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OBJECTIVE: To determine whether nativity is associated with abdominal wall defects among births to Mexican-American women. STUDY DESIGN: Using a cross-sectional, population-based design, stratified and multivariable logistic regression analyses were performed on the 2014-2017 National Center for Health Statistics live-birth cohort dataset of infants of US-born (n = 1 398 719) and foreign-born (n = 1 221 411) Mexican-American women. RESULTS: The incidence of gastroschisis was greater among births to US-born compared with Mexico-born Mexican-American women: 36.7/100 000 vs 15.5/100 000, RR = 2.4 (2.0, 2.9). US-born (compared with Mexico-born) Mexican-American mothers had a greater percentage of teens and cigarette smokers, P < .0001. In both subgroups, gastroschisis rates were greatest among teens and decreased with advancing maternal age. Adjusting for maternal age, parity, education, cigarette smoking, pre-pregnancy body mass index, prenatal care usage, and infant sex), OR of gastroschisis for US-born (compared with Mexico-born) Mexican-American women was 1.7 (95% CI 1.4-2.0). The population attributable risk of maternal birth in the US for gastroschisis equaled 43%. The incidence of omphalocele did not vary by maternal nativity. CONCLUSIONS: Mexican-American women's birth in the US vs Mexico is an independent risk factor for gastroschisis but not omphalocele. Moreover, a substantial proportion of gastroschisis lesions among Mexican-American infants is attributable to factors closely related to their mother's nativity.

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OBJECTIVE: To determine the whether a greater percentage of deaths of infants born at term among US-born (vs foreign-born) women is attributable to paternal nonacknowledgement. STUDY DESIGN: Using a cross-sectional population-based design, stratified and multivariable binomial regression analyses were performed on a subset of the 2017 National Center for Health Statistics linked live birth-infant death cohort dataset of singleton infants born at term (37-42 weeks) of US-born (N = 2 127 243) and foreign-born (N = 334 664) women. RESULTS: Infants of US-born women had a prevalence of paternal nonacknowledgement of 11.3% vs 7.5% for foreign-born women, P < .001. The infant mortality rate of term births to US-born women with paternal nonacknowledgment equaled 5.0/1000 vs 2.0/1000 for those with paternal acknowledgment; relative risk (RR) = 2.47 (2.31, 2.86). The infant mortality rate of term births to foreign-born women with paternal nonacknowledgment equaled 2.5/1000 vs 1.6/1000 for those with paternal acknowledgment, RR = 1.61 (1.24, 2.10). The adjusted (controlling for selected covariates) RR of first-year mortality of term births among US-born and foreign-born women with nonacknowledged (vs acknowledged) fathers equaled 1.43 (1.33, 1.54) and 1.38 (1.04, 1.84), respectively. The population-attributable risk percent of deaths in infants born at term for paternal nonacknowledgement among US-born and foreign-born women equaled 4.9% (246 deaths) and 2.8% (15 deaths), respectively. CONCLUSIONS: Paternal nonacknowledgement is associated with a 40% greater infant mortality rate among term births to US-born and foreign-born women; however, a greater proportion of first-year deaths among term births to US-born (vs foreign-born) women is attributable to paternal nonacknowledgment. These findings highlight the importance of a father's involvement in the outcomes of infants born at term.

