Prenatal Diagnosis Rate of Critical Congenital Heart Disease Remains Inadequate with Significant Racial/Ethnic and Socioeconomic Disparities and Technical Barriers

Background: Prenatal diagnosis (preDx) of critical congenital heart disease (CCHD) decreases neonatal morbidity and mortality. Obstetrical fetal cardiac imaging guidelines in 2013 aimed to increase preDx. Objective: To determine the contemporary preDx rate of CCHD and identify maternal-fetal factors and variations in prenatal care that may be potential barriers . Methods: : This retrospective single center study evaluated maternal demographics and characteristics of infants with CCHD (requiring cardiac catheterization or surgical intervention before 6 months-old) between 2016 and 2019. Results: : 58% of the 339 infants with CCHD had preDx. Infants with preDx were more likely to have mothers ≥ 35 years-old (p=0.028), family history of CHD (p=0.017), health insurance (p=0.002), or anatomic scan with perinatology (p<0.001). Hispanic infants were less likely to have preDx (45.6%, p=0.005). PreDx rates were higher in infants with extracardiac/genetic anomalies (p<0.001) and significantly different between CCHD subtypes (76% for single ventricle, 51% for biventricular, 59% for proximal outflow tract anomalies, and 48% for distal great artery anomalies; p=0.024). In infants without preDx, 25% of their mothers had indication for, but did not undergo, fetal echocardiography. Conclusion: PreDx rates of CCHD remains inadequate across subtypes detectable by standard fetal cardiac screening views, particularly in uninsured and Hispanic communities.