Fetal Congenital Heart Disease Counseling and Socioeconomic Factors - Is There an Impact?

Background: Prenatal diagnosis of congenital heart disease (CHD) allows for complex decisions about care to be made in a timely manner and allows parents the opportunity to fully participate in those decisions. Counseling provides information to families regarding diagnosis, prognosis, management and treatment options, however, dynamics may vary from family to family. This study sought to investigate if the characteristics of fetal counseling were impacted by parental socioeconomic factors.

Methods: We performed a retrospective chart review of all fetal cardiac patients seen at our institution from 1/1/17 to 12/31/18. We evaluated counseling sessions based on documentation in the fetal echocardiogram report regarding use of interpreter, time spent counseling, people accompanying mother, and treatment option chosen. In addition, we looked at the gestational age at the first fetal echocardiogram, age of mother, zip code of residence and maternal ethnicity.

Results: 138 maternal-fetal dyads met inclusion criteria. There was no significant difference between maternal ethnicity and age of mother, gestational age at first fetal echocardiogram, elected termination or palliative delivery, number of follow-up fetal echocardiograms or family accompanying mother to the visit. Interpreter use did not increase visit length. The amount of time spent counseling was different between the 7 fetal cardiologists (p <0.0001). In addition, for fetuses with single ventricles, there was a significant increase in the amount of time spent counseling parents (p 0.002). Finally, there was a difference between the amount of time spent counseling and where the patient lived in the state (p<0.05).

Conclusion: Prenatal counseling and family decision making is multifaceted, however we demonstrated that at our center there was no difference between various parental socioeconomic factors and counseling. As expected, patients who came from further away for their first fetal echocardiogram or had single ventricle heart disease had longer counseling sessions. Variation amongst cardiologists should be further investigated and may be improved with use of standardized parental CHD resources.