<p>False-negative screening for prenatal congenital (CHD) and critical congenital heart disease (CCHD) requiring early intervention may result in increased morbidity and mortality. The association between false-negative obstetric screening and maternal community population remains unclear. A retrospective review of prenatal and postnatal CHD diagnoses was performed at Children’s Nebraska from January to December 2024. Maternal households and associated obstetric practices were designated rural or urban status using USDA Rural–Urban Continuum Codes (RUCC). Differences in prenatal CHD detection were compared between mothers and obstetricians in rural versus urban communities using chi-square analyses. Differences between rural and urban maternal residency for postnatally diagnosed CHD versus CCHD were also evaluated. A total of 247 cases were analyzed, including 180 fetuses diagnosed prenatally and 67 infants diagnosed postnatally. Rural maternal residency was significantly associated with a higher rate of failure to detect prenatal CHD, <i>χ</i>² (1, <i>n</i> = 247) = 6.10, <i>p</i> = 0.013. There was no statistically significant association between maternal geography, <i>χ</i>² (1, <i>n</i> = 67) = 0.02, <i>p</i> = 0.894, or location of obstetric services with prenatal diagnosis of CCHD, <i>χ</i>² (1, <i>n</i> = 194) = 0.65, <i>p</i> = 0.420. Prenatal CHD detection is significantly lower among infants born to mothers residing in rural communities, placing these infants at increased risk for delayed diagnosis and subsequent postnatal cardiac complications. These findings highlight the need for targeted strategies to improve prenatal cardiac screening in underserved areas.</p>