Breed was already known for its importance to the health outcomes of infants with congenital heart disease (CC), the most common birth defect, affecting 1 in 100 live births. During the first year of life, African Americans are 1.4 times more likely and Hispanics are 1.7 times more likely to die of coronary heart disease than whites. However, no one knew why race affected these results.
“We’ve known for a few decades now that outcomes are worse in minority groups, compared to their white counterparts,” said John Costello, MD, pediatric cardiologist and director of research for MUSC Children’s Health Pediatric & Congenital Heart Center at the MUSK Shawn. Jenkins Children’s Hospital. “But we never really understood why these differences in results exist. »
There is now a partial answer to this question, thanks to a joint effort between Costello; Stephanie Santana, MD, Pediatric Cardiology Fellow for MUSC Children’s Health; and their colleagues from the University of California, San Francisco (UCSF) and Northwestern University. They report in the Journal of Pediatrics that maternal health status during pregnancy may partially explain racial differences in outcomes for patients with coronary artery disease.
As a first-generation Hispanic physician, Santana has always been passionate about health disparities. At MUSC, she became interested in why coronary heart disease outcomes are worse in infants of color. After discussing those interests with Costello, the two reached out to collaborators at UCSF and Northwestern. Together, they tapped into a large California administrative dataset that allowed them to draw links between maternal health and outcomes for infants with coronary artery disease. A prior conference presentation on this work led to Santana receiving the American Heart Association’s 2021 Outstanding Research Award in Pediatric Cardiology.
The recently published study is unique in that it not only assessed the health of infants with coronary artery disease, but also that of their mothers. This maternal component was important to include because coronary heart disease begins during development when the baby and mother are interconnected in the womb.
“The journey of a child, adolescent or patient with congenital heart disease does not begin at birth,” Santana said. “It starts in that mother-baby unit and all the influences and factors that negatively or positively impact that environment. »
This survey assessed the records of over 8,000 infants and their mothers from various populations. It found that maternal placental and metabolic syndromes during pregnancy explained 25% of the disparity in coronary heart disease outcomes among blacks and 18% among Hispanics. Among the conditions associated with these syndromes are high blood pressure, obesity, diabetes, and high cholesterol.
The results are exciting, Santana says, because these conditions can be treated.
Armed with the knowledge from this study, she believes doctors can modify treatment plans for at-risk mothers. For example, they can provide education or preventive medication. Although there is still a long way to go to address racial disparities in coronary heart disease, Santana believes that identifying one of the factors responsible for it gives hope for improved outcomes at the coming.
“One of the first steps is to name these factors and show that there is a difference,” Santana said. “Whether we change that factor by removing it, educating mothers about it, or treating them with different medications, I think that opens the door. »