Abstract 9331: Adverse Maternal Fetal Environment Partially Mediates Disparate Outcomes in Hispanic and Non Hispanic Black Infants With Critical Congenital Heart Disease

Abstract

Introduction: Etiologies of racial and ethnic disparities in critical congenital heart disease (CCHD) outcomes are not fully understood. We sought to determine whether differential exposure to an adverse maternal fetal environment (AMFE) partially explains disparate outcomes. Methods: We included infants with CCHD in a population-based administrative California database (2011-2017). Primary exposure was race/ethnicity. Primary mediator was AMFE, defined as maternal metabolic syndrome (MMS: any diabetes, abnormal BMI, or hyperlipidemia) or maternal placental syndrome (MPS: pre-eclampsia/ eclampsia, gestational hypertension, or placental abruption). Outcomes: days alive out of hospital in first year of life (DAOOH); composite of 1-year mortality or severe morbidity (e.g., ECMO, cardiac arrest, BPD, etc.). Mediation analyses (CCHD severity-adjusted) determined % contribution to outcome for each mediator on pathways between race/ethnicity and outcomes. Results: Included were 2,747 Non-Hispanic (NH) White [REF group], 5,244 Hispanic, and 625 NH Black infants. Hispanic and NH Black infants had higher risk for composite outcome (crude OR, 1.18; crude OR, 1.25 respectively) and fewer DAOOH (-6 & -12 days, respectively). Relative to NH White infants (MMS 28%; MPS 12%), Hispanic infants had higher MMS exposure (43%, OR, 1.89), while NH Black infants had higher MMS (44%, OR, 1.97) & MPS exposure (18%, OR, 1.66). Both MMS exposure (OR, 1.21) and MPS exposure (OR 1.56) were related to composite outcome and fewer DAOOH (-25 & -16 days, respectively). AMFE explained 25% of relationship between NH Black race and composite outcome, and 18% of relationship between Hispanic ethnicity and composite outcome. AMFE explained 16% (NH Black race) and 21% (Hispanic ethnicity) of the association with DAOOH (Table). Conclusions: Increased exposure to AMFE contributes to disparate outcomes in NH Black and Hispanic infants with CCHD. This novel finding merits clinical attention.