Adverse Maternal Fetal Environment Partially Mediates Disparate Outcomes in Non-White Neonates with Major Congenital Heart Disease.
J Pediatr
; 251: 82-88.e1, 2022 12.
Article
in En
| MEDLINE
| ID: mdl-35803301
ABSTRACT
OBJECTIVE:
To determine whether differential exposure to an adverse maternal fetal environment partially explains disparate outcomes in infants with major congenital heart disease (CHD). STUDYDESIGN:
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.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Metabolic Syndrome
/
Heart Defects, Congenital
Type of study:
Observational_studies
/
Risk_factors_studies
Limits:
Female
/
Humans
/
Infant
/
Newborn
/
Pregnancy
Language:
En
Journal:
J Pediatr
Year:
2022
Type:
Article