RESEARCH ARTICLE


Antenatal Diagnosis of Congenital Heart Disease in the State of Alabama: Challenges and Opportunities



Joseph R. Buckman1, Rachel G. Sinkey2, Kathryn S. Maxwell1, Martha S. Wingate3, Janet M. Bronstein3, Robert J. Dabal1, Robert A. Sorabella1, Daisy Padilla1, David C. Cleveland1, Luz A. Padilla1, 4, *
1 Department of Surgery, Division of Cardiovascular and Thoracic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
2 Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Alabama at Birmingham, AL, USA
3 Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, AL, USA
4 Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, AL, USA


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Creative Commons License
© 2022 Buckman et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, AL 35294-0022, USA; Tel: (502) 262-6255; E-mail: lpadilla@uabmc.edu


Abstract

Background:

Antenatal diagnosis of congenital heart disease (CHD) has positive effects on clinical outcomes. However, the prevalence of antenatal diagnosis remains low. The objective of this study is to measure the prevalence and distribution of antenatal CHD diagnosis in Alabama.

Methods:

Data were obtained from the Society of Thoracic Surgeons national database on surgeries for children with CHD and stratified by antenatal diagnosis. Demographic, census, and hospital data were compared between pre- and post-natally diagnosed cases. Cases were mapped by ZIP code to describe the distribution for the prevalence of CHD antenatal diagnosis.

Results:

From 2013-2019, 1733 children required cardiac repair for CHD, 20% were diagnosed prenatally and 80% postnatally. Only 43% of those with Hypoplastic Left Heart Syndrome, 22% with Tetralogy of Fallot and 26% with Transposition of the Great Arteries had a prenatal diagnosis. No factors were associated with receiving a prenatal diagnosis. Lastly, 82% of ZIP codes were below the reported national average for antenatal CHD diagnosis.

Conclusion:

Prenatal detection of CHD in Alabama is lower than the reported national averages. More studies are needed to explore reasons for missed antenatal CHD diagnoses. Mitigation of factors related to low antenatal diagnosis can support patients and improve neonatal outcomes.

Keywords: Antenatal diagnosis, Congenital heart disease, Geographical spatial analysis, Patients, Diagnosis, Heart transplantation.