Proximity to risk-appropriate perinatal hospitals for pregnant women with congenital heart defects in New York state

Abstract Background Most individuals born with congenital heart defects (CHDs) survive to adulthood, but healthcare utilization patterns for adolescents and adults with CHDs have not been well described. We sought to characterize the healthcare utilization patterns and associated costs for adolescents and young adults with CHDs.Methods We examined 2009-2013 New York State inpatient admissions of individuals ages 11-30 years with ≥1 CHD diagnosis codes recorded during any admission. We conducted multivariate linear regression using generalized estimating equations to examine associations between inpatient costs and sociodemographic and clinical variables.Results We identified 5,100 unique individuals with 9,593 corresponding hospitalizations over the study period. Median inpatient cost and length of stay (LOS) were $10,307 and 3.0 days per admission, respectively; 55.1% were emergency admissions. Admission volume increased 48.7% from 2009 (1,538 admissions) to 2013 (2,287 admissions), while total inpatient costs increased 111.2% from 2009 ($24.7 million) to 2013 ($52.2 million). Inpatient admissions and costs rose more sharply over the study period for those with non-severe CHDs compared to severe CHDs. Characteristics associated with higher costs were longer LOS, severe CHD, cardiac/vascular hospitalization classification, surgical procedures, greater severity of illness, and admission in New York City.Conclusions This study provides an informative baseline of health care utilization patterns and associated costs among adolescents and young adults with CHDs in New York State.

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Congenital heart defects and pregnancy: current view on the mechanisms of placental adaptation to circulatory hypoxia

Voprosy ginekologii akušerstva i perinatologii ◽

10.20953/1726-1678-2020-6-70-82 ◽

2020 ◽

Vol 19 (6) ◽

pp. 70-82

Author(s):

L.A. Rudyuk ◽

◽

O.S. Reshetnikova ◽

Keyword(s):

Pregnant Women ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Heart Defects ◽

Preventive Therapy ◽

Health Improvement ◽

Current View ◽

Compensatory Mechanisms ◽

Circulatory Hypoxia ◽

Fetoplacental Complex

In this review, we perform clinical and morphological analysis of the mechanisms underlying adaptation of the human placenta to hypoxia in the fetoplacental complex in pregnant women with congenital heart defects (CHDs). We assessed specific characteristics of macroscopic and microscopic structure of the placenta in women with this extragenital pathology. We descried morphological involutive dystrophic and compensatory mechanisms that develop in the placenta of women with impaired hemodynamics. We proposed molecular markers, whose investigation will clarify functional state of the placental barrier and ways of remodeling vascular-stromal components of the villous chorion. Potential risks associated with circulatory hypoxia in the mother-placenta-fetus system should be taken into account in the management of pregnant women with CHDs. Detection of placental maladaptation signs in mothers with CHDs will help to identify the risk group of newborns, organize preventive therapy, prophylaxis of diseases, health improvement, and treatment of newborns. Key words: compensatory and adaptive processes, hypoxia, immunohistochemistry, morphology, placenta

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Inpatient admissions and costs for adolescents and young adults with congenital heart defects in New York, 2009–2013

Birth Defects Research ◽

10.1002/bdr2.1809 ◽

2020 ◽

Author(s):

Wan‐Hsiang Hsu ◽

Kristin M. Sommerhalter ◽

Claire E. McGarry ◽

Sherry L. Farr ◽

Karrie F. Downing ◽

...

Keyword(s):

New York ◽

Young Adults ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Heart Defects ◽

Adolescents And Young Adults

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Proximity to Pediatric Cardiac Surgical Care among Adolescents with Congenital Heart Defects in 11 New York Counties

Birth Defects Research ◽

10.1002/bdr2.1129 ◽

2017 ◽

Vol 109 (18) ◽

pp. 1494-1503 ◽

Cited By ~ 6

Author(s):

Kristin M. Sommerhalter ◽

Tabassum Z. Insaf ◽

Tugba Akkaya-Hocagil ◽

Claire E. McGarry ◽

Sherry L. Farr ◽

...

Keyword(s):

New York ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Heart Defects ◽

Surgical Care

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Abstract WP185: The Risk of Pregnancy-associated Stroke Does not Increase With Age: an Analysis of Claims Data From New York State

Stroke ◽

10.1161/str.47.suppl_1.wp185 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Hajere J Gatollari ◽

Eliza C Miller ◽

Gloria Too ◽

Amelia K Boehme ◽

Anna Colello ◽

...

