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Disparities in the prenatal detection of critical congenital heart disease
Author(s) -
Hill G. D.,
Block J. R.,
Tanem J. B.,
Frommelt M. A.
Publication year - 2015
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.4622
Subject(s) - medicine , prenatal diagnosis , heart disease , pediatrics , population , cohort , pregnancy , obstetrics , fetus , genetics , environmental health , biology
Objectives Prenatal diagnosis of critical congenital heart disease, which requires surgical or catheter intervention in the first 30 days of life, allows for delivery at a specialized center and can reduce preoperative morbidity and mortality. We sought to identify the risk factors for a missed prenatal diagnosis of critical congenital heart disease. Methods Patients presenting to the Children's Hospital of Wisconsin with critical congenital heart disease from 2007 to 2013 were included. Those with a prenatal diagnosis were compared with those with a postnatal diagnosis. Results The cohort included 535 patients with prenatal diagnosis made in 326 (61%). The prenatal diagnostic rate improved from 44% in 2007 to 69% in 2013. Independent factors associated with a postnatal diagnosis were a lesion that required a view other than a four chamber view to make the diagnosis ( p < 0.0001), absence of another organ system anomaly ( p < 0.0001), and living in a higher poverty ( p = 0.02) or lower population density communities ( p = 0.002). Conclusions While the prenatal diagnostic rate for critical congenital heart disease is improving, those living in impoverished or rural communities are at highest risk of not having a diagnosis made prenatally. Interventions to improve prenatal detection of congenital heart disease should target these vulnerable areas. © 2015 John Wiley & Sons, Ltd.