Enhancing Fetal Cardiac Care: Addressing Unwarranted Variation in Prenatal Congenital Heart Disease Detection and Counseling.

purpose of reviewTo summarize sources of variation in prenatal diagnosis of congenital heart disease (CHD) in the United States and low- and middle-income countries, and to review current and emerging interventions aimed at reducing this variation. RECENT

findingsIn the United States, approximately half of infants requiring cardiac surgery before 6 months of age receive a prenatal diagnosis of congenital heart disease. There is substantial variation in this rate domestically and globally. This variation reflects two primary contributors: socioeconomic disparities and clinical practice variation. Strategies to reduce unwarranted variation include standardized ultrasonography guidelines, local policy interventions, and emerging technologies including artificial intelligence and tele-echocardiography. Successful prenatal cardiac diagnosis encompasses three domains: (1) accessing fetal cardiac care, (2) obtaining accurate anatomic assessment, and (3) and receiving comprehensive counseling. Addressing socioeconomic disparities and clinical practice variation could reduce overall variation and increase prenatal diagnosis rates.