PM1016: Prenatal Diagnosis of Critical Congenital Heart Disease Continues to Improve Despite the Pandemic, but Vulnerable Populations Still Lag Behind

Background: Prenatal diagnosis of critical congenital heart disease (CCHD) has increased over time, particularly with the development of improved fetal echocardiography (FE) guidelines and training. Previous studies have revealed factors influencing rates of prenatal diagnosis such as CHD subtype and socioeconomic status (SES). We sought to assess current prenatal detection rates of CCHD during the pandemic compared to historical data and to investigate potential factors associated with lack of prenatal diagnosis.

Methods: This was a single center retrospective study of newborns with CCHD admitted to Children’s Hospital Los Angeles (CHLA) for cardiac intervention from March 19th, 2020 (date California’s Stay at Home order went into effect) to March 18th, 2021 (pandemic period). CCHD was defined as congenital heart disease requiring surgical or catheter-based intervention within the first 30 days of life. Patients with an isolated patent ductus arteriosus were excluded. Fetal and maternal demographic data potentially associated with prenatal detection were collected, evaluated, and compared to those of neonates with CCHD undergoing cardiac intervention at CHLA from an historical data collection period (2009-2016, pre-pandemic period).

Results: Ninety-nine patients with CCHD were identified during the pandemic period and compared to 791 patients in the combined historical periods. The overall prenatal detection rate increased from 45.4% to 57.6% (p=0.0219) from the pre-pandemic to the pandemic period. Differences were observed in prenatal detection rates for various CHD lesion types over the study period (Table 1). The prenatal diagnosis of single ventricle lesions increased from 67.8% in 2009-2016 to 94.1% in 2020-2021 (p=0.0269). Although not statistically significant, prenatal diagnosis for outflow track anomalies improved from 37.3% (2009-2012) to 50.5% (2013-2016) to 56.1% (2020-2021) (p=0.0513). In the pandemic cohort, patients with commercial insurance were 3.2 times more likely to have a prenatal diagnosis of CCHD than those with public insurance (OR = 3.21, 95% CI 1.29-7.98, p = 0.0121) after controlling for maternal age and Non-Hispanic White race.

Conclusion: Prenatal detection of CCHD has improved significantly over the past decade through the pandemic period. Patients with commercial insurance were greater than 3 times more likely to have a prenatal diagnosis of CCHD than were those with public insurance during the pandemic period. Further investigation is needed to examine the reasons and potential avenues of mitigation for lower rates of prenatal diagnosis in pregnant people with public insurance.