95 - Mortality Among Infants of Diabetic Mothers with Hypertrophic Cardiomyopathy

Poster Number: 95
Publication Number: 95.303

Elijah H. Bolin, University of Arkansas for Medical Sciences College of Medicine, Little rock, AR, United States; Beverly J. Spray, Arkansas Children's Hospital, North Little Rock, AR, United States; Peter M. Mourani, University of Arkansas for Medical Sciences, Little Rock, AR, United States; Craig Porter, University of Arkansas for Medical Sciences College of Medicine, little rock, AR, United States; Ronnie T. Collins, Stanford University School of Medicine, Palo Alto, CA, United States

Background: Infants of diabetic mothers (IDMs) suffer from higher perinatal mortality compared to children born to nondiabetic mothers. Hypertrophic cardiomyopathy (HCM) is often observed in newborn IDMs, although it is unclear if HCM contributes to higher risk of mortality.

Objective: We sought to determine if HCM is associated with mortality in the neonatal period by studying a large, multi-site contemporary cohort.

Design/Methods: We performed a retrospective cohort study of hospitalized IDMs admitted at ≤ 14-days-old in the Pediatric Health Information System (years 2004 – 2019). Multivariable logistic regression was used to evaluate the association between HCM and mortality; covariates in the model were prematurity, sex, and congenital malformations of the cardiovascular, nervous, urinary and musculoskeletal systems.

Results: Among 32,993 IDMs, there were 204 (0.6%) with HCM (Table 1). Black and Hispanic children were disproportionately represented among children with HCM compared to those without HCM (23.2% vs. 14.9%, p = 0.001 for Black, and 30.0% vs. 22.1%, p = 0.007 for Hispanic; Table 2). IDMs with HCM were also larger at birth (median birth weight 4120g [interquartile range 3600-4703] vs. 3280g [interquartile range 2540-3912]; p < 0.001). In-hospital mortality in patients with HCM was greater than in those without HCM (4.9% vs. 1.3%, p < 0.001), and odds of mortality were greater among those with HCM (adjusted odds ratio 2.10, 95% confidence interval: 1.04 – 4.25, p = 0.038; Table 3).Conclusion(s): In the largest study to date of IDMs with HCM, we identify HCM as a contributor to in-hospital mortality. These data reinforce the need both for better prevention of maternal diabetes and effective screening and therapies for HCM in IDMs.
Table 1. Demographic and Clinical Characteristics According to Presence of Hypertrophic Cardiomyopathy.a = Children coded as “Other” or “Unknown” not listed. b = Atrial septal defect, ventricular septal defect, and/or patent ductus arteriosus; HCM = hypertrophic cardiomyopathy, IQR = Interquartile Range
Table 2. Unadjusted Outcomes According to Presence of Hypertrophic Cardiomyopathy.HCM = hypertrophic cardiomyopathy, IQR = interquartile range