Determining associations between prenatal maternal mental health and social determinants of health with outcomes in children with critical CHD.

Abstract

Prenatal maternal mental health and social determinants of health may influence pregnancy, child hospitalisation, and child neurodevelopmental outcomes in critical congential heart disease (CHD). We examined 189 mother-child dyads of children born with CHD who underwent neonatal cardiac surgery and completed neurodevelopmental assessment between the ages 13 and 29 months. We used latent profile analysis to identify distinct maternal groups based on prenatal maternal mental health screening scores and individual- and neighbourhood-level social determinants of health factors. We examined the association between maternal groups with their child's gestational age, birth weight, hospital length of stay (HLOS), and neurodevelopment. Latent profile analysis identified two distinct groups: high-risk (n = 46) and low-risk (n = 143). Mothers in the high-risk group had higher mental health screening scores, lower age, higher social vulnerability, lower education, and were more likely to have Medicaid insurance and represent a minority group than mothers in the low-risk group. The high-risk group had children with lower gestational age and weight at birth, longer HLOS, and lower cognitive, language, and motor scales than children in the low-risk group (p < 0.05). Sensitivity analysis in mother-infant dyads without foetal extracardiac conditions found that significant relationships persisted in the high-risk group, with lower gestational age and lower language scale scores than the low-risk group (p < 0.05). Children of mothers with adverse prenatal maternal mental health and social determinants of health risks had significantly worse pregnancy and child outcomes. Interventions are critically needed to address maternal mental health and social determinants of health risks beginning in the prenatal period.