Determinants of childbearing intentions among pregnant women with a suspected fetal congenital heart disease.

BACKGROUND

The Saudi population is characterized by a high fertility rate, a conservative sociocultural context, and an ongoing societal and lifestyle transition. Yet, data regarding childbearing intentions and the associated factors is scarce. Furthermore, childbearing intention may be impacted by abnormal pregnancy events, such as the clinical suspicion or diagnosis of a fetal congenital disease and the negative experience that may result from it.

OBJECTIVES

The present study explored childbearing intention and determined the sociodemographic and health-related factors discouraging from future pregnancies among women visiting the cardiology clinic for antenatal screening of congenital heart diseases (CHD).

METHODS

A one-year cross-sectional study involved 150 consecutive pregnant women aged between 18 and 47 years old, who presented for antenatal screening of CHD at the fetal echocardiography clinic for, of a teaching hospital in Jeddah, Saudi Arabia. An interview-based questionnaire was administered before the clinic visit and collected sociodemographic data, obstetrical history, risk factors of congenital diseases, mothers' knowledge about fetal echocardiography and CHDs, and childbearing intention (the primary outcome).

RESULTS

Fetal echocardiography and CHD were correctly described by 60 % and 31.3 % of the participants respectively, while 40.7 % and 12 % recognized the association of congenital diseases with consanguinity and advanced maternal age respectively. Childbearing intentions showed 68.0 % of the participants declared desiring a future baby while the remaining 32.0 % declared having no further pregnancy expectations. Attitudes towards a hypothetical baby with CHD were positive in 97.3 % of the participants, and only 30 % declared that the fetal echocardiography results will impact their future childbearing decision. However, childbearing intention showed no significant association with knowledge or attitudes towards CHD. On the other hand, childbearing intention was independently associated with the number of children (OR=0.34; p<0.001), consanguinity with husband (OR=3.64; p = 0.010), and history of gestational diabetes (OR=0.28; p = 0.040).

CONCLUSION

Fertility expectations among Saudi mothers are more likely to be impacted by the personal experience and judgment of own pregnancy fitness, while no significant impact of fetal risks and events. This demonstrates a certain level of autonomy balanced with deeply rooted religious ethics yet combined with a lack of awareness about fetal and maternal risks associated with advanced maternal age and consanguinity. We emphasize the unmet need of education and family planning.