What are the novel findings of this work?Of 1405 cases of major congenital heart disease (CHD), a prenatal diagnosis was made in 814. Residence in rural areas, compared with residence < 100 km from a tertiary fetal cardiology center, was associated with a 7% lower rate of prenatal diagnosis of major CHD and 19% higher rate of late diagnosis i.e. after 22 weeks' gestation. Low socioeconomic status was associated with lower prenatal-diagnosis rate in metropolitan regions and higher risk of prenatal diagnosis after 22 weeks overall. What are the clinical implications of this work?Despite universal healthcare in Alberta, Canada, socioeconomic and regional inequalities in prenatal fetal cardiac diagnoses exist. To improve CHD outcomes, further efforts are required to identify modifiable underlying reasons for these findings and to guide novel and targeted health service delivery.

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