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Prenatal care coordination, racial and socioeconomic inequities, and pre- and post-operative outcomes in hypoplastic left heart syndrome

Journal of Perinatology volume 43, pages 378–384 (2023)Cite this article

Subjects

Abstract

Objective

We sought to identify associations between prenatal care coordination (PNC) and outcomes in hypoplastic left heart syndrome (HLHS).

Study design

We hypothesized that suboptimal PNC is associated with worse pre-operative status. HLHS patients from 2016 through 2019 were identified using a multicenter registry. Optimal PNC was defined as (1) a completed interdisciplinary conference and (2) closed-loop communication with the obstetric team. Associations between PNC and outcomes were identified.

Results

Of 1441 patients, 1242 (86%) had prenatal diagnosis. Among those with a prenatal diagnosis, PNC was achieved in only 845 (68%). Suboptimal PNC was associated with adverse events (50% vs 40%, p < 0.001), inotrope need (19% vs 13%, p = 0.007), mechanical ventilation (22% vs 16%, p = 0.016), and parenteral feeding (60% vs 46%, p < 0.001). African–American race and non-commercial insurance were associated with a lower likelihood of optimal PNC (p = 0.006 and p < 0.001, respectively).

Conclusion

Improving PNC and overcoming racial and socioeconomic barriers are important targets to improve HLHS perinatal care.

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Fig. 1: Associations between prenatal care coordination and pre-operative status.
Fig. 2: Associations between race, insurance type, and prenatal care coordination.

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Data availability

All data are presented in the main manuscript.

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Author information

Authors and Affiliations

  1. Department of Cardiology, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA

    David N. Schidlow, Kimberlee Gauvreau, Emily M. Bucholz, Terra Lafranchi, Christina Ronai & David W. Brown

  2. Board of Directions, Sisters by Heart, Los Angeles, CA, USA

    Amy Bennett

  3. Division of Cardiology, Children’s Hospital Los Angeles, Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA, USA

    Jay Pruetz

  4. Department of Pediatrics, Division of Cardiology, University of Virginia, Charlottesville, VA, USA

    Jeffrey Vergales

Authors
  1. David N. Schidlow
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  2. Kimberlee Gauvreau
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  3. Emily M. Bucholz
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  4. Amy Bennett
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  5. Terra Lafranchi
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  6. Jay Pruetz
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  7. Christina Ronai
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  9. David W. Brown
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Contributions

DS, EB, AB, TL, JP, CR, JV, and DB contributed to the design of the work and interpretation of the data. KG and EB performed data analysis. All authors participated in drafting and critically revising the manuscript for important intellectual content. All authors approved the final version of this manuscript and agree to be accountable for all aspects of the work.

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Correspondence to David N. Schidlow.

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The authors declare no competing interests.

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Schidlow, D.N., Gauvreau, K., Bucholz, E.M. et al. Prenatal care coordination, racial and socioeconomic inequities, and pre- and post-operative outcomes in hypoplastic left heart syndrome. J Perinatol 43, 378–384 (2023). https://doi.org/10.1038/s41372-022-01571-7

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