Association Between Institutional Services and Counseling Options in Fetal Cardiology

BACKGROUND: Congenital heart defects (CHD) are the most common congenital anomaly with increasing prevalence and expectation of prenatal diagnosis and comprehensive counseling. Recent changes in state and federal laws have altered the availability of some services, potentially affecting counseling content. We describe the association between access to services and content of prenatal counseling in critical CHD. METHODS: An anonymous survey was distributed to fetal cardiologists. Respondents indicated characteristics of their counseling discussion for newly diagnosed hypoplastic left heart syndrome, including intervention, palliative care involvement, and termination. Chi-square analysis assessed whether counseling content differed based on institutional services available. RESULTS: Of 138 respondents, there was a statistically significant association between institutional access to termination and whether providers included termination as an option in counseling. In multivariable logistic regression analyses, this association remained significant after accounting for practice characteristics, with no evidence that geographic setting, practice size, or institutional affiliation modified the association. Providers at institutions where termination was not available were consistently less likely to include this pregnancy option in counseling. CONCLUSION: Providers at institutions where termination is not available are less likely to include this pregnancy option in counseling, suggesting that institutional services may alter patients' access to comprehensive counseling.