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OBJECTIVE: To determine whether differential exposure to an adverse maternal fetal environment partially explains disparate outcomes in infants with major congenital heart disease (CHD). STUDY DESIGN: Retrospective cohort study utilizing a population-based administrative California database (2011-2017). Primary exposure: Race/ethnicity. Primary mediator: Adverse maternal fetal environment (evidence of maternal metabolic syndrome and/or maternal placental syndrome). OUTCOMES: Composite of 1-year mortality or severe morbidity and days alive out of hospital in the first year of life (DAOOH). Mediation analyses determined the percent contributions of mediators on pathways between race/ethnicity and outcomes after adjusting for CHD severity. RESULTS: Included were 2747 non-Hispanic White infants (reference group), 5244 Hispanic, and 625 non-Hispanic Black infants. Hispanic and non-Hispanic Black infants had a higher risk for composite outcome (crude OR: 1.18; crude OR: 1.25, respectively) and fewer DAOOH (-6 & -12 days, respectively). Compared with the reference group, Hispanic infants had higher maternal metabolic syndrome exposure (43% vs 28%, OR: 1.89), and non-Hispanic Black infants had higher maternal metabolic syndrome (44% vs 28%; OR: 1.97) and maternal placental syndrome exposure (18% vs 12%; OR, 1.66). Both maternal metabolic syndrome exposure (OR: 1.21) and maternal placental syndrome exposure (OR: 1.56) were related to composite outcome and fewer DAOOH (-25 & -16 days, respectively). Adverse maternal fetal environment explained 25% of the disparate relationship between non-Hispanic Black race and composite outcome and 18% of the disparate relationship between Hispanic ethnicity and composite outcome. Adverse maternal fetal environment explained 16% (non-Hispanic Black race) and 21% (Hispanic ethnicity) of the association with DAOOH. CONCLUSIONS: Increased exposure to adverse maternal fetal environment contributes to racial and ethnic disparities in major CHD outcomes.

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OBJECTIVE: To determine the importance of infant factors, maternal prenatal care use, and demographic characteristics in explaining the racial disparity in infant (age <365 days) mortality due to congenital heart defects (CHD). STUDY DESIGN: In this cross-sectional population-based study, stratified and multivariable logistic regression analyses were performed on the 2003-2004 National Center for Health Statistics linked live birth-infant death cohort files of term infants with non-Hispanic white (n = 3 684 569) and African-American (n = 782 452) US-born mothers. Infant mortality rate, including its neonatal (<28 day) and postneonatal (28-364 day) components, due to CHD was the outcome measured. RESULTS: The infant mortality rate due to CHD for African-American infants (296 deaths; 3.78 per 10 000 live births) exceeded that of white infants (1025 deaths; 2.78 per 10 000 live births) (relative risk [RR], 1.36; 95% CI, 1.20-1.55). The racial disparity was wider in the postneonatal period (2.08 per 10 000 vs 1.42 per 10 000; RR, 1.53; 95% CI, 1.29-1.83) compared with the neonatal period (1.70 per 10 000 vs 1.44 per 10 000; RR, 1.20; 95% CI, 0.99-1.45). Compared with white mothers, African-American mothers had a higher percentage of high-risk characteristics. In multivariable logistic regression models, the adjusted OR of postneonatal and neonatal mortality due to CHD for African-American mothers compared with white mothers was 1.20 (95% CI, 0.98-1.48) and 0.95 (95% CI, 0.77-1.19), respectively. CONCLUSION: The racial disparity in infant mortality rate due to CHD among term infants with US-born mothers is driven predominately by the postneonatal survival disadvantage of African-American infants. Commonly cited individual-level risk factors partly explain this phenomenon. The study is limited by the lack of information on neighborhood factors.

