Impact of maternal social vulnerability and timing of prenatal care on outcome of prenatally detected congenital heart disease

Objectives: Early prenatal detection of congenital heart disease allows mothers to plan for their pregnancy and delivery; however, the effect of sociodemographic and fetal factors on prenatal care have not been thoroughly investigated. This study evaluated the relative impact of maternal and fetal characteristics on (1) the timing of prenatal diagnosis of congenital heart disease (CHD) and (2) fetal and postnatal outcomes. Methods: This retrospective multicenter cohort study included women with a fetal echocardiogram diagnosis of CHD from 2010-2019. Women were grouped into quartiles of social vulnerability (Q1-4; low-high) using the 2014 Social Vulnerability Index (SVI) provided by the Centers for Disease Control and Prevention. A fetal disease severity score (range 1-7) was calculated based on CHD severity (mild = 1, moderate = 2, severe two ventricle = 3, severe single ventricle = 4), and prenatally diagnosed genetic abnormality, non-cardiac abnormality, and fetal hydrops (1 each). Late diagnosis was defined as a fetal echocardiogram diagnosis of CHD after 24 weeks gestation. Results: Among 441 pregnancies included, 94 (21%) had a late diagnosis of CHD. Late diagnosis was more common in the most socially vulnerable quartile (38%) than the other 3 quartiles (14-18%). Late diagnosis was also associated with Catholic or other Christian religion versus non-denominational or other religion, and with a lower fetal disease severity score. In the study group, there were 93 (21%) pregnancy terminations and 26 (6%) in-utero demises. Factors associated with pregnancy termination included early diagnosis and higher fetal disease severity. Compared to other quartiles, the most socially vulnerable quartile had a higher incidence of fetal demise and a lower incidence of pregnancy termination. Among the 322 live births, 46 (14%) died or underwent heart transplant in follow-up. Factors associated with postnatal death or heart transplant included longer delay between obstetric ultrasound and fetal echocardiogram and higher fetal disease severity. Conclusions: High social vulnerability, Catholic or other Christian religion, and low fetal disease severity are associated with late prenatal CHD diagnosis. Delays in CHD diagnosis are associated with less TOP and worse postnatal outcomes. Therefore, efforts to expedite fetal echocardiography following obstetric screening, particularly for at-risk women (e.g., high SVI), have the potential to impact pregnancy and postnatal outcomes among the prenatally diagnosed CHD population. This article is protected by copyright. All rights reserved.