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Timing of Critical Congenital Heart Defect Detection: A Multisite Population-Based Study
Shannon E Moss1, Elizabeth Ailes1, Karrie F Downing1
1Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA.
Insights
Prenatal detection of critical congenital heart defects (CCHD) increased, but late detection remains a concern, particularly for uninsured mothers. Early CCHD diagnosis is vital for infant health outcomes.
Area of Science:
- Pediatric Cardiology
- Public Health
- Medical Diagnostics
Background:
- Critical congenital heart defects (CCHD) are a significant cause of infant mortality and morbidity.
- Early detection of CCHD is crucial for timely intervention and improved outcomes.
- Variations in detection timing, including prenatal, timely postnatal, and late postnatal, impact management strategies.
Purpose of the Study:
- To determine the prevalence and trends of prenatal and late CCHD detection.
- To identify demographic and clinical factors associated with prenatal and late CCHD detection.
- To understand disparities in CCHD detection timing.
Main Methods:
- Analysis of infants with CCHD from the Birth Defects Study To Evaluate Pregnancy exposureS (2014-2021).
- Categorization of CCHD detection timing: prenatal, timely postnatal (0-3 days), and late (>3 days).
- Statistical modeling (log-linear and log-binomial) to assess trends and prevalence ratios.
Main Results:
- Prenatal CCHD detection rose from 25.0% in 2014 to 39.1% in 2021.
- Late CCHD detection prevalence decreased slightly but remained significant (22.7% in 2014 to 16.4% in 2021).
- Infants with extracardiac defects had higher prenatal detection rates; late detection was more common in infants of uninsured mothers.
Conclusions:
- Significant disparities in CCHD detection timing exist based on defect characteristics and maternal insurance status.
- Improved prenatal detection methods are needed to identify a wider range of CCHD types.
- Enhancing access to prenatal care is essential to reduce late CCHD detection and improve early diagnosis.
Objective:
To evaluate prevalence of and characteristics associated with prenatal and late critical congenital heart defect (CCHD) detection among infants.
Study Design:
Infants with CCHD born during 2014-2021 with interviewed mothers were included from the Birth Defects Study To Evaluate Pregnancy exposureS, a multisite, population-based case-control study. Timing of detection was based on date of earliest fetal or postnatal echocardiogram: prenatal, timely postnatal (0-3 days after birth), and late (>3 days after birth). Unadjusted log-linear models evaluated trends in timing of CCHD detection by birth year. Multivariable log-binomial models calculated adjusted prevalence ratios for prenatal and late CCHD detection by demographic and clinical characteristics.
Results:
There were 996 liveborn infants with CCHD included in this analysis. Prenatal detection increased from 2014 (25.0%) to 2021 (39.1%; P for trend = .01). The prevalence of late detection was 22.7% in 2014 and 16.4% in 2021; P = .06. Almost half (48.6%) of infants had timely postnatal detection. Prenatal detection was 1.2 times (95% CI 1.1-1.5) more likely among infants with extracardiac compared with isolated defects. Late CCHD detection was 2.0 times (95% CI 1.2-3.4) more common among infants whose mothers lacked prenatal insurance compared with those with prenatal insurance.
Conclusions:
Disparities in timing of CCHD detection exist by defect characteristics and insurance. Implementation of improved prenatal detection methods to detect more defect types and interventions to increase access to prenatal care may further improve earlier CCHD detection.
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