Fetal Heart Program Delivers Enhanced Outcomes and Patient Experience
An expanded Special Delivery Unit and two groundbreaking research studies are positively impacting care for Fetal Heart Program mothers and their babies diagnosed with congenital heart disease in utero.
Expanded Special Delivery Unit offers immediate advanced care for babies with fetal heart conditions
In 2020, Cincinnati Children’s Fetal Care Center expanded its Special Delivery Unit for expecting moms whose babies require complex care, including those with heart conditions. In certain circumstances, expecting mothers are able to deliver their baby in this special unit when advanced medical care or surgery is needed right after birth.
The Special Delivery Unit, provided in collaboration with TriHealth, is one of only a few birthing centers in the world located inside a pediatric hospital. The unit includes two new operating rooms for fetal surgery and C-section deliveries, a triage room, and six dedicated rooms for labor, delivery and postpartum recovery.
Many babies born with heart disease, whose lives are in the balance, are delivered at other hospitals in the region and must be urgently transported to Cincinnati Children’s for care. With the Special Delivery Unit, these babies avoid emergency transport, since they are delivered a short distance from the Cardiac Intensive Care Unit (CICU).
“The expanded Special Delivery Unit enhances the care we can provide for families of babies with congenital heart disease,” says James Cnota, MD, director of the Heart Institute’s Fetal Heart Program. “It means that we can keep both patients—mother and baby—together in one location. We can provide the advanced care that is needed for the baby right away. And mom remains just a few steps away while recovering from the delivery.”
Trailblazing research underway testing the effects of psychological intervention after fetal cardiac diagnosis
Until now, there have been no randomized controlled trials testing the effects of prenatally delivered psychological intervention for parents after fetal cardiac diagnosis. A new study led by Nadine Kasparian, PhD, and Cnota will fill this gap.
The researchers aim to reduce the psychological distress that expectant parents so commonly experience after fetal cardiac diagnosis and improve family coping and wellbeing post-diagnosis.
The three-year study is funded by Additional Ventures and is a bi-national, multicenter trial in collaboration with Monroe Carell Jr. Children’s Hospital at Vanderbilt, Children’s Hospital Los Angeles, and the Sydney Children’s Hospitals Network in Sydney, Australia.
“Pregnancy offers a critical window of opportunity to support families and reduce the high levels of stress that expectant moms and dads experience after diagnosis,” explains Kasparian, director of the Cincinnati Children’s Center for Heart Disease and Mental Health. “We are also exploring the notion that by improving maternal mental health during pregnancy, we may be able to improve developmental outcomes for babies with heart disease as well.”
Kasparian says that developmental changes happen for these babies in utero, but it’s not clear why. She hopes this study will help to uncover some of the mechanisms by which development may be altered for babies with complex heart disease.
This project builds on many years of prior work done by Kasparian in Australia to better integrate mental health care within medical care.
“In these situations, families are looking for an opportunity to do something to help their baby, and they often feel powerless in their ability to do that,” says Cnota, co-principal investigator. “We are excited to get started on this project and to partner not only with these other institutions, but also with families so we can try to help.”
The intervention includes virtually administered sessions with a psychologist, tailored educational resources, and a personalized mental health care plan to support longer-term maternal, child and family wellbeing.
Taking these results and putting them into widespread practice is the end goal. Says Kasparian, “If we are able to show positive effects of this intervention for moms and their babies, we want to roll out this program as far and wide as we can.”
Maternal health and nutrition study looks at effects of dietary counseling during pregnancy
A second research project underway also is looking for answers to health questions during pregnancy after a prenatal congenital heart disease diagnosis. This one is centered around diet, nutrition and mental health.
The study seeks to reveal whether a healthy diet after prenatal diagnosis can promote improved mental health, and longer, healthier pregnancies that will result in more mature and bigger babies at time of delivery. It is led by pediatric cardiologist Allison Divanovic, MD, associate director of the Fetal Heart Program.
“If we can get babies to full term with a normal healthy birth weight, this is a strong predictor for cardiac surgery outcomes and later clinical outcomes in children” says Cnota, who is working on this study with Divanovic.
The study involves both psychosocial and dietary screening for mothers after a prenatal cardiac diagnosis followed by individualized counseling. Once a mother has been identified as struggling with increased stress and anxiety related to the fetal diagnosis, they are offered services aimed at improving their mental health to discover if this intervention can help lead to longer pregnancies.
The project is funded by a grant from the Congenital Heart Alliance of Cincinnati. The investigators are midway through enrolling patients but already are looking to outcomes of this research. Divanovic says the hope is to take this preliminary data and conduct a larger study to support more collaboration with psychologists and dietitians.
“Ultimately, we want this to be the standard of care for our mothers,” says Divanovic. “We feel every expecting mother should have access to both mental health services and dietary counseling. Our hope is to show that it’s effective to be able to support having those specialties embedded in our Fetal Heart Program.”
Visit the Fetal Heart Program to learn more about the services provided by this team.
