Trends in the Prenatal Detection of Major Congenital Heart Disease in Alberta From 2008–2018

Kaur, A; Hornberger, Lisa K.; Fruitman, Deborah; Ngwezi, Deliwe P.; Chandra, Sujata; Eckersley, Luke

doi:10.1016/j.jogc.2022.03.020

Cited by 11 publications

(10 citation statements)

References 30 publications

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“…Although determination of which of the above factors most influences gestational age at diagnosis is the focus of future study in this field, we observed an improvement in prenatal diagnosis of major CHD and rate of diagnosis < 22 weeks during the study period. We speculate that improvements in obstetric screening guidelines and ultrasound equipment, as well as fetal heart‐focused workshops provided by the fetal cardiology service for obstetric sonographers may have contributed to this 31 . Further work will aim to improve the skills of those performing and reviewing prenatal screening examinations, with mapping of sites with the lowest rates of detection that could be targeted for such interventions first.…”

Section: Discussionmentioning

confidence: 99%

Impact of rural residence and low socioeconomic status on rate and timing of prenatal detection of major congenital heart disease in a jurisdiction of universal health coverage

Kaur

Hornberger

Fruitman

et al. 2022

Ultrasound in Obstet & Gyne

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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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Section: Discussionmentioning

confidence: 99%

Impact of rural residence and low socioeconomic status on rate and timing of prenatal detection of major congenital heart disease in a jurisdiction of universal health coverage

Kaur

Hornberger

Fruitman

et al. 2022

Ultrasound in Obstet & Gyne

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“…Early reports of prenatal sCHD detection rates from 2000 to 2010 had a broad range from 15% to 59%, 16 while reports since 2010 have ranged from 30% to 88%. 31,[37][38][39][40] This improvement likely stemmed from technical advances in ultrasound technology, improved sonographer training, better scrutiny of outflow tract views, and implementation of a three-vessel and trachea view. We compared our results to studies published since 2010 14,23-32 and found that our overall live-born detection rate of 62% (CI 56-68) was comparable, validating the efficacy of the described referral paradigm, which recommends a referral to pediatric cardiology for cardiac abnormalities alone, excluding fetal and maternal risk factors.…”

Section: Discussionmentioning

confidence: 99%

Prenatal detection rates for congenital heart disease using abnormal obstetrical screening ultrasound alone as indication for fetal echocardiography

Vepa,

Alavi,

et al. 2024

Prenatal Diagnosis

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ObjectiveTo determine the live born prenatal detection rate of significant congenital heart disease (CHD) in a large, integrated, multi‐center community‐based health system using a strategy of referral only of patients with significant cardiac abnormalities on obstetrical screening ultrasound for fetal echocardiography. Detection rates were assessed for screening in both radiology and maternal fetal medicine (MFM). The impact on fetal echocardiography utilization was also assessed.MethodsThis was a retrospective cohort study using an electronic health record, outside claims databases and chart review to determine all live births between 2016 and 2020 with postnatally confirmed sCHD that were prenatally detectable and resulted in cardiac surgery, intervention, or death within 1 year.ResultsThere were 214,486 pregnancies resulting in live births. Prenatally detectable significant CHD was confirmed in 294 infants. Of those 183 were detected for an overall live‐born detection rate of 62%. Detection rates in MFM were 75% and in radiology were 52%. The number of fetal echocardiograms needed to detect (NND) sCHD was 7.ConclusionsA focus on quality and standardization of obstetrical screening ultrasound with referral to fetal echocardiography for cardiac abnormalities alone achieves benchmark targets for live‐born detection of significant CHD requiring fewer fetal echocardiograms.

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“…A regional study in the Netherlands from 2002 to 2012 noted significantly higher prenatal detection rates (93%) in single ventricle lesions, with an overall CHD prenatal detection rate of 59% [24]. In Alberta, Canada between 2008 and 2018, 58% of major CHD was diagnosed prenatally with higher detection rates of 82% for lesions requiring the four-chamber view versus those 66% of those requiring the outflow tract view [25]. More recent studies done after the 2013 modified guidelines [12] in the United States and internationally have continued to show variable and wide ranges of prenatal diagnosis rates, with CHD diagnosable by the standard four-chamber view more often diagnosed prenatally (Table 6) [5,22,26,27].…”

Section: Discussionmentioning

confidence: 99%

Prenatal Diagnosis Rate of Critical Congenital Heart Disease Remains Inadequate with Significant Racial/Ethnic and Socioeconomic Disparities and Technical Barriers

Davtyan,

Ostler,

Golding

et al. 2023

Pediatr Cardiol

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Prenatal diagnosis (preDx) of critical congenital heart disease (CCHD) decreases neonatal morbidity and mortality. Obstetrical fetal cardiac imaging guidelines in 2013 aimed to increase preDx. The objectives of this study were to determine the contemporary preDx rate of CCHD and identify maternal–fetal factors and variations in prenatal care that may be potential barriers. This retrospective single center study evaluated maternal demographics and characteristics of infants with CCHD (requiring cardiac catheterization or surgical intervention before 6 months-old) between 2016 and 2019. 58% of the 339 infants with CCHD had preDx. Infants with preDx were more likely to have mothers ≥ 35 years-old (p = 0.028), family history of CHD (p = 0.017), health insurance (p = 0.002), or anatomic scan with perinatology (p < 0.001). Hispanic infants were less likely to have preDx (45.6%, p = 0.005). PreDx rates were higher in infants with extracardiac/genetic anomalies (p < 0.001) and significantly different between CCHD subtypes (76% for single ventricle, 51% for biventricular/four-chamber view, 59% for proximal outflow tract anomalies, and 48% for distal great artery anomalies; p = 0.024). In infants without preDx, 25% of their mothers had indication for, but did not undergo, fetal echocardiography. PreDx rates of CCHD remains inadequate across subtypes detectable by standard fetal cardiac screening views, particularly in uninsured and Hispanic communities.

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Trends in the Prenatal Detection of Major Congenital Heart Disease in Alberta From 2008–2018

Cited by 11 publications

References 30 publications

Impact of rural residence and low socioeconomic status on rate and timing of prenatal detection of major congenital heart disease in a jurisdiction of universal health coverage

Impact of rural residence and low socioeconomic status on rate and timing of prenatal detection of major congenital heart disease in a jurisdiction of universal health coverage

Prenatal detection rates for congenital heart disease using abnormal obstetrical screening ultrasound alone as indication for fetal echocardiography

Prenatal Diagnosis Rate of Critical Congenital Heart Disease Remains Inadequate with Significant Racial/Ethnic and Socioeconomic Disparities and Technical Barriers

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