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BACKGROUND: US-born Mexican American women have greater rates of preterm birth and consequent overall infant mortality than their Mexico-born peers. However, the relation of Mexican American women's nativity to rates of congenital anomalies is poorly understood. Hispanic ethnicity and young maternal age are well-known risk factors for gastroschisis. OBJECTIVE: To determine the extent to which nativity of Mexican American women is associated with abdominal wall defects. METHODS: Stratified and multivariable logistic regression analyses were performed on the 2003-2004 National Center for Health Statistics linked live birth-infant death cohort. Only Mexican American infants were studied. Maternal variables examined included nativity, age, education, marital status, parity, and prenatal care usage. RESULTS: Infants with US-born Mexican American mothers (n=451,272) had an abdominal wall defect rate of 3.9/10,000 compared with 2.0/10,000 for those with Mexico-born mothers (n=786,878), RR=1.9 (1.5-2.4). Though a greater percentage of US-born (compared wtih Mexico-born) Mexican American mothers were teens, the nativity disparity was actually widest among women in their 20s. The adjusted (controlling for maternal age, education, marital status, parity, and prenatal care) odds ratio of abdominal wall defects among infants of US-born (compared with Mexico-born) Mexican American mothers was 1.6 (1.2-2.0). CONCLUSIONS: US-born Mexican American women have nearly a two-fold greater rate of delivering an infant with an abdominal wall defect than their Mexico-born counterparts. This phenomenon is only partially explained by traditional risk factors and highlights a detrimental impact of lifelong residence in the United States, or something closely related to it, on the pregnancy outcome of Mexican American women.

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OBJECTIVES: To describe the use of extracorporeal membrane oxygenation (ECMO) in patients with trisomy 21 (T21), to identify risk factors for hospital mortality, and to compare outcomes with those of patients without T21. STUDY DESIGN: Children under age 18 years registered in the Extracorporeal Life Support Organization Registry were included. Comparisons between patients with T21 and patients without T21 were performed using the χ(2) or Wilcoxon rank-sum test and multivariable logistic regression. RESULTS: The study cohort included 623 patients with T21 and 46 239 patients without T21. The prevalence of T21 was 13.5/1000 patients receiving ECMO. ECMO utilization in patients with T21 increased over time, with 60% of cases occurring in the last decade. There was no significant difference in survival between patients without T21 and those with T21 (63% vs 57%; P = .23). In patients with T21, independent risk factors for mortality before cannulation were a cardiac indication for ECMO support and milrinone use (P ≤ .001 for both). Multivariable risk factors for mortality on ECMO included hemorrhagic, neurologic, renal, and pulmonary complications (P < .04 for all). CONCLUSION: The use of ECMO in patients with T21 has increased over time. Patients with a cardiac indication for ECMO have higher mortality compared with those supported for respiratory indications. Despite differences in indications for ECMO, patients with T21 have similar hospital survival as those without T21; thus, by itself, a diagnosis of T21 should not be considered a risk factor for in-hospital mortality when contemplating ECMO cannulation.

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To determine whether maternal nativity (US-born versus foreign-born) is associated with the first year mortality rates of term births. Stratified and multivariable binomial regression analyses were performed on the 2003-2004 National Center for Health Statistics linked live birth-infant death cohort files. Only term (37-42 weeks) infants with non-Latina White, African-American, and Mexican-American mothers were studied. The infant mortality rate (<365 days, IMR) of births to US-born non-Latina White mothers (n = 3,684,569) exceeded that of births to foreign-born White mothers (n = 226,621): 2.4/1,000 versus 1.3/1,000, respectively; relative risk (RR) = 1.8 [95 % confidence interval (CI) 1.6-2.0]. The IMR of births to US-born African-American mothers (n = 787,452) exceeded that of births to foreign-born African-American mothers (n = 118,246): 4.1/1,000 versus 2.2/1,000, respectively; RR = 1.8 (1.6-2.1). The IMR of births to US-born Mexican-American mothers (n = 338,337) exceeded that of births to Mexican-born mothers (n = 719,837): 2.4/1,000 versus 1.8/1,000, respectively; RR = 1.3 (1.2-1.4). These disparities were not limited to a singular cause of death and were widest among deaths due to Sudden Infant Death Syndrome. In multivariable binomial regression models, the adjusted RR of infant mortality for non-LBW, term births to US-born (compared to foreign-born) for White, African-American, and Mexican-American mothers equaled 1.5 (1.3-1.7), 1.7 (1.5-2.1) and 1.6 (1.4-1.8), respectively. The IMR of term births to White, African-American, and Mexican-American mothers exceeds that of their counterparts with foreign-born mothers independent of traditional individual level risk factors.