Keyword(s):

New York ◽

Pregnant Women ◽

Older Women ◽

Post Partum ◽

New York State ◽

Vital Statistics ◽

York State Department ◽

Limited Information ◽

York State ◽

Increased Risk

Introduction: Stroke is a rare but feared complication of pregnancy and the postpartum period. Prior studies have found that older age is associated with increased risk of pregnancy-associated stroke (PAS). It is unclear to what extent pregnancy contributes to this increased risk of PAS. There is limited information on age-specific incidence ratios to assess whether the risk of PAS is comparable to stroke in similarly aged non-pregnant women. Hypothesis: Increased incidence of PAS in older women is attributable to the increasing risk of stroke with age. Methods: We used the 2008-2012 New York State Department of Health (NYS DOH) Statewide Planning and Research Cooperative System (SPARCS) inpatient database to identify women aged 12-50 with ischemic (ICD-9 433, 434, 436), ICH (ICD-9 431), SAH (ICD-9 430), and non-specified PAS, including post-partum stroke (ICD-9 671.7, 674). Population data were obtained from NYS DOH Vital Statistics. Age-specific incidence ratios were calculated for strokes in pregnant or postpartum women compared to non-pregnant women. We used standard age groups considered by obstetricians to be at low, moderate, or high risk for pregnancy complications, including stroke. Results: Of 7099 stroke hospitalizations occurring in women, 386 were in pregnant women. The table shows the incidence of stroke in women stratified by pregnancy status and age group, and age-specific incidence risk ratios associated with pregnancy. Conclusions: Compared to non-pregnant women of the same age, pregnant women appeared to be at similarly increased risk of stroke at all ages, except for those over age 40. These results suggest that pregnancy itself does not further increase the risk of stroke in older women, though they could also reflect a tendency for healthier women to have pregnancies at later ages. More research is needed to investigate the characteristics that may put younger women at increased risk of stroke, compared to their non-pregnant contemporaries.

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Circulating LncRNAs as Novel, Non-Invasive Biomarkers for Prenatal Detection of Fetal Congenital Heart Defects

Cellular Physiology and Biochemistry ◽

10.1159/000443088 ◽

2016 ◽

Vol 38 (4) ◽

pp. 1459-1471 ◽

Cited By ~ 23

Author(s):

Meng Gu ◽

Aibin Zheng ◽

Wenjuan Tu ◽

Jing Zhao ◽

Lin Li ◽

...

Keyword(s):

Pregnant Women ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Heart Defects ◽

Roc Curves ◽

Differentially Expressed ◽

Rt Pcr ◽

Clinical Value ◽

Roc Curve Analysis ◽

Novel Biomarkers

Objectives: To explore the clinical value of circulating long non-coding RNAs (lncRNAs) as biomarkers to predict fetal congenital heart defects (CHD) in pregnant women. Methods: Differential expression of lncRNAs isolated from the plasma of pregnant women with typical fetal CHD or healthy controls was analyzed by microarray. Gene ontology (GO), pathway and network analysis were performed to study the function of the lncRNAs. Differentially expressed lncRNAs were validated in plasma samples from 62 pregnant women with typical CHD and 62 matched controls by RT-PCR. The sensitivity and specificity of each lncRNA in the diagnosis of fetal CHD was determined by ROC curve analysis. Results: Microarray analysis identified 3694 up-regulated and 3919 down-regulated (fold change ≥2.0) lncRNAs. The top ten significantly differentially expressed, CHD-associated lncRNAs were validated by RT-PCR. Five significantly up-regulated or down-regulated lncRNAs were identified: ENST00000436681, ENST00000422826, AA584040, AA709223 and BX478947 with the AUC of ROC curves calculated as 0.892, 0.817, 0.755, 0.882 and 0.886, respectively. Conclusions: Specific lncRNAs aberrantly expressed in the plasma of pregnant women with typical fetal CHD may play a key role in the development of CHD and may be used as novel biomarkers for prenatal diagnosis of fetal CHD.

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UTILIZATION TRENDS OF CONGENITAL HEART DISEASE PATIENTS 10-29 YEARS IN NEW YORK STATE AND CALIFORNIA

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(13)60466-0 ◽

2013 ◽

Vol 61 (10) ◽

pp. E466

Author(s):

Roberta G. Williams

Keyword(s):

New York ◽

Congenital Heart Disease ◽

Heart Disease ◽

Congenital Heart ◽

New York State ◽

York State

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Adverse Pregnancy Conditions Among Privately Insured Women With and Without Congenital Heart Defects

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.119.006311 ◽

2020 ◽

Vol 13 (6) ◽

Author(s):

Karrie F. Downing ◽

Naomi K. Tepper ◽

Regina M. Simeone ◽

Elizabeth C. Ailes ◽

Michelle Gurvitz ◽

...

