Timing of Critical Congenital Heart Defect Detection: A Multisite Population-Based Study

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.