Neighborhood location and nutritional resources as a risk factor for congenital heart disease in the fetus

Abstract

BackgroundCongenital heart disease (CHD) is the most common birth defect, influenced by maternal health, environmental conditions, and genetics. Maternal health and nutrition, particularly maternal diabetes, is a modifiable risk factor for development of CHD in the fetus. However, the importance of food access during pregnancy on the development of CHD remains unknown. The objective of this study was to investigate the association between maternal neighborhood characteristics, particularly food access, and occurrence of prenatally diagnosed CHD.MethodsA retrospective case series studied maternal‐fetal dyads with prenatally diagnosed CHD between 2019 and 2021 in Washington, DC. Moran's I of maternal addresses evaluated geographic clustering of disease. Negative binomial regression assessed association between census tract demographics and population‐adjusted CHD rate.ResultsA total of 307 dyads were analyzed. Global Moran's I showed significant CHD clustering (p‐value = .004). However, degree of clustering was not clinically meaningful. After adjusting for neighborhood socioeconomic status, residing in food deserts was not a predictor for CHD. However, neighborhoods with a higher percentage of households receiving Supplemental Nutrition Assistance Program (SNAP) benefits were associated with higher rates of conotruncal heart defects (Incident Rate Ratio [IRR] = 1.04, CI = 1.01–1.08) and aggregate CHD (IRR = 1.03, CI = 1.01–1.05).ConclusionsNeighborhood location and food access were not associated with CHD. However, increased enrollment in SNAP was associated with higher rates of CHD. The association between CHD and SNAP benefits warrants further exploration. Understanding food access and maternal nutrition may illuminate disparities in the burden of CHD.

Effects of Sociodemographic Factors on Access to and Outcomes in Congenital Heart Disease in the United States

“…Across socioeconomic lines and divides, for example in urban or rural communities, food deserts exist leading to insufficient nutritional options for mothers, increased rates of obesity, poor diet, and gestational diabetes, among other health issues. Notwithstanding, maternal nutritional choices can be influenced by societal and cultural norms and, again, may be limited by economics and proximity or access to food, as previously stated [6]. As one study demonstrated, these so-called "social-environmental" characteristics that affect nutrition are ".…”

“…These disparities start with maternal health and lived experiences that often undermine children with CHDs well before they are born. Extensive literature has documented the impact of maternal health factors, environment, and education on the outcomes associated with CHDs [4][5][6]. These studies have, time and again, highlighted the profound implications these factors have for both the mother and the fetus.…”

“…. .known risk factors for maternal health conditions such as diabetes and obesity [6], " both of which are linked to the development of CHDs among fetuses and worse outcomes for both fetus and mother. Obesity and diabetes have been linked to adverse pregnancy outcomes, neonatal complications, and morbidity such as still birth, macrosomia, congenital malformations, and CHDs [9].…”