171 - Prenatal Diagnosis Rate of Critical Congenital Heart Disease Remains Inadequate with Important Racial Disparities and Technical Barriers

Poster Number: 171
Publication Number: 171.101

Arpine Davtyan, University of California, San Diego School of Medicine, San Diego, CA, United States; Heidi Bark, Rady Children's Hospital San Diego, San DIego, CA, United States; Heather Y. Sun, Rady Children's Hospital San Diego, San Diego, CA, United States

Background: Prenatal diagnosis (PreDx) of critical congenital heart disease (CCHD) has been shown to decrease morbidity and mortality. In 2013, revision of obstetrical fetal cardiac imaging guidelines aimed to increase rates of preDx. 

Objective: We sought to determine the contemporary rate of preDx in infants with CCHD and identify maternal-fetal factors and variations in prenatal care that may be potential barriers.

Design/Methods: This retrospective study evaluated maternal demographics and characteristics of infants with CCHD (defined as requiring cardiac catheterization or surgical intervention before 6 months-old) from October 2016 to December 2019. Prospective telephone surveys ascertained prenatal care information from mothers of infants who underwent or died prior to intervention within the first month of life. Infants with isolated VSD, vascular ring, or branch pulmonary artery anomalies were excluded.

Results: Overall, 58% (197/339) of infants with CCHD had preDx. Infants with preDx were more likely to have mothers who were 35 or older (p=0.028), had family history of CHD (p=0.017), had health insurance (p=0.002), or saw a perinatologist for anatomic scan (p < 0.001). Hispanic infants were less likely to have preDx (45.6%) compared to African American (73%), Asian (63.6%), or Caucasian (63.6%) infants (p=0.005). In infants who had preDx versus those who did not, there was no significant difference between maternal primary language, BMI, annual household income, socioeconomic status (based on area deprivation index), health insurance type, or distance from a fetal cardiologist. PreDx rates were higher in infants with preDx of extracardiac/genetic anomalies (p < 0.001) and significantly different between subtypes of CCHD (76% in infants with single ventricle anomalies, 51% in infants with biventricular anomalies, 59% in infants with outflow tract anomalies, and 48% in infants with anomalies of the distal great arteries; p=0.024). In infants without preDx, 21% had CCHD detectable by fetal four chamber view and 54% had CCHD detectable by adequate outflow tract imaging; 30% of their mothers had indication for, but did not receive, fetal echocardiogram during the pregnancy.Conclusion(s): PreDx rates of CCHD remains inadequate across subtypes detectable by the standard fetal cardiac screening views. Outreach to primary obstetrical providers and education regarding fetal cardiac imaging and indications for fetal echocardiogram, particularly in uninsured and Hispanic communities, should be prioritized to increase rates of preDx of CCHD.
CVDavtyan-Arpine_CV_January2022.pdf