Parental Decision-Making Process in Termination of Pregnancy for Congenital Heart Disease: From the Multidisciplinary Perinatal Council of a Turkish Tertiary Center.

Background/

Objectives

Termination of pregnancy (TOP) following a prenatal diagnosis of congenital heart disease (CHD) is a complex decision shaped by clinical, ethical, and psychosocial factors. This study evaluated the clinical factors associated with parental acceptance of TOP after prenatal diagnosis of CHD in a multidisciplinary counselling setting.

Methods

This retrospective cohort study was conducted at a tertiary referral center where fetal CHD cases are evaluated in a multidisciplinary perinatology council. Pregnancies with a prenatal CHD diagnosis for which TOP was medically recommended between December 2023 and February 2026 were included. Maternal, fetal, and genetic data were analyzed. Cardiac severity was classified using the fetal cardiovascular disease severity scale. Because the cohort included only 62 pregnancies, a simplified multivariable logistic regression model with three clinically prespecified variables (four parameters: gestational age, cardiac severity, and genetic-evaluation status) was used to identify variables associated with termination acceptance.

Results

Sixty-two pregnancies were included; 41 (66.1%) accepted termination and 21 (33.9%) continued the pregnancy. Maternal characteristics and gestational age at diagnosis were similar between groups. In the multivariable model, genetic-evaluation status was the only variable independently associated with termination acceptance. Compared with cases without genetic testing, both major chromosomal/pathogenic anomalies (aOR 4.97; 95% CI 1.29-19.11; p = 0.020) and a normal genetic-evaluation status (aOR 4.71; 95% CI 1.07-20.77; p = 0.041) were associated with higher termination acceptance. Cardiac severity and gestational age were not independently associated with parental decision.

Conclusions

Genetic-evaluation status was associated with parental acceptance of termination after prenatal CHD diagnosis in a multidisciplinary counselling setting; given the small sample size and the selected, council-recommended cohort studied, this association should be interpreted as hypothesis-generating rather than as evidence of a causal or independent predictive effect.