More prenatal visits linked to right level of care for infants born with heart defects: JAMA Study
In cases of mild congenital heart defects, more prenatal visits are associated with greater likelihood of appropriate delivery at a community hospital, according to a study published in JAMA Network Open. Results suggest that more prenatal care is beneficial for families and may allow their newborns with mild heart defects to receive the right level of care closer to home, as opposed to traveling to a regional cardiac surgical center, which can be expensive, taxing and stressful for families.
Congenital heart defects are the most common and resource-intensive birth defects in the United States. Infants with the most complex heart defects are usually directed to regional cardiac surgical centers, while babies with mild heart defects can safely receive the right care at a community hospital.
“Our findings underscore the importance of prenatal care in driving the utilization of appropriate care for newborns with heart defects,” said senior author Joyce Woo, MD, MS, pediatric cardiologist at Ann & Robert H. Lurie Children’s Hospital of Chicago and Assistant Professor of Pediatrics and Medical Social Sciences at Northwestern University Feinberg School of Medicine. “One prenatal visit is usually not enough, since fetal heart disease can change over the duration of pregnancy. It can potentially become less severe than initially suspected. If the newborn does not need surgery right away, then remaining closer to home for delivery can be the right decision. Many families might prefer that. Risk-appropriate care benefits the overall healthcare system too.”
In the study, Dr. Woo and colleagues used a statewide administrative database to analyze data on 12,113 babies born with heart defects in Illinois between 2013-2021. They aimed to estimate how two components of prenatal care adequacy – initiation of care and frequency of visits – are related to delivery location for neonates with congenital heart defects.
They found that delayed prenatal care initiation was associated with increased likelihood of delivery at a cardiac surgical center compared to no prenatal care, regardless of the severity of the heart defect. But for babies with mild congenital heart defects, more prenatal visits were associated with a 7 percentage-point decrease in probability of delivery at a cardiac surgical center.
“Caring for children with heart defects begins before birth. Prenatal care ensures that babies with congenital heart defects are born at the right location with the appropriate intensity of care based on their clinical needs. It also allows for consideration for their family’s preferences for delivery location,” said Dr. Woo. “Our findings can also help inform statewide policies on perinatal resource allocation.”
