{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T21:43:24Z","timestamp":1776548604336,"version":"3.51.2"},"reference-count":59,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2024,9,23]],"date-time":"2024-09-23T00:00:00Z","timestamp":1727049600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Prenatal Diagnosis"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To delineate the mechanism behind insurance\u2010related disparities in the prenatal diagnosis of a congenital heart defect (CHD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective analysis of electronic health records of pregnant individuals whose infants received CHD surgery between 2019 and 2020 in the third\u2010largest United States metropolitan area. The outcome was whether a prenatal diagnosis was received. The exposure was the pregnant individual's insurance status. The mediator was second\u2010trimester ultrasound receipt. Control variables included sociodemographic and clinical characteristics of the pregnant individual and infant. The relationships between exposure, mediator, and outcome were quantified using mediation analysis with multivariable fixed\u2010effects regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 496 pregnant individuals met inclusion criteria; 215 (43.3%) were publicly insured and 305 (61.5%) had prenatal diagnosis. In bivariate regressions, public insurance was associated with a 12.6% lower probability (CI 3%\u201321%) of prenatal diagnosis. In multivariable models, public insurance was associated with 13.2% lower probability (CI 2%\u201325%) of second\u2010trimester ultrasound receipt but was no longer associated with prenatal diagnosis after adjusting for second\u2010trimester ultrasound receipt, suggesting a possible mediation effect. Mediation analysis confirmed that second\u2010trimester ultrasound receipt mediated 39% of the relationship between public insurance and prenatal diagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>An appreciable portion of insurance\u2010related differences in prenatal CHD diagnosis is due to the lower frequency of second\u2010trimester ultrasound receipt among those with public insurance.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pd.6675","type":"journal-article","created":{"date-parts":[[2024,9,23]],"date-time":"2024-09-23T14:01:13Z","timestamp":1727100073000},"page":"886-895","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Second\u2010Trimester Ultrasound Receipt Mediates the Relationship Between Public Insurance and Prenatal Diagnosis of a Congenital Heart Defect"],"prefix":"10.1002","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6958-4903","authenticated-orcid":false,"given":"Joyce L.","family":"Woo","sequence":"first","affiliation":[{"name":"Division of Cardiology Department of Pediatrics Ann &amp; Robert H. Lurie Children's Hospital of Chicago Northwestern University Feinberg School of Medicine  Chicago Illinois USA"},{"name":"Department of Medical Social Sciences Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rupali","family":"Gandhi","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Pediatrics Advocate Christ Medical Center  Oak Lawn Illinois USA"},{"name":"Section of Cardiology Department of Pediatrics University of Chicago Comer Children's Hospital  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina","family":"Laternser","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Pediatrics Ann &amp; Robert H. Lurie Children's Hospital of Chicago Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tara","family":"Iyengar","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Pediatrics Advocate Christ Medical Center  Oak Lawn Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lynn M.","family":"Yee","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2010Fetal\u2010Medicine Department of Obstetrics and Gynecology Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William A.","family":"Grobman","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2010Fetal\u2010Medicine Department of Obstetrics and Gynecology The Ohio State University College of Medicine  Columbus Ohio USA"},{"name":"Department of OBstetrics and Gynecology The Warren Alpert Medical School of Brown University  Providence Rhode Island USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew M.","family":"Davis","sequence":"additional","affiliation":[{"name":"Nemours Children's Health System  Wilmington Delaware USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angira","family":"Patel","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Pediatrics Ann &amp; Robert H. 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