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Homogenous access to fetal cardiac care in a heterogeneous state
Christina Ronai1,2, Laura Garcia Godoy1, Erin Madriago1
1Department of Pediatrics, Division of Pediatric Cardiology, Oregon Health and Sciences University, Portland, OR, USA.
Insights
Prenatal diagnosis of congenital heart disease (CHD) was timely for all families, regardless of socio-economic factors. Consistent counseling was provided, ensuring equitable care for diverse populations across Oregon.
Area of Science:
- Maternal-fetal medicine
- Pediatric cardiology
- Public health
Background:
- Timely prenatal diagnosis of congenital heart disease (CHD) is crucial for family planning and decision-making.
- Socio-economic factors may influence access to timely diagnosis and quality of prenatal counseling.
Conclusions:
- Despite Oregon's diverse population and geography, fetal echocardiogram referrals and initial visits occurred in a uniformly timely manner.
- Prenatal counseling and family decision-making processes were consistent across different socio-economic backgrounds.
- The study demonstrates equitable access to timely diagnosis and consistent counseling for congenital heart disease.
Background:
Timely prenatal diagnosis of CHD allows families to participate in complex decisions and plan for the care of their child. This study sought to investigate whether timing of initial fetal echocardiogram and the characteristics of fetal counselling were impacted by parental socio-economic factors.
Methods:
Retrospective chart review of fetal cardiac patients from 1 January, 2017 to 31 December, 2018. We reviewed gestational age at first fetal echo, maternal age and ethnicity, zip code, rurality index, and hospital distance. Counselling was evaluated based on documentation regarding use of interpreter, time billed for counselling, and treatment option chosen.
Results:
Total of 139 maternal-fetal dyads were included, and 29 dyads had single-ventricle heart disease. There was no difference in income, hospital distance or rurality index, and first fetal echo timing. There was no significant difference between maternal ethnicity and maternal age, gestational age at initial visit, or follow-up. Patients in rural areas had increased counselling time (p < .05). There was no difference between socio-economic factors and ultimate parental choices (termination, palliative delivery, or cardiac interventions).
Conclusion:
Oregon comprises a heterogeneous population from a large geographical catchment. While prenatal counselling and family decision-making are multifaceted, we demonstrated that dyads were referred from across the state and received care in a uniformly timely manner, and once at our centre received consistent counselling despite differences in parental socio-economic factors.
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