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Recording available 2/16-5/2

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Poster Session 2

Category: Health Equity/Community Health

Poster Session 2

(498) Impact of Specialized Cardiac Care Proximity on Maternal and Neonatal Outcomes in Fetal Heart Disease

Wednesday, February 11, 2026

3:30 PM - 5:00 PM

Submitting Author and Presenting Author(s)

Guadalupe Martinez, BS, MPH

University of California, Los Angeles (UCLA)
Los Angeles, California, United States

Coauthor(s)

AD

Angela Desmond, MD

CHLA
Los Angeles, California, United States
AJ

Anthony Jusuf, MD

UCLA
Los Angeles, California, United States
KC

Kara Calkins, MD, MS

UCLA
Los Angeles, California, United States
Yalda Afshar, MD, PhD (she/her/hers)

David Geffen School of Medicine at University of California, Los Angeles (UCLA)
Los Angeles, California, United States

Objective:
To assess the association between proximity to a specialized cardiac care center and mode of birth, maternal and neonatal length of stay (LOS), and gestational age at birth with prenatally suspected fetal congenital heart disease (CHD), aiming to identify modifiable drivers of health outcomes (Fig 1).

Study Design:
Prospective cohort study of pregnant people and neonates in California with prenatally suspected and postnatally confirmed fetal CHD at a single institution (2018-2022). Residence zip codes were mapped; and census-tract social determinants were extracted using CalEnivoScreen. Subjects were grouped by travel time to birth hospital: < 30min, 30-90min, and > 90min. Pregnancies were risk- stratified by a delivery room coordination algorithm based on prenatal CHD diagnosis. Outcomes included mode of birth, maternal and neonatal LOS, and gestational age. Chi-square, ANOVA, and regression analyses compared outcomes by distance and cardiac severity.

Results:
Among 214 maternal-neonatal dyads, CHD severity was categorized as: 21% category 1, 51% category 2, 16% category 3, 10% category 4, and 2% unclassified. Thirteen percent lived < 30min, 66% lived 30-90-min, and 21% lived >90min from the hospital. Hispanic or Latino ethnicity was more prevalent among those living farther away (38% vs 11%, p=0.003). Public insurance was more common in the >90 min group (56% vs. 11% for < 30 min, p=0.00038) and was associated with a 22-day longer neonatal LOS (p< 0.001). Those farther from care were more likely to have the highest-risk CHD (20% vs. 7%, p=0.02). No significant differences were observed in planned (p=0.433) or actual (p=0.141) mode of birth by distance.

Conclusion:
Greater distance from specialized cardiac care centers and public insurance status are associated with higher-risk CHD and prolonged LOS, highlighting structural barriers that adversely impact outcomes. Addressing geographic and socioeconomic disparities is essential to improve equity and outcomes for this vulnerable population.