Title: Detection of fetal cardiac anomalies in diabetic mothers: The utility of fetal echocardiography
Abstract: Infants of diabetic mothers are more likely to have congenital cardiac malformations than the general population. In our institution, we obtain a four-chamber view (4CH) as well as outflow tracts (LVOT, RVOT) on all fetuses and refer pre-gestational diabetics for a fetal echocardiogram. The objective of this study was to determine the utility of a fetal echocardiogram after a normal anomaly scan. Pre-gestational diabetic mothers were identified who had undergone screening ultrasound and fetal echocardiography at our hospital during the last four years. A retrospective review of maternal records was conducted to obtain these study results. Neonatal records were reviewed, when available, for confirmation of antenatal findings. One hundren and eighty-one patients had both a sonographic 3-view evaluation of the heart (4CH, LVOT, RVOT) and a fetal echocardiogram attempted, of which 146 had both completed. In this subgroup, eleven neonates (n = 67) were identified with abnormal postnatal echocardiograms. Four had clinically relevant cardiac disease which we defined as the need for surgical or medical intervention. The sensitivity for detecting clinically relevant disease was 75% (NPV 98.4%) for both sonographic methods (a VSD requiring surgical correction was not detected by either method). One fetus with a normal 3-view evaluation was found to have pulmonary stenosis with mild pulmonary and tricuspid regurgitation by fetal echocardiogram. These findings were confirmed in the neonatal period, but the child has had an uncomplicated clinical course. In our pre-gestational diabetic population, 3-view screening of the heart and fetal echocardiography have similar detection rates for cardiac anomalies. Given the high cost and limited availability of fetal echocardiography, 3-view screening alone may identify the majority of clinically important cardiac lesions. Fetal echocardiography may be reserved for suspected cardiac anomalies on a screening sonogram or patients with an incomplete study.