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Danish study shows 65 fold increase in abortions of babies with heart disease in 18 years

17 August 2018

 
More than half of babies found to have heart disease in the womb are aborted.

Experts warn that screening puts pressure on parents to abort

A new study on major congenital heart disease in Denmark has revealed how prenatal testing is being used to screen out babies with disabilities.

The paper, published in JAMA Cardiology, found that the rate of abortion for babies with major congenital heart disease (CHD) increased from 0.6% in 1996 to 39.1% in 2013 - a 65 fold increase.

Screening out disabled babies

For prenatally diagnosed major CHD, 57.8% of babies were aborted across the period of the trial. The rate is particularly high for some conditions - in the case of fetuses diagnosed with single ventricle defects (such as hypoplastic left heart syndrome, the most severe form of CHD), roughly 85% of pregnancies ended in abortion.

Denmark began offering universal prenatal screening free of charge in 2004, and is already known to have a very high abortion rate for babies with Down's syndrome. During the time period studied, the proportion of major CHD detected in the womb rose from 4.5% to 71.0%.

Instead of treating them

What makes the figures even more tragic is that many of these conditions can be successfully treated. Hani Najm, MD, of Cleveland Clinic in Ohio told Medpage Today: "We've gotten so good at operating on these complex hearts and we have impeccable results with an overall mortality even around 1%, so in some cases [it] depends on what the morphology is. So we have come a long way in how we manage these kids."

In fact, when prenatal testing is used therapeutically, it can improve the outcomes for surgical intervention, or allow the planning of neonatal palliative care.

Parents pressured by cost

As we so often see, the lives of unborn babies often lose out to economic factors. An article in response by Alexander A. Kon, MD, Ethical Implications of Prenatal Screening for Congenital Heart Disease, ​highlights some of the problems with the universal screening programme. Firstly, because the costs of treating a child with CHD are high, "parents who receive a prenatal diagnosis of major CHD could experience pressure, either intended or unintended, to terminate the pregnancy. Further, parents who choose to continue such a pregnancy may experience conscious or subconscious judgement by health care professionals and staff who consider TOP more beneficial from the perspective of overall health care cost."

Dr Kon also warns that "patients of minority status may experience greater pressure to terminate such pregnancies." Finally, parents of a lower socio-economic status might be less able to access the medical care needed for a child with a heart condition, and so might feel pressured to abort.

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