Socioeconomic barriers to prenatal diagnosis of critical congenital heart disease

Prenat Diagn. 2021 Feb;41(3):341-346. doi: 10.1002/pd.5864. Epub 2020 Nov 16.


Objective: The study was designed to assess the impact of socioeconomic barriers on the rate of prenatal diagnosis of critical congenital heart disease (CCHD).

Methods: This was a retrospective review of the Medicaid analytic extract (MAX) dataset, a national Medicaid administrative claims database with linked maternal-infant claims, from 2007 to 2012. Infants with CCHD were identified by searching for International Classification of Diseases (ICD) 9 codes and Procedural Coding System (PCS) codes for CCHD within the first 6 months after the delivery date. Multivariate logistic regression was used to evaluate the effect of maternal and socioeconomic factors on the prenatal diagnosis rate.

Results: There were 4702 mother-infant dyads included in the analysis. The prenatal diagnosis rate of CCHD was 27.9%. Factors independently associated with odds of prenatal diagnosis of CCHD were presence of maternal diabetes (OR, 2.055; P < .001), ZIP code level median household income (OR, 1.005; P = .015), sonographer labor quotient (OR, 1.804; P = .047), the year of the delivery (OR, 1.155; P < .001), and needing a view other than a 4 chamber or outflow tract view to obtain the diagnosis (OR, 0.383; P < .001).

Conclusion: Maternal health, diabetes, socioeconomic factors, and access to sonographers impacts prenatal diagnosis of CCHD.

MeSH terms

  • Adult
  • Female
  • Health Services Accessibility / standards
  • Health Services Accessibility / statistics & numerical data
  • Heart Defects, Congenital / diagnosis*
  • Heart Defects, Congenital / diagnostic imaging
  • Heart Defects, Congenital / epidemiology
  • Humans
  • Infant
  • Infant, Newborn
  • Logistic Models
  • Male
  • Pregnancy
  • Prenatal Diagnosis / economics*
  • Prenatal Diagnosis / trends
  • Retrospective Studies
  • Risk Factors
  • Socioeconomic Factors*
  • United States / epidemiology