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Adverse Maternal Fetal Environment Partially Mediates Disparate Outcomes in Non-White Neonates with Major Congenital
Stephanie Santana1, Shabnam Peyvandi2, John M Costello1
1Department of Pediatrics, Division of Cardiology, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC.
Insights
Adverse maternal conditions contribute to racial disparities in infant congenital heart disease (CHD) outcomes. These environmental factors partially explain why minority infants with CHD face worse results and fewer days alive.
Area of Science:
- Perinatal health
- Pediatric cardiology
- Health disparities research
Background:
- Infants with congenital heart disease (CHD) exhibit significant racial and ethnic outcome disparities.
- The role of the maternal-fetal environment in these disparities remains incompletely understood.
Purpose of the Study:
- To investigate if differential exposure to adverse maternal-fetal environments contributes to disparate outcomes in infants with major congenital heart disease (CHD).
Main Methods:
- A retrospective cohort study analyzed a California population-based database (2011-2017).
- Race/ethnicity was the primary exposure, with adverse maternal-fetal environment (maternal metabolic syndrome and/or maternal placental syndrome) as the mediator.
- Outcomes included a composite of 1-year mortality or severe morbidity and days alive out of hospital (DAOOH).
Main Results:
- Hispanic and non-Hispanic Black infants had higher risks for the composite outcome and fewer DAOOH compared to non-Hispanic White infants.
- These minority groups showed increased exposure to maternal metabolic syndrome and/or maternal placental syndrome.
- Adverse maternal-fetal environment explained 16-25% of the racial/ethnic disparities in CHD outcomes.
Conclusions:
- Increased exposure to adverse maternal-fetal environments significantly contributes to racial and ethnic disparities observed in major congenital heart disease outcomes.
- Addressing maternal health factors is crucial for mitigating outcome inequities in infants with CHD.
Objective:
To determine whether differential exposure to an adverse maternal fetal environment partially explains disparate outcomes in infants with major congenital heart disease (CHD).
Study Design:
Retrospective cohort study utilizing a population-based administrative California database (2011-2017). Primary exposure: Race/ethnicity. Primary mediator: Adverse maternal fetal environment (evidence of maternal metabolic syndrome and/or maternal placental syndrome).
Outcomes:
Composite of 1-year mortality or severe morbidity and days alive out of hospital in the first year of life (DAOOH). Mediation analyses determined the percent contributions of mediators on pathways between race/ethnicity and outcomes after adjusting for CHD severity.
Results:
Included were 2747 non-Hispanic White infants (reference group), 5244 Hispanic, and 625 non-Hispanic Black infants. Hispanic and non-Hispanic Black infants had a higher risk for composite outcome (crude OR: 1.18; crude OR: 1.25, respectively) and fewer DAOOH (-6 & -12 days, respectively). Compared with the reference group, Hispanic infants had higher maternal metabolic syndrome exposure (43% vs 28%, OR: 1.89), and non-Hispanic Black infants had higher maternal metabolic syndrome (44% vs 28%; OR: 1.97) and maternal placental syndrome exposure (18% vs 12%; OR, 1.66). Both maternal metabolic syndrome exposure (OR: 1.21) and maternal placental syndrome exposure (OR: 1.56) were related to composite outcome and fewer DAOOH (-25 & -16 days, respectively). Adverse maternal fetal environment explained 25% of the disparate relationship between non-Hispanic Black race and composite outcome and 18% of the disparate relationship between Hispanic ethnicity and composite outcome. Adverse maternal fetal environment explained 16% (non-Hispanic Black race) and 21% (Hispanic ethnicity) of the association with DAOOH.
Conclusions:
Increased exposure to adverse maternal fetal environment contributes to racial and ethnic disparities in major CHD outcomes.
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