Neighborhood location and nutritional resources as a risk factor for congenital heart disease in the fetus

Chromosomal Microarray Analysis and Karyotype Analysis for Prenatal Diagnosis of Fetuses With Abnormal Ultrasound Soft Markers

OBJECTIVE

To explore and evaluate the value of chromosomal microarray analysis (CMA) in fetuses with abnormal ultrasound soft markers.

METHODS

A retrospective study was conducted on 193 fetuses with abnormal ultrasound soft markers who received prenatal diagnosis at Meizhou People's Hospital, between October 2022 and February 2024. Genetic detection of fetal specimens obtained by ultrasound-guided puncture was carried out. The detection rates of karyotype analysis and CMA for chromosomal abnormalities in different ultrasonic abnormalities were analyzed.

RESULTS

Of the 193 fetuses, there were 77 (39.9%) fetuses with increased nuchal translucency(NT) thickness, 33 (17.1%) with ventriculomegaly, 29 (15.0%) with nasal bone hypoplasia, followed by choroid plexus cyst, pyelic separation, echogenic bowel, single umbilical artery, with persistent left superior vena cava, and persistent right umbilical vein. Aneuploidy was mainly found in fetuses with increased NT thickness or and nasal bone hypoplasia, while P/LP CNVs were mainly concentrated in fetuses with increased NT thickness or ventriculomegaly. The detection rate of karyotype was 5.7% (11/193), the detection rate of aneuploidy plus P/LP CNVs in fetuses with abnormal ultrasonic soft markers by CMA was 10.9% (21/193), and the additional detection rate of CMA was 5.2%.

CONCLUSIONS

CMA can significantly improve the detection rate of chromosomal abnormalities in fetuses with abnormal ultrasonic soft markers compared with karyotype analysis. There was a significant difference in detection rates of chromosomal abnormality between CMA and karyotype analysis in the single ultrasonic abnormality group, but none in the multiple ultrasonic abnormalities group.

Racial Disparities in Birth and Lactation Outcomes Among Neonates with Congenital Heart Defects at a Regional Mid-Atlantic Heart Center

BACKGROUND

Evidence regarding ways in which systemic racism impacts birth and lactation among neonates with congenital heart defects (CHD) is limited. Thus, we sought to examine racial disparities among a cohort of neonates with CHD by exploring associations between birth and lactation outcomes and individual and community-level indicators of systemic racism.

METHODS

This was a post hoc analysis of retrospective electronic health record (EHR) data from hospitalized neonates who had cardiac surgery and resided in the same county as the pediatric hospital (n = 20; 2016-2020). Associations between primary outcomes (birth weight and weight-for-age z-score, and 28-day total parental milk and overall human milk percentage) and systemic racism indicators (neonate's EHR documented race and zip code-derived index scores for community-level food insecurity and health inequity) were analyzed with multivariable regression models.

RESULTS

Compared to White neonates (n = 13), Black or biracial neonates (n = 5) had lower parental milk (β = - 59.4, p = 0.003) and human milk (β = - 62.1, p < 0.001) percentages. Higher community-level food insecurity index scores were associated with lower birth weight (β = - 104 g, p = 0.014), birth weight-for-age z-scores (β = - 0.195, p = 0.026), and human milk percentage (p = 0.003), whereas higher health inequity index scores were associated with lower parental milk (β = - 8.5, p = 0.03) and human milk (β = - 10.2, p < 0.001) percentages.

CONCLUSIONS

Significant racial inequities in birth and lactation outcomes may exist for neonates with CHD. More research is needed to identify structural barriers within pediatric cardiac care and develop interventions to mitigate these disparities.

Socioeconomic Determinants of Health: Remoteness From Care

Remoteness from care remains a major challenge to equitable provision of health services worldwide. Beyond the difficulties associated with geographically and climatically rugged terrain, there are also socioeconomic, cultural, and technological challenges associated with remote residence. The objective of this review is to examine the factors whereby remoteness can be associated with sociodemographic disadvantage in health care and describe some of the methodologies for measurement and analysis of remoteness, with examples from the literature, particularly focusing on Canada. As surrogates for remoteness, simple measurements of direct distance or travel time may correlate well with more complex measures and can be performed relative to specific health care services of interest (for example, tertiary obstetric service). These metrics may also be measured, as general proxies for service availability, to various sizes of population centres. More complex measures of remoteness may also incorporate modes of available transport and availability of specific services into an index such as the Canadian Index of Remoteness. As an important independent predictor of health, remoteness requires careful predictive modelling because of potential complex nonlinear relationships, edge effects created by health system zone boundaries, and covariance with other sociodemographic factors and Indigenous population proportions. To combat disadvantage caused by remoteness, innovation in health service delivery, policy, and technology is required. Health-resource allocation must be adequate, and innovative technological advances-such as remote monitoring, expert clinical support, and artificial intelligence algorithms-must be supported by development of appropriate technological infrastructure, targeting remote regions. With these, the barriers to equitable health imposed by remoteness can be overcome.

Effects of Sociodemographic Factors on Access to and Outcomes in Congenital Heart Disease in the United States

Congenital heart defects (CHDs) are complex conditions affecting the heart and/or great vessels that are present at birth. These defects occur in approximately 9 in every 1000 live births. From diagnosis to intervention, care has dramatically improved over the last several decades. Patients with CHDs are now living well into adulthood. However, there are factors that have been associated with poor outcomes across the lifespan of these patients. These factors include sociodemographic and socioeconomic positions. This commentary examined the disparities and solutions within the evolution of CHD care in the United States.