title: Disparities in the prenatal detection of critical congenital heart disease.
abstract: OBJECTIVE
  Prenatal diagnosis of critical congenital heart disease, which requires surgical or catheter intervention in the first 30 days of life, allows for delivery at a specialized center and can reduce preoperative morbidity and mortality. We sought to identify the risk factors for a missed prenatal diagnosis of critical congenital heart disease.
  
  
  METHODS
  Patients presenting to the Children's Hospital of Wisconsin with critical congenital heart disease from 2007 to 2013 were included. Those with a prenatal diagnosis were compared with those with a postnatal diagnosis.
  
  
  RESULTS
  The cohort included 535 patients with prenatal diagnosis made in 326 (61%). The prenatal diagnostic rate improved from 44% in 2007 to 69% in 2013. Independent factors associated with a postnatal diagnosis were a lesion that required a view other than a four chamber view to make the diagnosis (p < 0.0001), absence of another organ system anomaly (p < 0.0001), and living in a higher poverty (p = 0.02) or lower population density communities (p = 0.002).
  
  
  CONCLUSIONS
  While the prenatal diagnostic rate for critical congenital heart disease is improving, those living in impoverished or rural communities are at highest risk of not having a diagnosis made prenatally. Interventions to improve prenatal detection of congenital heart disease should target these vulnerable areas.
authors.affiliation: Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: G D
authors.initials: GD
authors.lastname: Hill
authors.affiliation: Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Block
authors.affiliation: Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: J B
authors.initials: JB
authors.lastname: Tanem
authors.affiliation: Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Frommelt
mesh_terms: D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000628:therapy; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D016216:Ultrasonography, Prenatal; D014922:Wisconsin