Epidemiological analysis of congenital heart disease in Beijing from 2017 to 2021

doi:10.3877/cma.j.issn.1673-5250.2023.01.009

Objective

To explore the epidemiological characteristics of fetal and neonatal congenital heart disease (CHD) in Beijing by analyzing the surveillance data of CHD in recent years.

Methods

From January 2017 to December 2021, a total of 985 603 perinatal infants were monitored in the Beijing Birth Defects Surveillance System, among which 11 356 fetuses/newborns were diagnosed with CHD, including intrauterine stillbirth, therapeutic induction of labor fetus and live birth, stillbirth and neonatal death within 7 d after birth. These 11 356 CHD fetuses/newborns were selected in study. From 2017 to 2021, the number of diagnosed CHD fetuses/newborns and monitored perinatal infants were 2 113 cases vs 243 438 cases, 2 276 cases vs 214 333 cases, 2 426 cases vs 218 922 cases, 2 192 cases vs 161 605 cases, and 2 349 cases vs 147 305 cases, respectively. By means of descriptive epidemiological analysis method, the overall incidence of CHD and the incidence of different types of CHD were analyzed in fetal/newborn population with gestational age of 13 weeks to 7 d after birth (observation period) and gestational age of 28 weeks to 7 d after birth (perinatal period) in Beijing Birth Defects Surveillance System. The procedures followed in this study were in line with World Medical Association Declaration of Helsinki revised in 2013.

Results

①From 2017 to 2021, the overall incidence of CHD in fetal/neonatal population was 1.15% (11 356/985 603) during observation period of Beijing Birth Defects Surveillance System. And the incidence of CHD during observation period from 2017 to 2021 was 0.87% (2 113/243 438), 1.06% (2 276/214 333), 1.11% (2 426/218 922), 1.36% (2 192/161 605) and 1.59% (2 349/147 305) respectively, which showed an increasing trend. The chromosomal abnormality rate of 11 356 CHD fetuses/newborns was 3.90% (444 cases), and the top three chromosomal abnormality were trisomy 18 (127 cases, 28.60%), trisomy 21 (104 cases, 23.42%) and 22q11.2 deletion syndrome (19 cases, 4.28%). The incidence of extracardiac malformations of 11 356 CHD fetuses/newborns was 11.91% (1 351/11 356), and the proportion of malformations other than cardiovascular and circulatory system in descending order was musculoskeletal system (326 cases, 24.13%), urinary system (248 cases, 18.36%) and nervous system (202 cases, 14.95%). The incidence of severe congenital heart disease (CCHD) was 0.20% (1 938/985 603). ②Among 11 356 CHD fetuses/newborns, 8 882 cases were diagnosed in perinatal period, and the overall incidence of perinatal CHD was 0.90% (8 882/985 603). The incidence of perinatal CHD from 2017 to 2021 was 0.62% (1 520/243 438), 0.82% (1 868/214 333), 0.86% (1 892/218 922), 1.12% (1 808/161 605), 1.30% (1 910/147 305) respectively, which also showed an increasing trend. The incidence of isolated atrial septal defect of perinatal CHD fetuses/newborns in 2021 was 0.36% (527/147 305), which was 4.33 times higher than that in 2017 (0.08%, 201/243 438), and its absolute increase in incidence accounted for 40.18% of the total absolute increase in the incidence of perinatal CHD. The top five CHD types in perinatal period were atrial septal defect (2 704 cases), ventricular septal defect (2 592 cases), patent ductus arteriosus (2 233 cases), patent foramen ovale (1 767 cases), and permanent left superior vena cava (478 cases). The incidence of perinatal CCHD was 0.04% (433/985 603).

Conclusions

From 2017 to 2021, the incidences of CHD in observation period and perinatal period in Beijing both show an increasing trend. The increase in incidence of CHD is mainly concentrated in simple atrial septal defect. The incidence of perinatal of CCHD is at a low level.

Key words: Congenital heart diseases, Critical congenital heart defects, Incidence, Epidemiologic studies, Heart septal defects, atrial, Heart septal defects, ventricular, Ductus arteriosus, patent, Foramen ovale, patent, Peripartum period, Fetus, Infant, newborn

表1 2017—2021年，观察期与围产期内北京市出生缺陷监测系统对985 603例围产儿不同分型CHD胎儿/新生儿监测结果

不同分型CHD	观察期		围产期
不同分型CHD	例数	发生率(×10^－4)	例数	发生率(×10^－4)
房间隔缺损	2 742	27.82	2 704	27.43
室间隔缺损	3 490	35.41	2 592	26.30
动脉导管未闭	2 233	22.66	2 233	22.66
卵圆孔未闭	1 767	17.93	1 767	17.93
永存左上腔静脉	677	6.87	478	4.85
右位主动脉弓	336	3.41	233	2.36
肺动脉/肺动脉瓣狭窄	425	4.31	179	1.82
法洛四联症	547	5.55	125	1.27
主动脉狭窄	236	2.39	97	0.98
完全性大动脉转位	270	2.74	82	0.83
完全性肺静脉异位引流	105	1.07	44	0.45
肺动脉闭锁	212	2.15	27	0.27
主动脉弓离断	98	0.99	22	0.22
右心室双出口	247	2.51	17	0.17
三尖瓣下移	44	0.45	17	0.17
永存动脉干	119	1.21	11	0.11
单心室	217	2.20	8	0.08
左心发育不良	171	1.73	7	0.07
三尖瓣闭锁	39	0.40	5	0.05
房室间隔缺损	270	2.74	35	0.36
心律失常	43	0.44	22	0.22
横纹肌瘤	61	0.62	37	0.38
心肌疾病	26	0.26	14	0.14
其他分型CHD	410	4.16	240	2.44

表1 2017—2021年，观察期与围产期内北京市出生缺陷监测系统对985 603例围产儿不同分型CHD胎儿/新生儿监测结果

不同分型CHD	观察期		围产期
不同分型CHD	例数	发生率(×10^－4)	例数	发生率(×10^－4)
房间隔缺损	2 742	27.82	2 704	27.43
室间隔缺损	3 490	35.41	2 592	26.30
动脉导管未闭	2 233	22.66	2 233	22.66
卵圆孔未闭	1 767	17.93	1 767	17.93
永存左上腔静脉	677	6.87	478	4.85
右位主动脉弓	336	3.41	233	2.36
肺动脉/肺动脉瓣狭窄	425	4.31	179	1.82
法洛四联症	547	5.55	125	1.27
主动脉狭窄	236	2.39	97	0.98
完全性大动脉转位	270	2.74	82	0.83
完全性肺静脉异位引流	105	1.07	44	0.45
肺动脉闭锁	212	2.15	27	0.27
主动脉弓离断	98	0.99	22	0.22
右心室双出口	247	2.51	17	0.17
三尖瓣下移	44	0.45	17	0.17
永存动脉干	119	1.21	11	0.11
单心室	217	2.20	8	0.08
左心发育不良	171	1.73	7	0.07
三尖瓣闭锁	39	0.40	5	0.05
房室间隔缺损	270	2.74	35	0.36
心律失常	43	0.44	22	0.22
横纹肌瘤	61	0.62	37	0.38
心肌疾病	26	0.26	14	0.14
其他分型CHD	410	4.16	240	2.44

图1 2017—2021年北京市围产期单纯动脉导管未闭、卵圆孔未闭、房间隔缺损、室间隔缺损及轻型CHD、CHD总体发生率变化趋势图注：轻型CHD指单纯房间隔缺损/卵圆孔未闭/室间隔缺损/动脉导管未闭。CHD为先天性心脏病

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