Racial Disparities in Birth and Lactation Outcomes Among Neonates with Congenital Heart Defects at a Regional Mid-Atlantic Heart Center.

BACKGROUND

Evidence regarding ways in which systemic racism impacts birth and lactation among neonates with congenital heart defects (CHD) is limited. Thus, we sought to examine racial disparities among a cohort of neonates with CHD by exploring associations between birth and lactation outcomes and individual and community-level indicators of systemic racism.

METHODS

This was a post hoc analysis of retrospective electronic health record (EHR) data from hospitalized neonates who had cardiac surgery and resided in the same county as the pediatric hospital (n = 20; 2016-2020). Associations between primary outcomes (birth weight and weight-for-age z-score, and 28-day total parental milk and overall human milk percentage) and systemic racism indicators (neonate's EHR documented race and zip code-derived index scores for community-level food insecurity and health inequity) were analyzed with multivariable regression models.

RESULTS

Compared to White neonates (n = 13), Black or biracial neonates (n = 5) had lower parental milk (β = - 59.4, p = 0.003) and human milk (β = - 62.1, p < 0.001) percentages. Higher community-level food insecurity index scores were associated with lower birth weight (β = - 104 g, p = 0.014), birth weight-for-age z-scores (β = - 0.195, p = 0.026), and human milk percentage (p = 0.003), whereas higher health inequity index scores were associated with lower parental milk (β = - 8.5, p = 0.03) and human milk (β = - 10.2, p < 0.001) percentages.

CONCLUSIONS

Significant racial inequities in birth and lactation outcomes may exist for neonates with CHD. More research is needed to identify structural barriers within pediatric cardiac care and develop interventions to mitigate these disparities.