Summary: A study found that Medicaid patients are less likely to receive prenatal heart defect diagnoses due to barriers in accessing 20-week ultrasounds, despite its importance in detecting birth defects and improving outcomes for infants with congenital heart defects.
Key Takeaways
- Medicaid patients are less likely to receive prenatal heart defect diagnoses, partly due to fewer 20-week ultrasounds, which are crucial for assessing major fetal organs.
- Barriers such as lack of time off work and transportation challenges limit access to the 20-week ultrasound, despite it being a covered routine part of Medicaid prenatal care.
- Improving access to 20-week ultrasounds could reduce insurance-related disparities and improve outcomes for infants with congenital heart defects by enabling earlier diagnosis and timely surgery.
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A study by Ann & Robert H. Lurie Children’s Hospital of Chicago and Advocate Christ Children’s Hospital found Medicaid patients are less likely to receive prenatal heart defect diagnoses, partly due to fewer 20-week ultrasounds.
Importance of 20-Week Ultrasound
“The 20-week ultrasound is hugely important in detecting birth defects because it involves assessment of the baby’s major organs. All pregnant people must know that this test should not be missed,” says lead author Joyce Woo, MD, MS, pediatric cardiologist at Lurie Children’s and Assistant Professor of Pediatrics and Medical Social Sciences at Northwestern University Feinberg School of Medicine.
“It is a routine part of prenatal care that is covered by Medicaid, but patients can still experience barriers to getting this test, such as inability to take time off work,” Woo adds. “Our study suggests that one way to increase rates of prenatal diagnosis of heart defects and mitigate insurance-related disparities, is to increase utilization of 20-week ultrasound.”
Prenatal CHD Diagnosis Leads to Better Infant Outcomes
Woo’s research aims to improve prenatal diagnosis so children with congenital heart defects (CHD) receive optimal care from birth. A previous study by her team showed prenatal CHD diagnosis leads to better outcomes. Another study identified key socioeconomic barriers, including appointment scheduling difficulties, transportation challenges, lack of time off work, and childcare issues.
For the current study, Woo and colleagues analyzed electronic health records of pregnant individuals whose infants received surgery to correct a CHD between 2019-2020 in the Chicago metropolitan area, the third-largest metropolitan area in the United States. They confirmed previously published findings that public insurance is associated with lower likelihood of prenatal CHD diagnosis. They also found that this disparity is driven by whether the patient receives the 20-week ultrasound (also called second trimester ultrasound or anatomy scan).
“Understanding the reasons behind insurance-related disparities in getting prenatal diagnosis—such as getting the second-trimester ultrasound—allows for the development of policies and programs that could lessen these disparities,” says Woo. “Prenatal diagnosis is critical to the health of babies with congenital heart defects. We know from our earlier research that prenatal diagnosis means timelier surgery, which is often better for the baby’s neurodevelopmental and physical outcomes.”