Keyword(s):

Pregnant Women ◽

Congenital Heart Defects ◽

American Heart Association ◽

Congenital Heart ◽

American Heart ◽

Heart Defects ◽

Heart Association ◽

Menstrual Period ◽

Last Menstrual Period ◽

Adverse Conditions

Background In women with congenital heart defects (CHD), changes in blood volume, heart rate, respiration, and edema during pregnancy may lead to increased risk of adverse outcomes and conditions. The American Heart Association recommends providers of pregnant women with CHD assess cardiac health and discuss risks and benefits of cardiac-related medications. We described receipt of American Heart Association–recommended cardiac evaluations, filled potentially teratogenic or fetotoxic (Food and Drug Administration pregnancy category D/X) cardiac-related prescriptions, and adverse conditions among pregnant women with CHD compared with those without CHD. Methods and Results Using 2007 to 2014 US healthcare claims data, we ascertained a retrospective cohort of women with and without CHD aged 15 to 44 years with private insurance covering prescriptions during pregnancy. CHD was defined as ≥1 inpatient code or ≥2 outpatient CHD diagnosis codes >30 days apart documented outside of pregnancy and categorized as severe or nonsevere. Log-linear regression, accounting for multiple pregnancies per woman, generated adjusted prevalence ratios (aPRs) for associations between the presence/severity of CHD and stillbirth, preterm birth, and adverse conditions from the last menstrual period to 90 days postpartum. We identified 2056 women with CHD (2334 pregnancies) and 1 374 982 women without (1 524 077 pregnancies). During the last menstrual period to 90 days postpartum, 56% of women with CHD had comprehensive echocardiograms and, during pregnancy, 4% filled potentially teratogenic or fetotoxic cardiac-related prescriptions. Women with CHD, compared with those without, experienced more adverse conditions overall (aPR, 1.9 [95% CI, 1.7–2.1]) and, specifically, obstetric (aPR, 1.3 [95% CI, 1.2–1.4]) and cardiac conditions (aPR, 10.2 [95% CI, 9.1–11.4]), stillbirth (aPR, 1.6 [95% CI, 1.1–2.4]), and preterm delivery (aPR, 1.6 [95% CI, 1.4–1.8]). More women with severe CHD, compared with nonsevere, experienced adverse conditions overall (aPR, 1.5 [95% CI, 1.2–1.9]). Conclusions Women with CHD have elevated prevalence of adverse cardiac and obstetric conditions during pregnancy; 4 in 100 used potentially teratogenic or fetotoxic medications, and only half received an American Heart Association–recommended comprehensive echocardiogram.

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Сongenital diseases of the heart among newborn children: genetic aspects

The Journal of V. N. Karazin Kharkiv National University, Series "Medicine" ◽

10.26565/2313-6693-2019-38-10 ◽

2019 ◽

Keyword(s):

Pregnant Women ◽

Birth Defects ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Chromosomal Abnormalities ◽

Heart Defects ◽

Circulatory System ◽

Reproductive Age ◽

Multiple Birth ◽

Perinatal Pathology

Congenital heart defects are a heterogeneous group of diseases that occur as isolation or a part of multiple birth defects, gene disorders or chromosomal abnormalities. Chromosomal abnormalities and its underlying syndromes are the cause of 6 to 36% of cases of congenital heart defects. Monogenic etiology is proven in about 8% of cases, and the main group - about 90% of the congenital heart defects is the result of an unfavorable combination of genetic predisposition and external factors. The causes of early neonatal infant mortality are dominated by incompatible birth defects: almost 26% of perinatal and neonatal deaths are associated with congenital child pathology. Heart defects compose about 30% of all birth defects. They rank first place among the diseases that lead to perinatal mortality and early disability. World statistics show that the incidence of birth defects in the world is 9 per 1000 newborns, in Europe - 8/1000, which is 4 times more frequent than neural tube defects and 6 times higher than chromosomal abnormalities. In Ukraine, about 5,000 children with congenital heart defects are born each year, and the total number of those children on dispensary records reaches more than 45,000. Knowledge about the prevalence of birth defects in the region is needed to develop new information markers of the risk of congenital pathology of the circulatory system for women of reproductive age. Data on the incidence of congenital heart defects of fetuses and newborns in the region will allow the creation of a database for follow-up studies, which will facilitate the timely identification of pregnant women at risk. This will improve the prognosis of pregnancy, reduce the level of perinatal pathology, which will have a significant medical and social effect. The data obtained will allow to create preconditions for improvement of approaches to the definition of risk groups of perinatal pathology, perfection of specialized care for pregnant women with risk of congenital heart defects of the fetus.

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