{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T20:23:13Z","timestamp":1790713393396,"version":"4.1.0"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"22","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,11,19]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Infants with critical congenital heart disease (\n                      <jats:styled-content style=\"fixed-case\">CCHD<\/jats:styled-content>\n                      ) are more likely to be small for gestational age (\n                      <jats:styled-content style=\"fixed-case\">SGA<\/jats:styled-content>\n                      ) or born to mothers with maternal placental syndrome. The objective of this study was to investigate the relationship between maternal placental syndrome,\n                      <jats:styled-content style=\"fixed-case\">SGA<\/jats:styled-content>\n                      , and gestational age (\n                      <jats:styled-content style=\"fixed-case\">GA<\/jats:styled-content>\n                      ) on 1\u2010year mortality in infants with\n                      <jats:styled-content style=\"fixed-case\">CCHD<\/jats:styled-content>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      In a population\u2010based administrative database of all live\u2010born infants in California (2007\u20132012) we identified all infants with\n                      <jats:styled-content style=\"fixed-case\">CCHD<\/jats:styled-content>\n                      without chromosomal anomalies. Our primary predictor was an impaired fetal environment (\n                      <jats:styled-content style=\"fixed-case\">IFE<\/jats:styled-content>\n                      ), defined as presence of maternal placental syndrome or\n                      <jats:styled-content style=\"fixed-case\">SGA<\/jats:styled-content>\n                      . We calculated hazard ratios to quantify the association between different components of\n                      <jats:styled-content style=\"fixed-case\">IFE<\/jats:styled-content>\n                      and 1\u2010year mortality and conducted a causal mediation analysis to assess\n                      <jats:styled-content style=\"fixed-case\">GA<\/jats:styled-content>\n                      at birth as a mediator. We identified 6863 infants with\n                      <jats:styled-content style=\"fixed-case\">CCHD<\/jats:styled-content>\n                      .\n                      <jats:styled-content style=\"fixed-case\">IFE<\/jats:styled-content>\n                      was present in 25.1%. Infants with\n                      <jats:styled-content style=\"fixed-case\">IFE<\/jats:styled-content>\n                      were more likely to die than infants without\n                      <jats:styled-content style=\"fixed-case\">IFE<\/jats:styled-content>\n                      (16.6% versus 11.1%; hazard ratios 1.55, 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      1.34\u20131.78). Only\n                      <jats:styled-content style=\"fixed-case\">SGA<\/jats:styled-content>\n                      (hazard ratios 1.76, 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      1.50\u20132.05) and placental abruption (hazard ratios 1.70, 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      1.17\u20132.48) were significantly associated with mortality; preeclampsia and gestational hypertension had no significant association with mortality. The mediation analysis showed that 32.8% (95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      24.9\u201347.0%) of the relationship between\n                      <jats:styled-content style=\"fixed-case\">IFE<\/jats:styled-content>\n                      and mortality is mediated through\n                      <jats:styled-content style=\"fixed-case\">GA<\/jats:styled-content>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      <jats:styled-content style=\"fixed-case\">IFE<\/jats:styled-content>\n                      is a significant contributor to outcomes in the\n                      <jats:styled-content style=\"fixed-case\">CCHD<\/jats:styled-content>\n                      population.\n                      <jats:styled-content style=\"fixed-case\">SGA<\/jats:styled-content>\n                      and placental abruption are the main drivers of postnatal mortality while other maternal placental syndrome components had much less of an impact. Only one third of the effect between\n                      <jats:styled-content style=\"fixed-case\">IFE<\/jats:styled-content>\n                      and mortality is mediated through\n                      <jats:styled-content style=\"fixed-case\">GA<\/jats:styled-content>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.119.013194","type":"journal-article","created":{"date-parts":[[2019,11,15]],"date-time":"2019-11-15T05:00:19Z","timestamp":1573794019000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":36,"title":["Impaired Fetal Environment and Gestational Age: What Is Driving Mortality in Neonates With Critical Congenital Heart Disease?"],"prefix":"10.1161","volume":"8","author":[{"given":"Martina A.","family":"Steurer","sequence":"first","affiliation":[{"name":"Department of Pediatrics University of California San Francisco San Francisco CA"},{"name":"Department of Epidemiology and Biostatistics University of California San Francisco San Francisco CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shabnam","family":"Peyvandi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of California San Francisco San Francisco CA"},{"name":"Department of Epidemiology and Biostatistics University of California San Francisco San Francisco CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca J.","family":"Baer","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of California San Diego La Jolla CA"},{"name":"Department of Obstetrics, Gynecology, and Reproductive Sciences University of California San Francisco San Francisco CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott P.","family":"Oltman","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics University of California San Francisco San Francisco CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina D.","family":"Chambers","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of California San Diego La Jolla CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary E.","family":"Norton","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproductive Sciences University of California San Francisco San Francisco CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelli K.","family":"Ryckman","sequence":"additional","affiliation":[{"name":"Department of Epidemiology College of Public Health University of Iowa Iowa City IA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita J.","family":"Moon\u2010Grady","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of California San Francisco San Francisco CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta L.","family":"Keller","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of California San Francisco San Francisco CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen C.","family":"Shiboski","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics University of California San Francisco San Francisco CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura L.","family":"Jelliffe\u2010Pawlowski","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics University of California San Francisco San Francisco CA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2017.07.001"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.005864"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2017-0999"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.009693"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.116.005213"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezy015"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)67726-4"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2012-302076"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa031884"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.12505"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)60074-4"},{"key":"e_1_3_1_13_2","volume-title":"International Classification of Diseases: ICD\u20109\u2010CM 2008","author":"American Medical Association","year":"2007","unstructured":"American Medical Association . 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