{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T16:13:21Z","timestamp":1778602401988,"version":"3.51.4"},"reference-count":22,"publisher":"Walter de Gruyter GmbH","issue":"7","license":[{"start":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T00:00:00Z","timestamp":1754352000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"2024 OBGYN Resident Research Grant","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_jpm-2024-0627_abs_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To examine the association between rurality, major adverse cardiac events (MACE), adverse pregnancy outcomes (APO) and neonatal outcomes in pregnant women with CHD (congenital heart disease).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jpm-2024-0627_abs_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort study using the HCUP-NIS database (Healthcare Cost and Utilization Project-National Inpatient Sample) from 2016 to 2021 was conducted with pregnant CHD patients by location of residence (urban vs. rural). Primary outcomes were MACE, APO and neonatal outcomes. Multivariate logistic regression with survey procedures and weighted odds ratios was used to represent national estimates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jpm-2024-0627_abs_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The weighted sample represented 24,295 (n=4,859) patients, of which 20,840 (n=4168) were in urban setting and 3,455 (n=691) lived rurally. Only 27\u202f% (n=185\/691) of rural patients accessed care at a rural hospital. Rurality was associated with lower odds of APO (adjusted-OR 0.76; 95\u202f%-CI 0.63\u20130.91; p=0.003). Rural patients with complex CHD had the lowest odds of APO. There was no statistically significant difference, by rurality, in odds of MACE (adjusted-OR 1.17; 95\u202f%-CI 0.98\u20131.40; p=0.09) or neonatal outcomes (adjusted-OR 0.78; 95\u202f%-CI 0.59\u20131.03; p=0.082). There was no effect modification of rurality by CHD complexity on the association between rurality and MACE (p-value=0.66), APO (p-value=0.60) or neonatal outcomes (p-value=0.75).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jpm-2024-0627_abs_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this national cohort, pregnant patients with CHD living in rural areas had decreased odds of APO and no significant difference in MACE or neonatal complications. Notably, the majority of rural CHD patients received care in urban hospitals, suggesting referral patterns may mitigate outcome disparities. These findings highlight the need for further research on access, delivery of care, and outcomes for rural patients with CHD, and underscore the importance of ensuring multidisciplinary cardio-obstetric care across geographic settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/jpm-2024-0627","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T14:02:08Z","timestamp":1754316128000},"page":"900-907","source":"Crossref","is-referenced-by-count":0,"title":["Outcomes in pregnant patients with congenital heart disease by rurality"],"prefix":"10.1515","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9847-8181","authenticated-orcid":false,"given":"Mehr","family":"Jain","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology , 27337 The Ottawa Hospital , Ottawa , Canada"},{"name":"Harvard T.H. Chan School of Public Health , Boston , MA , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Franklin","family":"Iheanacho","sequence":"additional","affiliation":[{"name":"Warren Alpert Medical School of Brown University , Providence , RI , USA"},{"name":"Department of Medical Oncology , Dana Farber Cancer Institute , Boston , MA , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristen","family":"Sparagna","sequence":"additional","affiliation":[{"name":"Harvard T.H. Chan School of Public Health , Boston , MA , USA"},{"name":"Division of Hospital Medicine , University of Minnesota , Minneapolis , MN , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shimon","family":"Shaykevich","sequence":"additional","affiliation":[{"name":"Division of General Medicine and Primary Care , Brigham and Women\u2019s Hospital , Boston , MA , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Camilo E. Jaimes","family":"Cobos","sequence":"additional","affiliation":[{"name":"Harvard T.H. Chan School of Public Health , Boston , MA , USA"},{"name":"Department of Radiology , Massachusetts General-Brigham , Boston , MA , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernando Baraona","family":"Reyes","sequence":"additional","affiliation":[{"name":"Department of Cardiology , Boston Children\u2019s Hospital , Boston , MA , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael H.","family":"Dahan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , McGill University , Montreal , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria A.","family":"Pabon","sequence":"additional","affiliation":[{"name":"Harvard T.H. Chan School of Public Health , Boston , MA , USA"},{"name":"Cardiovascular Division , Brigham and Women\u2019s Hospital , Boston , MA , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2025,8,5]]},"reference":[{"key":"2026051215421225118_j_jpm-2024-0627_ref_001","doi-asserted-by":"crossref","unstructured":"Lima, FV, Yang, J, Xu, J, Stergiopoulos, K. National trends and in-hospital outcomes in pregnant women with heart disease in the United\u00a0States. Am J Cardiol 2017;119:1694\u2013700. https:\/\/doi.org\/10.1016\/j.amjcard.2017.02.003.","DOI":"10.1016\/j.amjcard.2017.02.003"},{"key":"2026051215421225118_j_jpm-2024-0627_ref_002","doi-asserted-by":"crossref","unstructured":"Karamlou, T, Diggs, BS, McCrindle, BW, Welke, KF. A growing problem: maternal death and peripartum complications are higher in women with grown-up congenital heart disease. 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