Antenatal Diagnosis of Congenital Heart Disease in the State of Alabama: Challenges and Opportunities

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Abstract

Background:

Antenatal diagnosis of congenital heart disease (CHD) has positive effects on clinical outcomes. However, the prevalence of antenatal diagnosis remains low. The objective of this study is to measure the prevalence and distribution of antenatal CHD diagnosis in Alabama.

Methods:

Data were obtained from the Society of Thoracic Surgeons national database on surgeries for children with CHD and stratified by antenatal diagnosis. Demographic, census, and hospital data were compared between pre- and post-natally diagnosed cases. Cases were mapped by ZIP code to describe the distribution for the prevalence of CHD antenatal diagnosis.

Results:

From 2013-2019, 1733 children required cardiac repair for CHD, 20% were diagnosed prenatally and 80% postnatally. Only 43% of those with Hypoplastic Left Heart Syndrome, 22% with Tetralogy of Fallot and 26% with Transposition of the Great Arteries had a prenatal diagnosis. No factors were associated with receiving a prenatal diagnosis. Lastly, 82% of ZIP codes were below the reported national average for antenatal CHD diagnosis.

Conclusion:

Prenatal detection of CHD in Alabama is lower than the reported national averages. More studies are needed to explore reasons for missed antenatal CHD diagnoses. Mitigation of factors related to low antenatal diagnosis can support patients and improve neonatal outcomes.

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Most cited references 27

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Global, regional, and national burden of congenital heart disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

(2020)

Summary Background Previous congenital heart disease estimates came from few data sources, were geographically narrow, and did not evaluate congenital heart disease throughout the life course. Completed as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017, this study aimed to provide comprehensive estimates of congenital heart disease mortality, prevalence, and disability by age for 195 countries and territories from 1990 to 2017. Methods Mortality estimates were generated for aggregate congenital heart disease and non-fatal estimates for five subcategories (single ventricle and single ventricle pathway congenital heart anomalies; severe congenital heart anomalies excluding single ventricle heart defects; critical malformations of great vessels, congenital valvular heart disease, and patent ductus arteriosus; ventricular septal defect and atrial septal defect; and other congenital heart anomalies), for 1990 through to 2017. All available global data were systematically analysed to generate congenital heart disease mortality estimates (using Cause of Death Ensemble modelling) and prevalence estimates (DisMod-MR 2·1). Systematic literature reviews of all types of congenital anomalies to capture information on prevalence, associated mortality, and long-term health outcomes on congenital heart disease informed subsequent disability estimates. Findings Congenital heart disease caused 261 247 deaths (95% uncertainty interval 216 567–308 159) globally in 2017, a 34·5% decline from 1990, with 180 624 deaths (146 825–214 178) being among infants (aged <1 years). Congenital heart disease mortality rates declined with increasing Socio-demographic Index (SDI); most deaths occurred in countries in the low and low-middle SDI quintiles. The prevalence rates of congenital heart disease at birth changed little temporally or by SDI, resulting in 11 998 283 (10 958 658–13 123 888) people living with congenital heart disease globally, an 18·7% increase from 1990 to 2017, and causing a total of 589 479 (287 200–973 359) years lived with disability. Interpretation Congenital heart disease is a large, rapidly emerging global problem in child health. Without the ability to substantially alter the prevalence of congenital heart disease, interventions and resources must be used to improve survival and quality of life. Our findings highlight the large global inequities in congenital heart disease and can serve as a starting point for policy changes to improve screening, treatment, and data collection. Funding Bill & Melinda Gates Foundation.

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Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association.

Mary Donofrio, Anita Moon-Grady, Lisa Hornberger … (2014)

The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease.