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Disparities in the prenatal detection of critical congenital heart disease
G D Hill1, J R Block1, J B Tanem1
1Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
Insights
Prenatal diagnosis of critical congenital heart disease (CCHD) is improving, but missed diagnoses are more common in impoverished or rural areas. Targeted interventions are needed to improve detection rates in these vulnerable communities.
Area of Science:
- Cardiology
- Prenatal Medicine
- Public Health
Background:
- Critical congenital heart disease (CCHD) requires early intervention, and prenatal diagnosis improves outcomes by enabling specialized delivery.
- Missed prenatal diagnoses of CCHD increase risks for newborns.
Purpose of the Study:
- To identify risk factors associated with missed prenatal diagnoses of CCHD.
- To inform strategies for improving prenatal detection of CCHD.
Main Methods:
- Retrospective cohort study of 535 patients with CCHD at Children's Hospital of Wisconsin (2007-2013).
- Comparison of patients with prenatal versus postnatal CCHD diagnoses.
- Analysis of demographic and clinical factors associated with diagnosis timing.
Main Results:
- The prenatal diagnostic rate for CCHD improved from 44% to 69% between 2007 and 2013.
- Factors associated with postnatal diagnosis included complex lesions (requiring views beyond the four-chamber view), absence of other anomalies, and residence in high-poverty or low-density population areas.
- Patients in impoverished or rural communities had a higher risk of missed prenatal diagnosis.
Conclusions:
- Despite improvements, disparities in prenatal CCHD diagnosis persist.
- Vulnerable populations in impoverished or rural areas face higher risks of missed prenatal diagnoses.
- Interventions should focus on improving prenatal CCHD detection in underserved communities.
Objectives:
Prenatal diagnosis of critical congenital heart disease, which requires surgical or catheter intervention in the first 30 days of life, allows for delivery at a specialized center and can reduce preoperative morbidity and mortality. We sought to identify the 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 to 2013 were included. Those with a prenatal diagnosis were compared with 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 four 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.
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