{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T17:36:19Z","timestamp":1779212179987,"version":"3.51.4"},"reference-count":43,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2024,4,2]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Studies show that an impaired maternal\u2013fetal environment (iMFE) increases the mortality risk in children with single\u2010ventricle congenital heart defects (CHDs). We investigated the impact of an iMFE on death in children with various surgically corrected CHDs.<\/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\">In this nationwide register\u2010based study, we examined the association between an iMFE (including preeclampsia, gestational hypertension, gestational diabetes, maternal smoking during pregnancy) and death in a large cohort of children with surgically corrected CHDs in Denmark (1994\u20132018). Survival analysis was done using Cox regression, adjusted for confounding and mediating covariates. The cohort included 3304 children: 1662 (50.3%) with minor CHD and 1642 (49.7%) with major CHD. Among them, 792 (24%) children were exposed to an iMFE. During the study, there were 290 deaths: 71 (9.3%) in children exposed to an iMFE and 219 (8.7%) in those unexposed.<\/jats:p>\n            <jats:p xml:lang=\"en\">\n              There were no differences in mortality risk between children with CHD exposed to an iMFE and those unexposed (hazard ratio [HR], 1.12 [95% CI, 0.86\u20131.47];\n              <jats:italic>P<\/jats:italic>\n              =0.4). This was consistent across subgroups, including minor CHD (HR, 0.76 [95% CI, 0.39\u20131.47];\n              <jats:italic>P<\/jats:italic>\n              =0.4), major CHD (HR, 1.23 [95% CI, 0.92\u20131.64];\n              <jats:italic>P<\/jats:italic>\n              =0.2), and hypoplastic left heart syndrome\/univentricular heart (HR, 1.08 [95% CI, 0.64\u20131.85];\n              <jats:italic>P<\/jats:italic>\n              =0.8).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Impairment of the maternal\u2013fetal environment did not impact the mortality rate in children with CHD undergoing operation in Denmark from 1994 to 2018. We believe the cause of these discrepant findings to previous studies may be due to differences in the composition of CHD and prenatal maternal health care and health status of the population.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.123.031575","type":"journal-article","created":{"date-parts":[[2024,3,27]],"date-time":"2024-03-27T12:03:50Z","timestamp":1711541030000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Impact of an Impaired Maternal\u2013Fetal Environment on Death in Children With Congenital Heart Defects Undergoing Surgery in Denmark From 1994 to 2018"],"prefix":"10.1161","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5283-6502","authenticated-orcid":false,"given":"Rasmus","family":"Kristensen","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery Copenhagen University Hospital \u2013 Rigshospitalet Denmark"},{"name":"Faculty of Health Sciences Copenhagen University Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9718-201X","authenticated-orcid":false,"given":"Camilla","family":"Omann","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine Aarhus University Denmark"},{"name":"Department of Cardiothoracic &amp; Vascular Surgery Aarhus University Hospital Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8337-5101","authenticated-orcid":false,"given":"Charlotte K.","family":"Ekelund","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences Copenhagen University Denmark"},{"name":"Department of Obstetrics, Center for Fetal Medicine Copenhagen University Hospital \u2013 Rigshospitalet Copenhagen Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7955-5604","authenticated-orcid":false,"given":"J. William","family":"Gaynor","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery Children\u2019s Hospital of Philadelphia PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8047-0015","authenticated-orcid":false,"given":"Vibeke E.","family":"Hjortdal","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery Copenhagen University Hospital \u2013 Rigshospitalet Denmark"},{"name":"Faculty of Health Sciences Copenhagen University Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.03.587"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-05-0456"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-021311"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.120.020299"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezy015"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.119.013194"},{"key":"e_1_3_1_8_2","first-page":"1","article-title":"Pre\u2010eclampsia is associated with increased neurodevelopmental disorders in children with congenital heart disease","volume":"2","author":"Omann C","year":"2022","unstructured":"Omann C, Nyboe C, Kristensen R, Ernst A, Ramlau\u2010Hansen CH, Rask C, Tabor A, Gaynor JW, Hjortdal VE. Pre\u2010eclampsia is associated with increased neurodevelopmental disorders in children with congenital heart disease. Eur Hear J Open. 