{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T03:45:58Z","timestamp":1790567158306,"version":"4.1.0"},"reference-count":41,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Regionalization is a system by which neonates with congenital heart defects (CHDs) are directed to risk-appropriate levels of care. However, the role of prenatal care in delivery location remains unclear.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To estimate associations between prenatal care adequacy and the likelihood of delivery at a pediatric cardiac center.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cross-sectional study examined retrospective data from the Illinois Department of Public Health\u2019s Adverse Pregnancy Outcomes Reporting System. Participants included neonates born with CHDs in Illinois from 2013 to 2021. Data were analyzed from November 2024 to May 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Two binary exposure variables: (1) prenatal care initiation\u2014none vs inadequate prenatal care (initiated after the fourth month or less than 50% of recommended visits) and (2) prenatal visit frequency\u2014intermediate (50% to 79% of recommended visits) vs adequate (80% to 109% of recommended visits) or adequate plus (110% or more of recommended visits) prenatal care.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Delivery at a pediatric cardiac center was the main outcome. Multivariable linear probability models estimated associations between prenatal care and delivery hospital, controlling for demographic and clinical characteristics. Regressions were stratified by CHD severity (eg, mild, moderate, and severe), as severe defects require intervention at a cardiac center within the first week of life.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Of 12\u202f113 neonates with CHD, 3076 (25.4%) were born at a cardiac center and 1579 (13.0%) had severe CHD. Distribution for prenatal care initiation was: 272 (2.3%) had no prenatal care and 1617 (13.4%) had inadequate prenatal care. Distribution for prenatal visit frequency was: 1304 (10.8%) had intermediate prenatal care, 4217 (34.8%) had adequate prenatal care, and 4703 (38.8%) had adequate plus prenatal care. Prenatal care initiation was associated with a 10.5 (95% CI, 4.7 to 16.2) percentage point higher probability of delivery at a cardiac center for those with fetuses who had mild CHD and 30.2 (95% CI, 13.6 to 46.9) percentage point higher probability for severe CHD. For mild CHD, adequate plus prenatal care was associated with a lower probability of delivery at a cardiac center by 6.7 (95% CI, \u22124.0 to \u22129.4) percentage points compared with intermediate prenatal care. Prenatal visit frequency was not associated with delivery at a cardiac center for severe CHD.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cross-sectional study, delayed prenatal care initiation was associated with higher probability of delivery at a cardiac center, especially for severe CHD. More prenatal visits may help appropriately direct mild cases to noncardiac centers. Operationalization of regionalized CHD care requires consideration of many factors, including prenatal events.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.42135","type":"journal-article","created":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T19:30:16Z","timestamp":1762716616000},"page":"e2542135","source":"Crossref","is-referenced-by-count":3,"title":["Prenatal Care and Perinatal Regionalization for Congenital Heart Defects"],"prefix":"10.1001","volume":"8","author":[{"given":"Christina","family":"Laternser","sequence":"first","affiliation":[{"name":"Division of Pediatric Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William A.","family":"Grobman","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia","family":"Albaro","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Department of Pediatrics, University of Illinois College of Medicine, Peoria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett R.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York"},{"name":"Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York"},{"name":"Center for Child Health Services Research, Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beau","family":"Batton","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Southern Illinois University School of Medicine, Springfield"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynn M.","family":"Yee","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joyce L.","family":"Woo","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Department of Pediatrics, Ann & Robert H. 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