Disparities in the prenatal detection of critical congenital heart disease

Abstract

Objectives Prenatal diagnosis of critical congenital heart disease, that requiring surgical or catheter intervention in the first 30 days of life, allows for delivery at a specialized center which can reduce preoperative morbidity and mortality. We sought to identify risk factors for a missed prenatal diagnosis of critical congenital heart disease. Methods Patients presenting to the Children’s Hospital of Wisconsin with critical congenital heart disease from 2007-2013 were included. Those with a prenatal diagnosis were compared to those with a postnatal diagnosis. Results The cohort included 535 patients with prenatal diagnosis made in 326 (61%). The prenatal diagnostic rate improved from 44% in 2007 to 69% in 2013. Independent factors associated with a postnatal diagnosis were a lesion that required a view other than a 4 chamber view to make the diagnosis (p<0.0001), absence of another organ system anomaly (p<0.0001), and living in a higher poverty (p=0.02) or lower population density communities (p=0.002). Conclusions While the prenatal diagnostic rate for critical congenital heart disease is improving, those living in impoverished or rural communities are at highest risk of not having a diagnosis made prenatally. Interventions to improve prenatal detection of congenital heart disease should target these vulnerable areas.

Newborn pulse oximetry screening in the context of a high antenatal detection rate of critical congenital heart disease

“…The antenatal detection achieved in this study is superior to rates reported by many other developed countries . This may be attributed to various factors.…”

“…This relates to the relative simplicity of diagnosing single ventricle anomalies, that are associated with a guarded outlook, such as HLHS and TA by means of the four‐chamber view of the fetal heart. The presence of an extra‐cardiac or chromosomal anomaly also improves the likelihood of antenatal detection significantly, but the presence of these co‐morbidities is another poor prognostic indicator. A higher mortality rate was observed among those born before 37 weeks’ gestation.…”

Population trends in prenatal detection of transposition of great arteries: impact of obstetric screening ultrasound guidelines

“…Its routine application led to the detection of many forms of CHD and early incorporation into ultrasound practice guidelines. As a consequence, detection rates of > 85% have been achieved for four‐chamber pathologies, including hypoplastic left and right heart syndrome and complex cardiac pathology associated with heterotaxy syndrome.…”

Socio‐economic inequalities in mortality in children with congenital heart disease: A systematic review and meta‐analysis

“…Differences in case mix between the most versus least deprived are one possible mechanism. In some populations, prenatal diagnosis of CHD is less common in those living in higher poverty . This may affect case mix if severe cases are undiagnosed and therefore more likely to continue to term in those of lower compared to higher SES.…”