Timing of Critical Congenital Heart Defect Detection:A Multi-Site Population-Based Study.

Abstract

Objective: To evaluate prevalence of and characteristics associated with prenatal and late critical congenital heart defect (CCHD) detection among infants.

Study design: Infants with CCHD born during 2014-2021 with interviewed mothers were included from the Birth Defects Study To Evaluate Pregnancy exposureS (BD-STEPS), a multi-site, population-based case-control study. Timing of detection was based on date of earliest fetal or postnatal echocardiogram: prenatal, timely postnatal (0-3 days after birth), and late (>3 days after birth). Unadjusted log-linear models evaluated trends in timing of CCHD detection by birth year. Multivariable log-binomial models calculated adjusted prevalence ratios (aPRs) for prenatal and late CCHD detection by demographic and clinical characteristics.

Results: There were 996 liveborn infants with CCHD included in this analysis. Prenatal detection increased from 2014 (25.0%) to 2021 (39.1%; P for trend=0.01). The prevalence of late detection was 22.7% in 2014 and 16.4% in 2021; P=0.06. Almost half (48.6%) of infants had timely postnatal detection. Prenatal detection was 1.2 times (95% CI 1.1-1.5) more likely among infants with extracardiac compared with isolated defects. Late CCHD detection was 2.0 times (95% CI 1.2-3.4) more common among infants whose mothers lacked prenatal insurance compared with those with prenatal insurance.

Conclusions: Disparities in timing of CCHD detection exist by defect characteristics and insurance. Implementation of improved prenatal detection methods to detect more defect types and interventions to increase access to prenatal care may further improve earlier CCHD detection.