title: Assessing sociodemographic differences (or lack thereof) in prenatal diagnosis of congenital heart defects: a population-based study.
abstract: OBJECTIVE
  Our main objective was to assess sociodemographic differences in the probability of prenatal diagnosis of congenital heart defects (CHD); we also looked at differences in termination of pregnancy for fetal anomaly (TOPFA).
  
  
  METHODS
  Prospective cohort observational study.
  
  
  METHODS
  Population-based cohort of CHD (live births, TOPFA, fetal deaths) born to women residing in the Greater Paris area (Paris and its surrounding suburbs, N=317,538 total births).
  
  
  METHODS
  2867 cases of CHD, including 2348 (82%) live births, 466 (16%) TOPFA and 53 (2%) fetal deaths.
  
  
  METHODS
  Differences in the probability of prenatal diagnosis by maternal occupation, geographic origin and place of residence; differences in the probability of TOPFA.
  
  
  RESULTS
  29.1% (95% CI 27.5% to 30.8%) of all CHD were prenatally diagnosed. Probability of prenatal diagnosis was similar by maternal occupation, geographic origin and place of residence. In contrast, there were substantial differences in the probability of TOPFA by maternal geographic origin; differences by maternal occupation and place of residence were generally smaller and not statistically significant.
  
  
  CONCLUSIONS
  Our findings suggest that an appropriate health system organisation aimed at providing universal, reimbursed specialised services to all women can provide comparable access to prenatal diagnosis for all sociodemographic groups. In contrast, we found substantial differences in TOPFA for women of different geographic origins, which may reflect women's preferences that should be respected, but that can nonetheless lead to the situation where families with fewer resources will be disproportionately responsible for care of newborns with more severe forms of CHD.
authors.affiliation: INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France.
authors.forename: Babak
authors.initials: B
authors.lastname: Khoshnood
authors.affiliation: INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Lelong
authors.affiliation: INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France.
authors.forename: Thibaut
authors.initials: T
authors.lastname: Andrieu
authors.affiliation: Service de chirurgie des cardiopathies congénitales, Hôpital Marie Lannelongue, Le Plessis Robinson, France.
authors.forename: Lucile
authors.initials: L
authors.lastname: Houyel
authors.affiliation: Centre de référence M3C-Necker, Université Paris Descartes, Paris, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Bonnet
authors.affiliation: Hôpital Trousseau, AP-HP, Centre pluridisciplinaire de diagnostic prénatal, UPMC, Paris, France.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Jouannic
authors.affiliation: INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France Maternité de Port-Royal, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: Goffinet
mesh_terms: D000028:Abortion, Induced / Q000706:statistics & numerical data; D000328:Adult; D005260:Female; D005313:Fetal Death; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006330:Heart Defects, Congenital / Q000175:diagnosis*; D006801:Humans; D016015:Logistic Models; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000592:standards*; D011446:Prospective Studies; D012959:Socioeconomic Factors
keywords: PUBLIC HEALTH; sociodemographic