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Prenatal Care and Perinatal Regionalization for Congenital Heart Defects
Christina Laternser1, William A Grobman2, Cecilia Albaro3
1Division of Pediatric Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
JAMA Network Open
|November 9, 2025
Summary
Delayed prenatal care initiation increases the likelihood of delivery at a pediatric cardiac center for neonates with congenital heart defects (CHDs), particularly severe cases. Adequate prenatal visits may help direct milder CHDs to appropriate non-cardiac facilities.
Area of Science:
- Neonatal care
- Cardiology
- Public health
Background:
- Regionalization aims to direct neonates with congenital heart defects (CHDs) to appropriate care levels.
- The impact of prenatal care adequacy on delivery location for CHDs is not well understood.
Purpose of the Study:
- To determine the association between prenatal care adequacy and the probability of delivery at a pediatric cardiac center for neonates with CHDs.
Main Methods:
- Cross-sectional study using retrospective data from Illinois' Adverse Pregnancy Outcomes Reporting System (2013-2021).
- Analyzed associations between prenatal care initiation and visit frequency with delivery at a cardiac center, controlling for confounders.
- Stratified analyses by CHD severity (mild, moderate, severe).
Main Results:
- Delayed prenatal care initiation was linked to a higher probability of cardiac center delivery, especially for severe CHDs (30.2% increase).
- For mild CHDs, adequate plus prenatal care was associated with a lower probability of cardiac center delivery compared to intermediate care (-6.7%).
- Prenatal visit frequency did not show an association with delivery at a cardiac center for severe CHDs.
Conclusions:
- Delayed prenatal care initiation is associated with increased delivery at cardiac centers for neonates with CHDs, particularly severe cases.
- Optimizing prenatal visit frequency may aid in directing milder CHD cases to non-cardiac centers.
- Prenatal care is a crucial factor in the effective operationalization of regionalized CHD care systems.
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