Maternal Socioeconomic Opportunity and Race‐Ethnicity Intersect to Influence Fetal Brain Volumes in Congenital Heart Disease

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Abstract
Background: Neurodevelopmental outcome disparities, partially linked to socioeconomic status, race‐ethnicity, persist in congenital heart disease (CHD). Fetal brain development is a key predictor of subsequent neurocognitive outcomes. Methods: Magnetic resonance imaging was performed on fetuses with and without complex CHD at 2 sites. Childhood Opportunity Index (COI) and maternal race‐ethnicity were used to assess neighborhood and individual‐level maternal social determinants of health, respectively. The contributions of COI and race‐ethnicity on fetal brain volume, controlling for fetal gestational age and sex, were compared using multivariable regression between both groups. Results: Among 168 fetuses in this analysis, 106 (63.10%) were from non‐Hispanic White mothers, 43 (25.60%) were from Hispanic mothers, and 19 (11.31%) were from non‐Hispanic Black mothers. Total brain volume in the group with CHD (n=49) was significantly associated with the interaction of maternal race‐ethnicity and the COI Social and Economic subdomain Score (β=−0.74, P P =0.04). Maternal race‐ethnicity, COI Social and Economic subdomain Score, and their interaction accounted for 30% of the variance in total fetal brain volume in the group with CHD, although the same effect was not noted in the control group. Conclusions: Results indicate that maternal COI likely modifies the relationship between maternal race‐ethnicity and fetal brain development in CHD. The impact of maternal race‐ethnicity and COI on brain development differs between fetuses with and without CHD. Addressing maternal social determinants of health could reduce disparities in neurodevelopmental outcomes in CHD. Although limitations in sample size temper conclusions, initial analysis suggests that maternal social determinants of health and environment can contribute to neurodevelopmental outcome variance in individuals with CHD.

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