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

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

doi:10.1161/JAHA.119.013194

Back

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

Journal article

Open access

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

Martina A Steurer, Shabnam Peyvandi, Rebecca J Baer, Scott P Oltman, Christina D Chambers, Mary E Norton, Kelli K Ryckman, Anita J Moon-Grady, Roberta L Keller, Stephen C Shiboski, …

Journal of the American Heart Association, Vol.8(22), pp.e013194-e013194

11/19/2019

DOI: 10.1161/JAHA.119.013194

PMCID: PMC6915289

PMID: 31726960

Files and links (1)

url

https://doi.org/10.1161/JAHA.119.013194View

Published (Version of record) Open Access

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.

Abruptio Placentae - epidemiology

Chronic Disease

Eclampsia - epidemiology

Female

Gestational Age

Heart Defects, Congenital

Humans

Hypertension - epidemiology

Hypertension, Pregnancy-Induced - epidemiology

Infant

Infant Mortality

Infant, Newborn

Infant, Small for Gestational Age

Male

Pre-Eclampsia - epidemiology

Pregnancy

Pregnancy Complications, Cardiovascular - epidemiology

Premature Birth - epidemiology

Proportional Hazards Models

Risk Factors

Severity of Illness Index

Transposition of Great Vessels

Truncus Arteriosus, Persistent

Univentricular Heart

Details

Title: Subtitle: Impaired Fetal Environment and Gestational Age: What Is Driving Mortality in Neonates With Critical Congenital Heart Disease?
Creators: Martina A Steurer - Department of Epidemiology and Biostatistics University of California San Francisco San Francisco CA
Shabnam Peyvandi - Department of Epidemiology and Biostatistics University of California San Francisco San Francisco CA
Rebecca J Baer - Department of Obstetrics, Gynecology, and Reproductive Sciences University of California San Francisco San Francisco CA
Scott P Oltman - Department of Epidemiology and Biostatistics University of California San Francisco San Francisco CA
Christina D Chambers - Department of Pediatrics University of California San Diego La Jolla CA
Mary E Norton - Department of Obstetrics, Gynecology, and Reproductive Sciences University of California San Francisco San Francisco CA
Kelli K Ryckman - Department of Epidemiology College of Public Health University of Iowa Iowa City IA
Anita J Moon-Grady - Department of Pediatrics University of California San Francisco San Francisco CA
Roberta L Keller - Department of Pediatrics University of California San Francisco San Francisco CA
Stephen C Shiboski - Department of Epidemiology and Biostatistics University of California San Francisco San Francisco CA
Laura L Jelliffe-Pawlowski - Department of Epidemiology and Biostatistics University of California San Francisco San Francisco CA
Resource Type: Journal article
Publication Details: Journal of the American Heart Association, Vol.8(22), pp.e013194-e013194
DOI: 10.1161/JAHA.119.013194
PMID: 31726960
PMCID: PMC6915289
NLM abbreviation: J Am Heart Assoc
ISSN: 2047-9980
eISSN: 2047-9980
Grant note: K23 NS099422 / NINDS NIH HHS
Language: English
Date published: 11/19/2019
Academic Unit: Stead Family Department of Pediatrics; Epidemiology
Record Identifier: 9984214852202771

Metrics

14 Record Views

35 Times Cited - Web of Science