Selective Fetal Echocardiogram Referral Program for Pregnancies Affected by Pregestational Diabetes

Area of Science:

• Cardiology
• Obstetrics
• Neonatology

Background:

• Fetal echocardiography (FE) is recommended for pregnancies with pregestational diabetes.
• Congenital heart disease (CHD) is a significant concern in these pregnancies.

Purpose of the Study:

• To evaluate a selective FE referral policy for detecting CHD in pregnancies with pregestational diabetes.
• To determine if this policy misses clinically relevant defects.

Main Methods:

• Retrospective cohort study of pregnancies with type 1 or 2 diabetes (July 2018-July 2023).
• Detailed obstetric ultrasounds with expanded cardiac views performed by maternal-fetal medicine (MFM) sonographers.
• Selective FE referral based on specific indications (suboptimal or abnormal views).

Main Results:

• 10 (1.7%) clinically significant CHD were diagnosed prenatally.
• All clinically significant CHD were detected, including those with A1C >9.0.
• Selective FE referral reduced FE utilization to 27.5% of pregnancies.

Conclusions:

• A selective FE referral policy is effective in identifying clinically significant CHD in pregestational diabetes pregnancies.
• This approach substantially reduces FE utilization in experienced tertiary centers.
• Expanded cardiac imaging protocols enhance prenatal CHD detection.