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

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.