{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T11:46:49Z","timestamp":1775821609293,"version":"3.50.1"},"reference-count":16,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T00:00:00Z","timestamp":1758326400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet & Gyne"],"published-print":{"date-parts":[[2025,11]]},"abstract":"ABSTRACT<\/jats:title>\n \n Objective<\/jats:title>\n Travel restrictions, reallocation of health resources and physical distancing during the coronavirus disease 2019 (COVID\u201019) pandemic caused extraordinary strain on healthcare systems. The overall impact of public health measures during COVID\u201019 on the prenatal diagnosis of congenital heart disease (CHD) has received limited attention. We sought to determine the rate of prenatal diagnosis and the pregnancy and postnatal outcomes of critical CHD prior to and during the COVID\u201019 pandemic.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Cases of critical CHD with estimated due date between 1 January 2016 and 31 March 2022 that required or were expected to require neonatal intervention were identified from all tertiary fetal cardiac centers in Ontario and Alberta, Canada. Pregnancies were stratified based on reaching 18\u2009weeks' gestation before (pre\u2010COVID\u201019) or after 1 March 2020 (during COVID\u201019), as the latter group would require ultrasound scanning under COVID\u201019 pandemic restrictions. Outcomes included timing of critical CHD diagnosis (prenatal or postnatal), gestational age at prenatal diagnosis, pregnancy outcome and infant mortality at 30\u2009days and 1\u2009year after birth. The rate of prenatal diagnosis was assessed using Cox proportional hazard modeling with time\u2010varying and time\u2010invariant cofactors.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Prenatal diagnosis occurred in 1238\/1774 (69.8%) cases of critical CHD overall, of which 858\/1257\u00a0(68.3%) cases were in the pre\u2010COVID\u201019 group and 380\/517 (73.5%) cases were in the COVID\u201019 exposure group (\n P<\/jats:italic>\n \u2009=\u20090.03). There was no difference between the pre\u2010COVID\u201019 group and the COVID\u201019 exposure group in median gestational age at obstetric ultrasound (20.1 (interquartile range (IQR), 19.0\u201322.0)\u2009weeks\n vs<\/jats:italic>\n 19.8 (IQR, 19.1\u201321.3)\u2009weeks;\n P<\/jats:italic>\n \u2009=\u20090.07), median time from obstetric ultrasound to diagnosis of critical CHD (1.2 (IQR, 0.6\u20132.2)\u2009weeks\n vs<\/jats:italic>\n 1.2 (IQR, 0.6\u20132.2)\u2009weeks;\n P<\/jats:italic>\n \u2009=\u20090.59) and prenatal diagnosis <\u200922\u2009weeks' gestation (454\/848 (53.5%)\n vs<\/jats:italic>\n 221\/378 (58.5%);\n P<\/jats:italic>\n \u2009=\u20090.11). Termination of pregnancy was more common in the COVID\u201019 exposure group (pre\u2010COVID\u201019, 20.9%\n vs<\/jats:italic>\n during COVID\u201019, 27.5%;\n P<\/jats:italic>\n \u2009=\u20090.01). Infant mortality at 30\u2009days (pre\u2010COVID\u201019, 2.5%\n vs<\/jats:italic>\n COVID\u201019, 1.8%;\n P<\/jats:italic>\n \u2009=\u20090.44) and at 1\u2009year after birth (pre\u2010COVID\u201019, 8.9%\n vs<\/jats:italic>\n COVID\u201019, 8.6%;\n P<\/jats:italic>\n \u2009=\u20090.86) did not differ between eras. Once adjusted for province, trends in calendar time, week of gestation, distance to closest tertiary fetal cardiac service and genetic diagnosis, the rate of prenatal diagnosis of critical CHD continued to increase, with a trend towards an increased rate during the COVID\u201019 pandemic compared with the pre\u2010COVID\u201019 era.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Despite the reduction in clinical services during the COVID\u201019 pandemic, the rate of prenatal diagnosis of critical CHD continued to increase during the pandemic in two of Canada's largest provinces. These findings provide reassurance regarding the impact of refined fetal cardiology referral indications for resource\u2010limited scenarios. \u00a9 2025 The Author(s).\n Ultrasound in Obstetrics & Gynecology<\/jats:italic>\n published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/uog.70028","type":"journal-article","created":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T22:30:24Z","timestamp":1758407424000},"page":"606-613","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Rate of prenatal diagnosis of critical congenital heart disease continued to improve despite\n COVID<\/scp>\n \u201019 pandemic: multicenter\n Canadian<\/scp>\n study"],"prefix":"10.1002","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2638-2775","authenticated-orcid":false,"given":"L.","family":"Eckersley","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Pediatrics University of Alberta Edmonton AB Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Lad","sequence":"additional","affiliation":[{"name":"The Hospital for Sick Children, Division of Cardiology, Department of Pediatrics University of Toronto Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H.","family":"Rose","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Pediatrics University of Alberta Edmonton AB Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Lougheed","sequence":"additional","affiliation":[{"name":"Children's Hospital of Eastern Ontario Ottawa ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H.","family":"Poolsaar","sequence":"additional","affiliation":[{"name":"The Hospital for Sick Children, Division of Cardiology, Department of Pediatrics University of Toronto Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Szabo","sequence":"additional","affiliation":[{"name":"McMaster University Hamilton ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L.","family":"Nield","sequence":"additional","affiliation":[{"name":"Sunnybrook Health Sciences Centre Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D.","family":"Fruitman","sequence":"additional","affiliation":[{"name":"Alberta Children's Hospital Calgary AB Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G.","family":"Mansuskani","sequence":"additional","affiliation":[{"name":"London Health Sciences Centre London ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L. K.","family":"Hornberger","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Pediatrics University of Alberta Edmonton AB Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8552-5396","authenticated-orcid":false,"given":"B.","family":"Arya","sequence":"additional","affiliation":[{"name":"Seattle Children's Hospital Seattle WA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D.","family":"Dover","sequence":"additional","affiliation":[{"name":"Canadian Vigour Centre University of Alberta Edmonton AB Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E.","family":"Blagdon","sequence":"additional","affiliation":[{"name":"Canadian Vigour Centre University of Alberta Edmonton AB Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1221-081X","authenticated-orcid":false,"given":"L.","family":"Freud","sequence":"additional","affiliation":[{"name":"The Hospital for Sick Children, Division of Cardiology, Department of Pediatrics University of Toronto Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,9,20]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0040-1712121"},{"issue":"6","key":"e_1_2_6_3_1","first-page":"969.e5","article-title":"Considerations for scaling down fetal echocardiography during the COVID\u201019 pandemic","volume":"36","author":"Cardinal MP","year":"2020","journal-title":"Can J Cardiol"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00668-1"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1089\/tmj.2020.0508"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1515\/jpm-2021-0343"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10153423"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-024-03487-9"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.26030"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.7863\/jum.2013.32.6.1083"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.8831"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2020.04.005"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2021.09.005"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.121.013796"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ppedcard.2020.101259"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2024.01.015"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.26107"}],"container-title":["Ultrasound in Obstetrics & Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.70028","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T18:56:59Z","timestamp":1763492219000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/uog.70028"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,20]]},"references-count":16,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1002\/uog.70028"],"URL":"https:\/\/doi.org\/10.1002\/uog.70028","archive":["Portico"],"relation":{},"ISSN":["0960-7692","1469-0705"],"issn-type":[{"value":"0960-7692","type":"print"},{"value":"1469-0705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,20]]},"assertion":[{"value":"2025-01-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}