Impact of pregnancy termination law reforms in Ireland on pregnancy termination rates in the setting of fetal congenital heart disease: A trend analysis.

Abstract

Objective: Prior to 2019, termination of pregnancy (TOP) was unlawful in Ireland. We sought to examine the impact of legislative change on TOP for major congenital heart disease (CHD) and its effect on parental decision-making regarding the options of complex surgery, TOP, or palliative perinatal care.

Methods: This was a trend analysis of second-trimester TOP for major CHD before and after the law reforms relating to pregnancy termination in Ireland. Retrospective data were collected on pregnancies complicated by major CHD at the largest tertiary referral obstetric center in Ireland from January 2017 to December 2023. Suspected CHD cases were referred to a dedicated fetal medicine/cardiology service. Major CHD was defined as an expected requirement for cardiac intervention in the first year of life. Genetic testing was performed where required, counseling was offered, and individualized care plans were developed.

Results: In a consecutive unselected cohort, 269 of 60 871 screened pregnancies fulfilled criteria for a diagnosis of major CHD. Major CHD was an isolated abnormality in 55% (147/269) of cases, while an extracardiac diagnosis was identified in 45% (162/269). TOP was chosen in 21% (16/76) of cases prior to legislative change and in 20% (39/193) of cases after legislative change (P = 0.158). The TOP rate was 8% (13/147) in isolated CHD cases, compared with 34% (42/122) in the setting of additional abnormalities (structural or genetic).

Conclusion: We observed no difference in the rate of TOP for major CHD before and after TOP law reforms in Ireland on the grounds of fetal abnormality.