2022;2:1\u201316.","journal-title":"Eur Hear J Open"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2023.1073046"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.2147\/CLEP.S91125"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/1403494811401482"},{"key":"e_1_3_1_12_2","first-page":"320","article-title":"The Danish medical birth registry","volume":"45","author":"Knudsen LB","year":"1998","unstructured":"Knudsen LB, Olsen J. The Danish medical birth registry. Dan Med Bull. 1998;45:320\u2013323.","journal-title":"Dan Med Bull"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-018-0356-1"},{"key":"e_1_3_1_14_2","unstructured":"Dansk Cytogenetisk Centralregister (DCCR). Accessed February 1 2023. https:\/\/www.fagperson.auh.dk\/afdelinger\/klinisk\u2010genetisk\u2010afdeling\/dccr\/"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.021793"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.002832"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1002\/uog.15961"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.019089"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000603"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.012033"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/hc3101.093968"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(02)01886-7"},{"key":"e_1_3_1_23_2","unstructured":"Nordic Health & Welfare Statistics. Updated February 6 2021. Accessed February 1 2023. https:\/\/nhwstat.org\/publications\/ncsp\u2010classification\u2010surgical\u2010procedures."},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.1067\/mtc.2002.119064"},{"key":"e_1_3_1_25_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.024600"},{"key":"e_1_3_1_26_2","unstructured":"The Danish Society of Obstetrics and Gynecology . DSOG \u2013 Preeclampsia and hypertension; 1\u201348. 2018. Accessed October 5 2022. https:\/\/www.dsog.dk\/obstetrik"},{"key":"e_1_3_1_27_2","unstructured":"The Danish Society of Obstetrics and Gynecology . Guideline on gestational diabetes mellitus. 2014. Accessed October 5 2022. https:\/\/www.dsog.dk\/obstetrik"},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.1177\/1403494811399958"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12581"},{"key":"e_1_3_1_30_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1651-2227.1996.tb14164.x"},{"key":"e_1_3_1_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2013.10.013"},{"key":"e_1_3_1_32_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001052"},{"key":"e_1_3_1_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jash.2008.08.001"},{"key":"e_1_3_1_34_2","unstructured":"Noncommunicable diseases data portal. World Health Organization. Accessed June 27 2023. https:\/\/ncdportal.org"},{"key":"e_1_3_1_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2021.109050"},{"key":"e_1_3_1_36_2","doi-asserted-by":"publisher","DOI":"10.1177\/1403494817736943"},{"key":"e_1_3_1_37_2","doi-asserted-by":"publisher","DOI":"10.1111\/ppe.12252"},{"key":"e_1_3_1_38_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.017465"},{"key":"e_1_3_1_39_2","unstructured":"Schramm S Hoffmann SH Jarlstrup NS Christensen AI. Danskernes rygevaner \u2013 \u00c5rsrapport 2017. Sundhedsstyrelsen. 2018. https:\/\/www.sst.dk\/\u2010\/media\/Udgivelser\/2018\/Danskernes\u2010rygevaner\u20102017\/Danskernes\u2010rygevaner\u2010\u2010\u2010\u00c5rsrapport\u20102017.ashx?sc_lang=da&hash=FC416497FC1F2B73557794E6BF543BD8"},{"key":"e_1_3_1_40_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2018.2009"},{"key":"e_1_3_1_41_2","unstructured":"Population Figures. Statistics Denmark. 2023. Accessed June 27 2023. https:\/\/www.dst.dk\/da\/Statistik\/emner\/borgere\/befolkning\/befolkningstal"},{"key":"e_1_3_1_42_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2022.06.036"},{"key":"e_1_3_1_43_2","first-page":"449","article-title":"Impact of a new national screening policy for Down's syndrome in Denmark: population based cohort study","volume":"338","author":"Ekelund CK","year":"2009","unstructured":"Ekelund CK, J\u00f8rgensen FS, Petersen OB, Sundberg K, Tabor A, Andersen HJ, Christensen J, Ersbak V, Farlie R, Henriques C, et\u00a0al. Impact of a new national screening policy for Down's syndrome in Denmark: population based cohort study. BMJ. 2009;338:449\u2013452.","journal-title":"BMJ"},{"key":"e_1_3_1_44_2","doi-asserted-by":"publisher","DOI":"10.2147\/CLEP.S15627"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.123.031575","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T12:37:21Z","timestamp":1715603841000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.123.031575"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,2]]},"references-count":43,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2024,4,2]]}},"alternative-id":["10.1161\/JAHA.123.031575"],"URL":"https:\/\/doi.org\/10.1161\/jaha.123.031575","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,2]]},"assertion":[{"value":"2023-07-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-28","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-03-27","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e031575"}}