{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T20:08:55Z","timestamp":1778098135338,"version":"3.51.4"},"reference-count":58,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2022,1,18]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>BACKGROUND<\/jats:title>\n            <jats:p xml:lang=\"en\">Children with single ventricle heart disease have significant morbidity and mortality. The maternal\u2013fetal environment (MFE) may adversely impact outcomes after neonatal cardiac surgery. We hypothesized that impaired MFE would be associated with an increased risk of death after stage 1 Norwood reconstruction.<\/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              We performed a retrospective cohort study of children with hypoplastic left heart syndrome (and anatomic variants) who underwent stage 1 Norwood reconstruction between 2008 and 2018. Impaired MFE was defined as maternal gestational hypertension, preeclampsia, gestational diabetes, and\/or smoking during pregnancy. Cox proportional hazards regression models were used to investigate the association between impaired MFE and death while adjusting for confounders. Hospital length of stay was assessed with the competing risk of in\u2010hospital death. In 273 children, the median age at stage 1 Norwood reconstruction was 4\u00a0days (interquartile range [IQR], 3\u20136 days). A total of 72 children (26%) were exposed to an impaired MFE; they had more preterm births (18% versus 7%) and a greater percentage with low birth weights &lt;2.5\u00a0kg (18% versus 4%) than those without impaired MFE. Impaired MFE was associated with a higher risk of death (hazard ratio [HR], 6.05; 95% CI, 3.59\u201310.21;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) after adjusting for age at surgery, Hispanic ethnicity, genetic syndrome, cardiac diagnosis, surgeon, and birth era. Children with impaired MFE had almost double the risk of prolonged hospital stay (HR, 1.95; 95% CI, 1.41\u20132.70;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>CONCLUSIONS<\/jats:title>\n            <jats:p xml:lang=\"en\">Children exposed to an impaired MFE had a higher risk of death following stage 1 Norwood reconstruction. Prenatal exposures are potentially modifiable factors that can be targeted to improve outcomes after pediatric cardiac surgery.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.020299","type":"journal-article","created":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T14:07:00Z","timestamp":1641910020000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":26,"title":["Impact of Maternal\u2013Fetal Environment on Mortality in Children With Single Ventricle Heart Disease"],"prefix":"10.1161","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5639-9119","authenticated-orcid":false,"given":"Jill J.","family":"Savla","sequence":"first","affiliation":[{"name":"Division of Cardiology Department of Pediatrics, Children\u2019s Hospital of Philadelphia and Perelman School of Medicine University of Pennsylvania Philadelphia PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary E.","family":"Putt","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology, and Informatics Perelman School of Medicine University of Pennsylvania Philadelphia PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology, and Informatics Perelman School of Medicine University of Pennsylvania Philadelphia PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel","family":"Parry","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Perelman School of Medicine University of Pennsylvania Philadelphia PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julie S.","family":"Moldenhauer","sequence":"additional","affiliation":[{"name":"Center for Fetal Diagnosis and Treatment Children\u2019s Hospital of Philadelphia and Perelman School of Medicine University of Pennsylvania Philadelphia PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samantha","family":"Reilly","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Pediatrics, Children\u2019s Hospital of Philadelphia and Perelman School of Medicine University of Pennsylvania Philadelphia PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivia","family":"Youman","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Pediatrics, Children\u2019s Hospital of Philadelphia and Perelman School of Medicine University of Pennsylvania Philadelphia PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8625-6565","authenticated-orcid":false,"given":"Jack","family":"Rychik","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Pediatrics, Children\u2019s Hospital of Philadelphia and Perelman School of Medicine University of Pennsylvania Philadelphia PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2170-5942","authenticated-orcid":false,"given":"Laura","family":"Mercer\u2010Rosa","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Pediatrics, Children\u2019s Hospital of Philadelphia and Perelman School of Medicine University of Pennsylvania Philadelphia PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. 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