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Trends in Preterm Delivery among Singleton Gestations with Critical Congenital Heart Disease
Daniel A Castellanos1, Keila N Lopez1, Jason L Salemi2
1Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX.
Insights
Preterm birth rates for infants with critical congenital heart disease (CHD) in Texas initially rose, then declined after 2005, mirroring general population trends. Socioeconomic factors influenced these preterm delivery patterns.
Area of Science:
- Neonatal Health
- Pediatric Cardiology
- Public Health Surveillance
Background:
- Critical congenital heart disease (CHD) affects a significant number of newborns.
- Preterm delivery is a known risk factor for adverse neonatal outcomes, particularly in infants with CHD.
- Understanding trends in preterm birth for this vulnerable population is crucial for healthcare planning.
Purpose of the Study:
- To analyze state-wide population trends in preterm delivery for infants diagnosed with critical CHD over an 18-year period.
- To investigate if preterm delivery rates for critical CHD initially increased with advancements in prenatal diagnosis and subsequently decreased.
- To compare these trends with the general livebirth population in Texas.
Main Methods:
- Utilized Texas Public Use Data File from 1999-2016.
- Evaluated annual preterm delivery rates (<37 weeks) for critical CHD cases.
- Employed joinpoint segmented regression to identify changes in trends over time.
- Compared CHD preterm delivery trends with all Texas livebirths and analyzed sociodemographic covariates.
Main Results:
- Out of 7146 critical CHD births, 18.7% were preterm.
- Preterm birth rates increased from 1999-2004 (1.69% per year) and decreased from 2005-2016 (-0.41% per year).
- These trends mirrored those in the general Texas livebirth population.
- Newborns in higher poverty neighborhoods showed the most rapid increase in preterm delivery initially and a plateau in the later period.
Conclusions:
- Preterm birth rates for infants with critical CHD in Texas exhibited an initial rapid increase followed by a decrease since 2005.
- These trends align with national patterns, suggesting broader influences on preterm delivery.
- Socioeconomic factors, particularly neighborhood poverty, played a role in the observed trends, highlighting disparities in preterm birth.
Objective:
To examine state-wide population trends in preterm delivery of children with critical congenital heart disease (CHD) over an 18-year period. We hypothesized that, coincident with early advancements in prenatal diagnosis, preterm delivery initially increased compared with the general population, and more recently has decreased.
Study Design:
Data from the Texas Public Use Data File 1999-2016 was used to evaluate annual percent preterm delivery (<37 weeks) in critical CHD (diagnoses requiring intervention at <1 year of age). We first evaluated for pattern change over time using joinpoint segmented regression. Trends in preterm delivery were then compared with all Texas livebirths. We then compared trends examining sociodemographic covariates including race/ethnicity, sex, and neighborhood poverty levels.
Results:
Of 7146 births with critical CHD, 1339 (18.7%) were delivered preterm. The rate of preterm birth increased from 1999 to 2004 (a mean increase of 1.69% per year) then decreased between 2005 and 2016 (a mean decrease of -0.41% per year). This represented a faster increase and then a similar decrease to that noted in the general population. Although the greatest proportion of preterm births occurred in newborns of Hispanic ethnicity and non-Hispanic black race, newborns with higher neighborhood poverty level had the most rapidly increasing rate of preterm delivery in the first era, and only a plateau rather than decrease in the latter era.
Conclusions:
Rates of preterm birth for newborns with critical CHD in Texas first were increasing rapidly, then have been decreasing since 2005.
