| Abstrakt: |
Introduction:Studies have demonstrated that preterm delivery (PTD) in infants with critical congenital heart disease (CCHD) is associated with worse outcomes compared to those delivered at term. PTD in singletons with CCHD is decreasing. However, little is known about PTD trends over time in multiple gestation deliveries (MGD) with CCHD.Hypothesis:We hypothesized that in a state population-based cohort over the last 20 years, PTD in MGD with CCHD initially increased compared to the general population, but more recently decreased coincident with advancements in prenatal detection of CCHD.Methods:The Texas Public Use Data File 1999-2018 was used to evaluate percent PTD (<37 weeks) in MGD with CCHD (diagnoses requiring intervention <1 year of age). Trends in PTD were compared with all Texas livebirths of MGD. We then compared trends by race/ethnicity and insurance.Results:Of 7,428,329 livebirths from 1999-2018, 211,931 (2.8%) were MGD and of those 129,253 (61%) were PTD. Overall, the rate of PTD increased from 1999 to 2003 (mean increase of 1%/y) then remained constant 2003-2018 (Figure). Of 308 MGD with CCHD, 229 (74%) were PTD. The rate of PTD in CCHD decreased from 1999 to 2003 (mean decrease of 2.2%/y) then remained relatively constant 2003-2018. When examining by race/ethnicity, there was an overall decrease in PTD with CCHD in Non-Hispanic White and Hispanic MGD, but an increase in Non-Hispanic Black MGD (Figure). There was a decrease in PTD with CCHD for those with private insurance however an increase for those with public insurance (Figure).Conclusions:For MGD with CCHD, while PTD rates initially decreased, they have remained somewhat constant over the last 15 years. The rate of PTD in non-Hispanic Black MGD and in those publicly insured, however, remains the highest. Mechanisms for persisting disparities in PTD for these populations requires further investigation, including determining associations with other social determinants of health and implicit bias. |
