WIP 44 - Fetal echocardiogram guidelines impact on reducing Socioeconomic disparities for Prenatal Diagnosis of Critical Congenital Heart Disease

Publication Number: WIP 44.7518

Alejandra Mallorga Hernandez, Children's Hospital Los Angeles, Los Angeles, CA, United States; Jay Pruetz, Children's Hospital Los Angeles, Culver City, CA, United States; Shuo Wang, Children's Hospital Los Angeles, Los Angeles, CA, United States

Background: Historically, low socioeconomic status (SES) has been linked to lower prenatal diagnosis (PD) rate of critical congenital heart disease (CCHD) regardless of type of lesion. New fetal echocardiography guidelines were implemented in 2013 mandating fetal outflow tract (OFT) imaging in addition to the standard 4-view chamber view and revisions in 2020 added more OFT views.

Objective: To determine if these new guidelines could reduce SES impact on PD of CCHD, in particular for OFT lesions.

Design/Methods: We are currently conducting a single center retrospective study of newborns with CCHD admitted to our institution for cardiac intervention from 03/2020 to 07/2024 compared to a cohort seen prior to the implementation of the new guidelines. Patients will be classified by CCHD lesion type (Single ventricle vs OFT anomalies vs remaining historically difficult to diagnose lesions) and social deprivation index (SDI) scores will be calculated for each patient using their zip code tabulation areas. We will evaluate associations between SES, insurance type, maternal age, lesion type, and PD using bivariate analysis and multivariate logistic regression.
Preliminary data analysis for the first two years (n=209), from 03/2020 to 03/2022 is available from a previously IRB approved study. The lesion distribution included: (1) single ventricle (n=50); (2) OFT anomalies (n=91); and (3) remaining historically difficult to diagnose lesions (n=68), mostly comprised of aortic arch obstruction (n=52) and total anomalous pulmonary venous return (n=7). PD occurred in 144 patients (68%). We found that SES patients across all quartiles had comparable PD rates for single ventricle or OFT anomalies. However, higher SES patients were 7 times more likely to have a PD of historically difficult to diagnose lesions (odds ratio 7.04, 95% CI, 1.6 to 31.2, p=0.0106). We are in the process of including two additional years of data to improve the study power, IRB has been submitted, and further data collection will occur between 11/2024- 01/2025. We plan to complete final data analysis by 02/2025.