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Maternal Predictors of Disparate Outcomes in Children With Single Ventricle Congenital Heart Disease
- Source :
- Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
- Publication Year :
- 2020
- Publisher :
- John Wiley and Sons Inc., 2020.
-
Abstract
- Background Significant variability in morbidity and mortality persists for children with functionally single ventricle congenital heart disease (SV‐CHD) despite standardization in medical and surgical care. We hypothesized that maternal health factors may be associated with an increased risk of poor outcomes in children with SV‐CHD. Methods and Results This retrospective, observational, cohort study included term maternal‐infant pairs with a diagnosis of SV‐CHD who underwent surgical palliation from 2006 to 2015 at Primary Children's Hospital. Pairs lacking maternal variables of interest or infant follow‐up data were excluded. The association of maternal risk factors of abnormal pre‐pregnancy body mass index, abnormal gestational weight gain (20 kg), hypertensive disorders, and gestational diabetes mellitus with death/transplant and hemodynamics were analyzed using regression models. Of 190 infants, 135 (71%) maternal‐infant dyads had complete data for inclusion. Death or transplant occurred in 48 infants (36%) during an average follow‐up of 2.2 years (0.1–11.7 years). Abnormal gestational weight gain was associated with an increased risk of death and/or transplant in logistic regression (odds ratio, 3.22; 95% CI, 1.32–7.86; P =0.01), but not Cox regression (hazard ratio, 1.9; 95% CI, 1.0–3.7; P =0.055). Mean pulmonary artery pressures were higher in the setting of abnormal gestational weight gain (16.5±2.9 versus 14.7±3.0 mm Hg; P P Conclusions Abnormal gestational weight gain (excessive or inadequate) is a novel risk factor for worse outcomes in SV‐CHD. The fetoplacental environment may alter the trajectory of vascular development to impact outcomes in infants with SV‐CHD.
- Subjects :
- Adult
Male
medicine.medical_specialty
Time Factors
Heart disease
Databases, Factual
Maternal Health
030204 cardiovascular system & hematology
Pediatrics
Risk Assessment
Univentricular Heart
Body Mass Index
03 medical and health sciences
Young Adult
0302 clinical medicine
Pregnancy
Risk Factors
Internal medicine
Pediatric Cardiology
medicine
Humans
Cardiac Surgical Procedures
Original Research
Retrospective Studies
■ outcomes ■ single ventricle
030219 obstetrics & reproductive medicine
abnormal gestational weight gain ■ congenital heart disease
business.industry
Hemodynamics
Infant, Newborn
Infant
Hypertension, Pregnancy-Induced
medicine.disease
Gestational Weight Gain
medicine.anatomical_structure
Treatment Outcome
Ventricle
Cardiology
Heart Transplantation
Female
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- Language :
- English
- ISSN :
- 20479980
- Volume :
- 9
- Issue :
- 12
- Database :
- OpenAIRE
- Journal :
- Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
- Accession number :
- edsair.doi.dedup.....a08e67a5fae46ed5b2166a4ce2c4c838