Congenital heart disease later diagnosed in Latino infants: study
Infants born to Latino, low-income or limited English-speaking parents are more likely to be diagnosed later with congenital heart disease than white infants – or not to have a prenatal diagnosis at all, according to a new study.
Congenital heart defects, which are structural abnormalities of the heart, are the most common type of birth defect. The results were published in the Journal of Pediatric Cardiology.
Experts say findings add urgency to better care for babies born to parents whose preferred language is not English, Latino and low-income families as part of America’s fight against structural racism in health care.
Although fetal interventions are limited, early prenatal diagnosis helps parents plan and make decisions about pregnancy, said co-author Dr. Alicia Chaves, pediatric cardiologist at the University of Maryland Medical System. It also allows clinicians to pre-plan important treatments soon after birth.
Babies without a prenatal diagnosis are at higher risk of adverse events after birth, while a prenatal diagnosis is associated with better outcomes, she explained.
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What is a congenital heart defect and how is it detected?
Congenital heart defects affect the structure of a baby’s heart. There are many types, with most ranging from mild — like a small hole in the heart that heals — to types that severely impair healthy heart function, according to the Centers for Disease Control and Prevention.
About 1 in 4 babies are born with a critical congenital heart defect, which means they may need surgery or other procedures throughout their life.
Generally, fetal echocardiography, an ultrasound of the baby’s heart, is limited to high-risk cases, such as pregnant women with a family history or problems detected during routine ultrasounds.
“Thus, if routine obstetrical screening ultrasound fails to detect coronary artery disease, it may result in a missed or late referral” for a fetal echocardiograph, delaying detection of congenital heart disease, Chaves and colleagues wrote. .
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What did the study find?
The researchers analyzed the records of 163 babies who underwent surgery within one month of birth at the University of Maryland Children’s Hospital between 2011 and 2020.
- Babies born to Latin mothers were 3.2 times less likely to be diagnosed before birth compared to their white counterparts.
- Babies born to mothers with a preferred language other than English were 5 times more likely to have no prenatal diagnosis than those born to English speakers.
- Non-English speaking mothers who received prenatal diagnosis were diagnosed, on average, 5 weeks later than English-speaking patients.
- Those in low socioeconomic status neighborhoods were diagnosed up to 3.4 weeks later.
The findings add to growing evidence of disparities in the diagnosis of fetal heart defects. Previous studies have shown that low-income, Hispanic, and rural patients or those with public insurance were less likely to receive prenatal diagnoses for certain types of congenital heart defects.
“Knowing ahead of time that they have significant congenital heart disease is extremely important because some of these defects will require immediate attention within the first minute after birth,” said Duke pediatric cardiac surgeon Dr. Ziv Beckerman. University Health.
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What could be causing the disparity?
Dr. Keila Natilde Lopez, a pediatric cardiologist and associate professor at Baylor College of Medicine in Houston, said the findings shed light on creating more accessible resources for families.
“Our health care system is very difficult to navigate. It’s even harder to navigate when English isn’t your primary language, or when you have low health literacy or come from a lower socioeconomic status,” she said. “Many of the websites of these various institutions that deal with children with complex needs are not written at an appropriate level of health literacy or in the appropriate language.”
Creating a pipeline of Latino, Hispanic and Spanish-speaking physicians is also important for diversifying medicine to better serve communities, Lopez said. Of all active physicians in the United States, only about 6% are Hispanic, although Hispanics and Latinos make up nearly 19% of the country’s population.
What can be done?
In addition to language barriers, access to prenatal care could also be a factor contributing to these disparities. Disadvantaged mothers may be less likely to be insured, which may delay their access to antenatal care and, in turn, delay or result in a missed diagnosis, Chaves said.
Women receiving prenatal care should have an anatomical scan around 18 to 20 weeks gestation, she explained.
“Ideally, even if the heart defect was not noted before then, it would be noted by then,” she said. “Typically after that they are referred to specialists like our fetal cardiology team.”
Many neighborhoods in the United States do not have tertiary care centers or hospitals that provide specialty care. Implementing a better detection protocol and providing translation services to parents in these areas is critical so they can be diagnosed and referred, Beckerman said.
“If you have a baby who is due to be delivered in an area without supportive cardiac care, they will do poorly and may not even make it to receive proper care,” he said.
Contact Nada Hassanein at firstname.lastname@example.org or on Twitter @nhassanein_.