Babies from poor and rural families less likely to have heart conditions found before birth
Study finds big ethnic and economic disparities in timing of congenital heart disease diagnosis
Who you are and where you live may play a role in whether doctors find your baby’s serious heart condition before birth or after birth. A large and far-ranging study in the journal Circulation finds that people from poorer neighborhoods and places that are far away from major heart centers are far less likely to have their baby’s heart condition diagnosed as early as possible. People who are Hispanic are also less likely to have their baby’s serious heart condition found before birth. Early diagnosis can be very important to determining if a baby is on track for a long and healthy life.
“The earlier we diagnose a heart defect, especially a serious one, the sooner we can make a plan for how to safely deliver the infant and reduce the impacts of that heart defect on the rest of the body,” says Anita Krishnan, M.D., first author and cardiologist at Children’s National Hospital. “Early detection and diagnosis of these conditions is crucial to ensuring the best possible outcome for the child, especially in protecting the brain.”
This is the largest and most geographically diverse study of these challenges to date. The study compared patient data of more than 1,800 children from the United States and Canada diagnosed with two of the most common, and the most serious, critical congenital heart defects. The first is hypoplastic left heart syndrome (HLHS), when the left side of the heart is not developed completely. The second is called transposition of the great arteries (TGA), when the two main arteries that carry blood away from the heart are reversed.
“The COVID-19 pandemic has brought national attention the idea of significant disparities in health care,” says Dr. Krishnan. “Even though many health care providers have seen these inequities firsthand in their own clinical experience, it was still surprising to see the strength of the association between socioeconomic position and the care available to mothers.”
Even when babies’ heart conditions were found before birth, babies from poorer neighborhoods were diagnosed later in the pregnancy than others.
In both the United States and Canada, routine prenatal care includes blood and ultrasound screening tests in the first trimester for early signs of heart and other conditions. In the second trimester, standard prenatal care includes a detailed ultrasound test that looks for any unusual structures in the baby’s heart. If any of these tests finds anything unusual, a special pediatric heart doctor can perform a fetal echocardiogram test to learn more.
The authors suggest that people in poor neighborhoods, who live far away from specialty health care, or who are of certain backgrounds, including people who are Hispanic, have less access to the special doctors who would recognize and these conditions during pregnancy.
“Prenatal detection rates may improve if we are able to leverage outreach and telehealth to strengthen the relationships between these specialties and the groups we identified in the study,” Dr. Krishnan says.
The study included a total of 1,862 patients, including 1,171 patients with HLHS (91.8% prenatally diagnosed) and 691 with TGA (58% prenatally diagnosed). The study group included prenatally diagnosed fetuses with HLHS or TGA and postnatally diagnosed infants less than two months old with HLHS or TGA. Data was collected from institutions participating in the Fetal Heart Society, a non-profit 501(c) multicenter research collaborative with a mission to advance the field of fetal cardiovascular care and science.
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