Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Nov 19;8(22):e013194.
doi: 10.1161/JAHA.119.013194. Epub 2019 Nov 15.

Impaired Fetal Environment and Gestational Age: What Is Driving Mortality in Neonates With Critical Congenital Heart Disease?

Martina A Steurer  1   2 , Shabnam Peyvandi  1   2 , Rebecca J Baer  3   4 , Scott P Oltman  2 , Christina D Chambers  3 , Mary E Norton  4 , Kelli K Ryckman  5 , Anita J Moon-Grady  1 , Roberta L Keller  1 , Stephen C Shiboski  2 , Laura L Jelliffe-Pawlowski  2
Affiliations

Impaired Fetal Environment and Gestational Age: What Is Driving Mortality in Neonates With Critical Congenital Heart Disease?

Martina A Steurer et al. J Am Heart Assoc. .

Abstract

Background Infants with critical congenital heart disease (CCHD) are more likely to be small for gestational age (SGA) or born to mothers with maternal placental syndrome. The objective of this study was to investigate the relationship between maternal placental syndrome, SGA, and gestational age (GA) on 1-year mortality in infants with CCHD. Methods and Results In a population-based administrative database of all live-born infants in California (2007-2012) we identified all infants with CCHD without chromosomal anomalies. Our primary predictor was an impaired fetal environment (IFE), defined as presence of maternal placental syndrome or SGA. We calculated hazard ratios to quantify the association between different components of IFE and 1-year mortality and conducted a causal mediation analysis to assess GA at birth as a mediator. We identified 6863 infants with CCHD. IFE was present in 25.1%. Infants with IFE were more likely to die than infants without IFE (16.6% versus 11.1%; hazard ratios 1.55, 95% CI 1.34-1.78). Only SGA (hazard ratios 1.76, 95% CI 1.50-2.05) and placental abruption (hazard ratios 1.70, 95% CI 1.17-2.48) were significantly associated with mortality; preeclampsia and gestational hypertension had no significant association with mortality. The mediation analysis showed that 32.8% (95% CI 24.9-47.0%) of the relationship between IFE and mortality is mediated through GA. Conclusions IFE is a significant contributor to outcomes in the CCHD population. SGA and placental abruption are the main drivers of postnatal mortality while other maternal placental syndrome components had much less of an impact. Only one third of the effect between IFE and mortality is mediated through GA.

Keywords: congenital heart disease; fetal environment; maternal placental syndrome; small for gestational age.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Directed acyclic graph illustrates the relationship between different variables and mortality. A, Generic definition of a mediator. B, Adapted to current study. CCHD indicates critical congenital heart disease.
Figure 2
Figure 2
Survival curves for infants with specific types of critical congenital heart disease by impaired fetal environment. IFE indicates impaired fetal environment; SV, single ventricle; TA, truncus arteriosus; TGA, transposition of the great arteries.
Figure 3
Figure 3
Survival curves for infants with critical congenital heart disease by impaired fetal environment stratified by gestational age groups. Preterm: gestational age <37 wks; early term: gestational age 37 to 38 wks; term: gestational age ≥39 wks. IFE indicates impaired fetal environment.
See this image and copyright information in PMC

References

    1. Jacobs ML, Jacobs JP, Hill KD, Hornik C, O'Brien SM, Pasquali SK, Vener D, Kumar SR, Habib RH, Shahian DM, Edwards FH, Fernandez FG. The Society of Thoracic Surgeons Congenital Heart Surgery Database: 2017 update on research. Ann Thorac Surg. 2017;104:731–741. - PubMed
    1. Costello JM, Pasquali SK, Jacobs JP, He X, Hill KD, Cooper DS, Backer CL, Jacobs ML. Gestational age at birth and outcomes after neonatal cardiac surgery: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. Circulation. 2014;129:2511–2517. - PMC - PubMed
    1. Steurer MA, Baer RJ, Keller RL, Oltman S, Chambers CD, Norton ME, Peyvandi S, Rand L, Rajagopal S, Ryckman KK, Moon‐Grady AJ, Jelliffe‐Pawlowski LL. Gestational age and outcomes in critical congenital heart disease. Pediatrics. 2017;140:e20170999. - PubMed
    1. Steurer MA, Baer RJ, Burke E, Peyvandi S, Oltman S, Chambers CD, Norton ME, Rand L, Rajagopal S, Ryckman KK, Feuer SK, Liang L, Paynter RA, McCarthy M, Moon‐Grady AJ, Keller RL, Jelliffe‐Pawlowski LL. Effect of fetal growth on 1‐year mortality in neonates with critical congenital heart disease. J Am Heart Assoc. 2018;7:e009693 DOI: 10.1161/JAHA.118.009693. - DOI - PMC - PubMed
    1. Best KE, Tennant PWG, Rankin J. Survival, by birth weight and gestational age, in individuals with congenital heart disease: a population‐based study. J Am Heart Assoc. 2017;6:e005213 DOI: 10.1161/JAHA.116.005213. - DOI - PMC - PubMed

Publication types

MeSH terms

LinkOut - more resources