January 16, 2009
Pregnancy
Question from Edmonton, Alberta, Canada:
I am 15 weeks pregnant with my second child and am currently living in Canada. We normally reside in the U.S., which is where I had my first baby. I have very tight glucose control, with an A1c of 5. I have no diabetic complications and my last pregnancy was uncomplicated. Even so, I was given a fetal echocardiogram during my last pregnancy to ensure that the baby had not developed any cardiac malformations, which she had not. My diabetes team in the U.S. offered and advocated universal screening for cardiac abnormalities. Now that I am living in Canada, I have been advised by my doctor that universal screening is not available. I would only be eligible for a fetal echocardiogram if my second trimester ultrasound showed some type of abnormality. I am very concerned about this. While I understand that this may be cost-effective for the Canadian health care system as a whole, I want to ensure that my baby is fine. I continue to hold insurance in the U.S. and could travel to there for a fetal echocardiogram, if I wanted to. Can you shed some light on the data here? Isn’t it the case that ordinary ultrasound might miss something that a fetal echocardiogram could reveal?
Answer:
As a perinatologist in a practice of high risk patients, I will do a detailed ultrasound of the fetus. For mothers with diabetes, I will always offer a fetal echocardiogram with a pediatric cardiologist. I feel that he is more skilled at heart evaluation than I am. However, if a survey of fetal anatomy is done by a perinatologist, major anomalies (particularly life-threatening) are usually ruled out. If the perinatologist sees something suspicious, then referral to a cardiologist is done. Even the cardiologist can miss a small defect. If you are very concerned, and want to come to the states for a fetal echocardiogram, I can give you some referrals depending on where you go.
OWJ
