The Role of Increased Nuchal Translucency in Predicting Fetal and Neonatal Losses in 18,050 Fetuses With Congenital Heart Defects

OBJECTIVE: The objective of this study is to investigate the distribution of increased nuchal translucency (NT) and its role in predicting fetal and neonatal losses in congenital heart disease (CHD). METHODS: This retrospective study analyzed 18,050 CHDs with documented NT measurements. Maternal characteristics, CHD subtypes, prenatal diagnoses, and fetal and neonatal losses were compared across NT categories. Cox regression analysis was performed to identify independent predictors of adverse outcomes. RESULTS: Increased NT occurred in 424 (2%) CHDs, more frequently in older mothers, those with previous adverse perinatal outcomes and prior CHDs. NT > 5.0 mm was more prevalent in critical CHDs and CHDs with extracardiac anomalies. Prenatal diagnosis rates increased from 17% (NT < 2.5 mm) to 94% (NT > 5.0 mm), whereas CHD-involved mortality rose from 10% to 90% (both p < 0.001). Cox regression analysis identified that severely increased NT increased at least a 3-fold higher risk of fetal and neonatal losses than the normal NT group. CONCLUSIONS: NT distribution varies by maternal sociodemographics. Increased NT is more common in critical CHD and CHD with extracardiac structural abnormalities. Increased NT also plays an important role in predicting fetal and neonatal losses in CHD.