417 - Distance to Specialized Cardiac Care: A Key Factor in Maternal and Neonatal Outcomes for Pregnancies Complicated by Congenital Heart Disease

Publication Number: 417.4525

Guadalupe Martinez, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States; Angela Desmond, Children's Hospital Los Angeles, Santa Monica, CA, United States; Joanne Newens, UCLA Mattel Childrens Hospital, Los Angeles, CA, United States; Lior Kashani Ligumsky, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States; Anthony Jusuf, Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA, United States; Gary Satou, UCLA, Los Angeles, CA, United States; Kara L. Calkins, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States; Yalda Afshar, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States

Background: Congenital heart disease (CHD) affects 1% of livebirths and carries a high rate of neonatal morbidity and mortality. Despite advances in cardiac care, pregnant people and neonates continue to be affected by social barriers that become amplified with increased distance from home to a tertiary care center offering specialized cardiac care.

Objective: This study aims to examine how distance to healthcare center affects maternal and neonatal outcomes in pregnancies affected by a prenatal diagnosis of CHD.

Design/Methods: Prospective cohort study of pregnant people and their neonates residing in California with prenatally suspected and postnatally confirmed CHD admitted to a single institution between 2018-2022. Residence zip codes were mapped, and census-tract level variables were pulled using CalEnivoScreen. Subjects were divided into three distance subgroups: < 30 minutes, 30-120 minutes, and >120 minutes from intended birth hospital. Maternal outcomes of interest include mode of birth and hospital length of stay (LOS). Neonatal outcomes of interest include gestational age, birthweight, and LOS. Chi-square and ANOVA tests compared outcomes between groups.

Results: 216 maternal-neonatal dyads met inclusion criteria. Average age was 32 years. 30% (n=30) lived < 30 min from hospital, 49% (n=105) lived 30-120 min away, and 38% (n=83) lived >120 min away. The cohort commuting longest distance (>120 min) experienced greater rate of cesarean births (48% vs 17%) compared to those commuting a short distance ( < 30 min group) (p=0.002). Pregnant people in the longest distance group gave birth at a younger mean gestational age (37 weeks) compared to the short distance group (38weeks) (p=0.013). Maternal LOS was longer for the longest distance group (6 days) than short group (4 days) (p=0.058). Mean birthweight of neonates in longest distance group was 2940g compared to 3033g in short distance group (p=0.441). Neonatal LOS was 41 days for longest group and 19 days for short distance group (p=0.030).

Conclusion(s): Pregnant patients with suspected fetal CHD who live farther from their designated healthcare center experience higher rates of cesarean births and their neonates experience longer LOS. Future steps include integrating cardiac risk stratification and census-level data to study their influences on maternal and neonatal outcomes. This work inspires the incorporation of risk stratification to include social determinants of health in prenatal suspected mechanisms to overcome barriers in accessing care to improve health outcomes for this vulnerable population.