Screening fetal echocardiography in diabetic mothers with normal findings on detailed anatomic survey

To evaluate the benefit of second-trimester fetal echocardiography for women with diabetes whose fetuses had no obvious heart disease on a detailed anatomic survey performed at skilled, high-volume obstetric centers, and to investigate the technical limitations of fetal echocardiography in this patient population.

This was a retrospective descriptive review of fetal echocardiograms performed at Children's Hospital Boston from 2000 to 2005. All women referred during the second trimester for fetal echocardiography because of maternal diabetes were included. Those with severe heart disease suspected on obstetric ultrasound examination were excluded.

There were 584 initial fetal echocardiograms. No patients were diagnosed with severe heart disease prenatally. Nineteen were diagnosed with suspected mild heart disease (such as small ventricular septal defect), five of whom had normal follow-up fetal evaluation and five of whom had normal postnatal evaluation. Most of these pregnancies did not have a postnatal cardiac evaluation. Forty-seven fetuses had benign cardiac findings. Nearly one third of patients had imaging that was felt to be limited or incomplete, mostly due to poor acoustic windows. Forty-eight patients were asked to return for at least one follow-up visit, most due to the inability to complete the exam at the initial visit.

In an environment with access to high-volume, skilled comprehensive ultrasound services, fetal echocardiography by a pediatric cardiology program adds little to the care of women with diabetes and no suspected heart disease on a detailed anatomic survey. Poor acoustic windows frequently necessitate multiple visits.