How do doctors work to identify congenital heart defects before a baby is born?
Congenital heart defects (CHD) are among the most common types of birth defects, with an estimated rate of around 1 in 100 newborns. The most common types of coronary heart disease include holes in the heart, abnormalities of the heart valves or problems with the blood vessels leaving the heart. Most coronary heart disease does not require special medications or heart surgery; our primary goal in diagnosing coronary artery disease before birth is to identify babies who could become ill from their heart disease if left untreated.
Most often, the first prenatal cardiac evaluation takes place between 18 and 26 weeks of pregnancy. There are several reasons why a specific prenatal ultrasound of the baby’s heart (echocardiogram) may be recommended. The most common reasons include:
■ Abnormal obstetric ultrasound
■ Family history of congenital heart disease, especially in the baby’s parent or sibling
■ Maternal health issues, such as autoimmune disease or diabetes
■ Use of assisted reproductive technology, such as in vitro fertilization (IVF)
Fetal cardiologists work closely with obstetricians and maternal-fetal medicine physicians (also known as high-risk obstetricians) to diagnose heart defects before birth to plan the most appropriate delivery location and care after birth. birth.
Depending on the type of coronary artery disease, parents will have several appointments with their cardiologist before the birth of their baby. These visits allow the healthcare team to provide a detailed description of the heart problem and a discussion of the plan, including any heart surgery that may be needed. Multiple cardiac ultrasounds are often needed to identify changes in cardiac function, as well as to clarify any questions about cardiac structure that might impact the planned management plan. Families can also meet with members of the social work team, the neonatal intensive care unit team and any other specialists who may be involved in the care of the baby.
Due to changes in the circulatory system that occur after birth and the limitations of prenatal ultrasound, some heart defects cannot be identified until babies are born. Screening for critical congenital heart disease using postnatal oxygen monitoring is part of the mandatory practice of newborn screening in the United States. Cardiologists also rely heavily on our partners in neonatal medicine and pediatrics to identify undiagnosed coronary artery disease and refer children for evaluation.
Dr. Shelby White is a pediatric cardiologist and director of the fetal cardiology program at UVa Children’s.
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