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. 2022 Dec:251:82-88.e1.
doi: 10.1016/j.jpeds.2022.06.036. Epub 2022 Jul 5.

Adverse Maternal Fetal Environment Partially Mediates Disparate Outcomes in Non-White Neonates with Major Congenital Heart Disease

Stephanie Santana  1 , Shabnam Peyvandi  2 , John M Costello  3 , Rebecca J Baer  4 , James W Collins Jr  5 , Tonia Branche  5 , Laura L Jelliffe-Pawlowski  6 , Martina A Steurer  2
Affiliations

Adverse Maternal Fetal Environment Partially Mediates Disparate Outcomes in Non-White Neonates with Major Congenital Heart Disease

Stephanie Santana et al. J Pediatr. 2022 Dec.

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).

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.

Keywords: cardiac defects; cardiovascular pregnancy complication; fetal diseases; health inequities; hospital mortality; infant morbidity; retrospective studies; risk factors.

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Conflict of interest statement

No funding of any kind was provided for this study. The authors declare no conflicts of interest.

Figures

Figure.
Figure.
Direct acyclic graphs for the conceptual framework of the relationship between race/ethnicity and outcomes in major CHD. A, General conceptual framework. B, non-Hispanic White vs non-Hispanic Black infants. C, non-Hispanic White vs Hispanic infants. Each arrow represents a different pathway by which the predictor (race/ethnicity) affects the outcome through the mediator, ie, in (B), the square dash arrow shows race/ethnicity effect on outcome as mediated by SGA. NH, Non-Hispanic; NHW, Non-Hispanic White; MPS, maternal placental syndrome; MMS, maternal metabolic syndrome.
See this image and copyright information in PMC

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