ABC | Volume 112, Nº5, May 2019

Guideline Brazilian Fetal Cardiology Guidelines – 2019 Arq Bras Cardiol. 2019; 112(5):600-648 Tabela 2.1 – Clinical conditions that increase the risk of fetal heart disease and are formal indications to perform fetal echocardiogram Absolute risk ≥ 2% GOR/LOE Pregestational maternal diabetes mellitus I/A Maternal diabetes mellitus diagnosed during the first trimester I/A Poorly controlled maternal phenylketonuria, I/A Maternal anti-RO and anti-LA (SSA/SSB) antibodies IIa/B Maternal medication exposures ACE IIa/B Retinoic acids I/B Nonsteroidal anti-inflammatory medications during the third trimester I/A Maternal rubella during the first semester I/C Maternal infection, with fetal myocarditis suspected I/C Use of assisted reproduction technology IIa/A CHD in first-degree relative (mother, father, or sibling) I/B Mendelian inheritance associated with CHD in first- or second-degree relative I/C Suspected CHD on obstetric ultrasound I/B Suspected noncardiac abnormality on obstetric ultrasound I/B Abnormal fetal karyotype I/C Fetal bradycardia, tachycardia, or irregular cardiac rhythm I/C Increased nuchal translucency > 95% (≥ 3 mm) IIa/A Monochorionic twins I/A Fetal hydrops or pleural effusion I/B Absolute risk between 1 and 2% Maternal medication exposures Anticonvulsants IIb/A Lithium IIb/B Vitamin A IIb/B Selected serotonin reuptake inhibitor (only paroxetine) IIb/A Nonsteroidal anti-inflammatory drugs during the first and second trimesters IIb/B CHD in second-degree relatives IIb/B Fetal abnormality of umbilical cord or placenta IIb/C Intra-abdominal fetal venous anomaly IIb/C Absolute risk ≤ 1% Gestational maternal diabetes mellitus with HbA1c < 6% III/B Maternal medication exposures Selected serotonin reuptake inhibitor (excepting paroxetine) III/A Vitamin K antagonists (warfarin) III/B Maternal infection other than rubella with seroconversion only III/C Isolated CHD in a distant relative (not first- or second-degree) III/B ACE: angiotensin-converting enzyme; CHD: congenital heart disease; GOR: grade of recommendation; HbA1c: hemoglobinA1c; LOE: level of evidence. Source:Adapted from Donofrio et al. 17 604