(730) Termination of Pregnancy for Major Congenital Heart Disease: The Impact of Constitutional Change in Ireland

Prior to 2019, termination of pregnancy (TOP) in Ireland was unlawful in all circumstances. Since the Health (Regulation of Termination of Pregnancy) Act 2018, TOP is permissible with no gestational limit in the setting of a serious maternal health risk or a lethal fetal abnormality. For cases of major congenital heart disease (CHD), we sought to compare TOP rates prior to and following this landmark legislative change.

Study Design:

A consecutive cohort attending a tertiary Fetal Center was examined for major CHD. Two comparative cohorts were created: prior to and following enactment of the Health (TOP) Act. For the latter group, a multidisciplinary forum, including MFM, Neonatology, Cardiology and Cardiothoracic surgery, was convened to determine individual case fulfilment of criteria for TOP in Ireland (specifically, relating to the lethality of the diagnosis). A chi-square test was used to compare the cases that opted for TOP prior to and following the legal change.

Results:

Among 42,114 pregnancies during 2017-2021, major CHD was identified in 275 pregnancies. Thirty-five women (13%) opted for TOP, at a gestational age of 13+5 to 29+0 weeks, with no change in incidence observed post-enactment of TOP law (15.0%  vs 11% , p >0.268). While prior to enactment of the TOP law, all cases availed of TOP in another jurisdiction, following legislative change 9/18 (50%) TOPs were performed in Ireland, with the remaining 9/18 (50%) being carried out overseas as the prenatal diagnosis was judged not to demonstrate evidence predictive of a fatal outcome. Across the 5-year study period, CHD was isolated in 5/35 (14%) of TOPs, with the majority of cases complicated by extra cardiac abnormalities, genetic diagnoses or both.

Conclusion: Legalization of pregnancy termination in Ireland for fatal fetal abnormality, without an upper gestational age limit, has not resulted in an increased incidence of TOP in the setting of major CHD. The majority of cases that undergo TOP are complicated by the combination of CHD and another abnormality, either structural or genetic.