Fetal Cardiology Prenatal Care Quality and Social Determinants of Health in Critical Congenital Heart Disease

Prenatal diagnosis of critical congenital heart disease (cCHD) and subsequent perinatal recommendations are vital components of prenatal care that affect infant morbidity and mortality. However, there is limited understanding of the relationship between fetal cardiology prenatal care quality, infant outcomes, and maternal social determinants of health (SDoH). The aim of this study was to better understand this relationship, and to further characterize the continuum of prenatal to postnatal care in a population of maternal-infant dyads diagnosed with cCHD. This was a single-site, retrospective cohort study of 217 maternal-infant dyads with cCHD cared for between 2021 and 2022. A community deprivation index was used as a marker of maternal SDoH. 198 dyads had a prenatal cCHD diagnosis. Maternal deprivation was similar in those with prenatal versus postnatal diagnosis. The majority were identified on obstetric anatomy ultrasound, with median 15 days (IQR: 7, 28) from concern to fetal echocardiogram. Nearly all had perinatal delivery recommendations, while 73% had cardiothoracic surgery and 60% genetics referral. Only 76% of those diagnosed prenatally were alive at birth admission discharge. Multivariable analysis demonstrated an association between fetal cardiology visit cancelation and earlier gestational age at birth (β -1.5, 95% CI -2.9, -0.05); time to fetal echocardiogram and no-show visits were not associated with outcomes. There was no association between higher maternal deprivation and fetal cardiology care. In conclusion, cCHD represents a subset of lesions with high morbidity and mortality, with nearly 1 in 4 prenatally diagnosed patients not reaching birth admission discharge. Identifying areas for fetal cardiology care optimization has the potential to affect outcomes; however further research is needed to understand the relationship between visit cancelation and gestational age at birth, as well as the impact of care quality and SDoH on optimal care delivery.