likelihood ratio (95% confidence interval) of 22.5 (11.4–45.5) for major CHD. Based on our data, for every 100 patients referred for fetal echocardiography with a nuchal translucency of 99th percentile or more, three will have a major cardiac anomaly.

CONCLUSION: Nuchal translucency sonography in the first trimester lacks the characteristics of a good screening tool for major CHD in a large unselected population. However, nuchal translucency of 2.5 or more MoM (99th percentile or more) should be considered an indication for fetal echocardiography.

LEVEL OF EVIDENCE: II

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