The American Heart Association has released the first scientific statement on current and recommended practices of diagnosis and management of fetal cardiac disease. The statement was released online in the journal Circulation.

Twenty years ago, there was little that could be done for anatomical cardiac defects in the fetus, with care divided neonatally by high-risk obstetricians, neonataologists, and pediatric cardiologists only after the baby was placed in the nursery or neonatal intensive care unit. Today, fetal cardiology has encompassed expanded roles to include diagnosing structural heart disease with precision, fetal vs. postnatal circulation, and cardiac functioning in overall fetal wellness and development. High-resolution ultrasound and three- and four-dimensional echocardiography, magnetic resonance imaging, fetal electrocardiography, and magnetocardiography all contribute to earlier and greater accuracy in diagnosis of fetal heart abnormalities.

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Some of the recommendations in the statement include:

  • Pregnant women with specific risk factors should be referred for fetal echocardiography, including those with diagnosed diabetes prior to pregnancy, diabetes diagnosed in the 1st trimester, have taken NSAIDs in their 3rd trimester, have congenital heart disease or a close relative with congenital heart disease, or other specific maternal medical conditions, and possibly those who conceived with in vitro fertilization.
  • Fetuses at risk include those identified with a chromosome problem or other abnormality, or those with a suspected heart problem. Fetuses diagnosed with a heart abnormality should be carefully monitored and healthcare providers should plan the delivery and post-delivery care that the baby will need.
  • Some fetal heart rhythm disturbances or heart function abnormalities can be treated with medicines given to the mother, which cross the placenta to reach the fetus. In-utero heart catheterization and surgical procedures are being performed, however are still considered experimental.

The statement authors also stress that providers should offer families holistic information that not only includes the specific of the condition and treatment, but also the long-term implications and challenges stemming from the heart condition. Providers are encouraged to assist families with help for psychological effects like anxiety and depression that may occur as a result of the diagnosis.

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