Should all pregnant diabetic women undergo a fetal echocardiography?
Odibo AO; Coassolo KM; Stamilio DM; Ural SH; Macones GA Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. firstname.lastname@example.org OBJECTIVE: To determine if a policy of universal fetal echocardiography for all pregnant diabetic women is cost-effective as a screening tool for congenital heart defects. STUDY DESIGN: Using a decision-analysis model, we compared the cost-effectiveness of four screening strategies: (1) none–no ultrasound is performed; (2) selective fetal echocardiography after abnormal detailed anatomic survey; (3) fetal echocardiography for only high hemoglobin A1C, and (4) universal fetal echocardiography for all diabetics. The sensitivity and specificity for each strategy were derived by literature search. The analysis was from a societal perspective using a willingness-to-pay threshold (50,000 dollars) and a theoretic cohort of 40,000 pregnant diabetics. Costs included costs of te