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To determine the age-related patterns of low birth weight, preterm birth, and intrauterine growth retardation among first generation and established US-born Mexican-American mothers. We performed stratified analyses on an Illinois transgenerational dataset of Mexican-American infants (1989-1991) and their mothers (1956-1976) with appended U.S. census income information. In Cook County, Illinois established (second or higher generation) US-born Mexican-American women (N = 2,006) had a low birth weight (<2,500 g) rate of 6.2% compared to 4.8% for first generation US-born Mexican-American women (N = 1,450), RR = 1.3 (1.0-1.6). In both subgroups, low birth weight, preterm, and intrauterine growth retarded components rates did not increase with advancing maternal age. First generation 30-35 year old US-born Mexican-American women (N = 159) had a low birth weight rate of 3.1% compared to 4.2% for their teen counterparts (N = 386), RR = 0.8 (0.3-2.0). Established 30-35 year old US-born Mexican-American women (N = 330) had a low birth weight rate of 4.9% compared to 7.4% for their teen counterparts (N = 459), RR = 0.7 (0.4-1.2). There was no evidence of weathering among US-born Mexican-American mothers with a lifelong residence in lower income neighborhoods, with a general downward trend in low birth weight rates with increasing age until age 30-35. Rates of low birth weight, preterm birth, and intrauterine growth retardation do not increase with advancing age among first generation and established US-born 15-35 year old Mexican-American women. This trend persists among both generations of women with a lifelong residence in lower income neighborhoods.

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OBJECTIVE: To explore the intergenerational birth-weight patterns of the direct female descendants of Mexican-American women. DESIGN: This is a population-based study. METHODS: Stratified analyses were performed on a transgenerational dataset of 1956-1975 and 1989-1991 Illinois computerized vital records of Mexican-American infants. RESULTS: Among the descendants of generation 1 US-born Mexican-American women (n=1,940), generation 3 females had a birth weight equivalent to that of their generation 2 mothers, (3294 g vs 3283 g); generation 3 infants with unmarried mothers had a birth weight 121 g less than that of generation 2 infants born to unmarried mothers (3163 g vs 3284 g, P<.01); and generation 3 female infants born to teenaged women had a birth weight 70 g less than that of their generation 2 mothers who were born to teenaged women (3178 g vs 3248 g, P<.01). Among the descendants of generation 1 Mexican-born women (n=1,017), generation 3 females had a birth weight equivalent to that of their generation 2 mothers (3335 g vs 3363 g); generation 3 infants with teenaged mothers had a birth weight 108 g less than that of generation 2 infants with teenaged mothers (3264 g vs 3372 g, P<.01). CONCLUSIONS: An intergenerational rise in birth weight does not occur among the direct female descendants of Mexican-American women.

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OBJECTIVE: To determine whether duration of generational residence in the United States is associated with the pregnancy outcome of Mexican Americans. DESIGN: This is a population-based study. METHODS: Stratified analyses were performed on a data set of 1989-1991 Illinois computerized vital records of Mexican-American infants. RESULTS: First generation (N=2,203) and second or higher (N=4,192) US-born Mexican-American women had infant low birth-weight rates of 7.5% and 6.1%, respectively, compared to 5.1% for Mexican-born women (N=39,050); relative risk=1.4 (1.2-1.7) and 1.2 (1.1-1.4), respectively. Among women with one or more high-risk sociodemographic characteristics (age less than 20 years, educational attainment less than 12 years, unmarried, high parity, or inadequate prenatal care), first generation (N=1,624) and second or higher generation (N=2,874) US-born Mexican-American women had infant low birth-weight rates of 8.3% and 6.5%, respectively, vs 5.2% for Mexican-born women (N=33,625); relative risk = 1.6 (95% confidence interval [CI], 1.3-1.9) and 1.2 (95% CI, 1.0-1.4), respectively. Among women with the lowest sociodemographic risk profile, infant low birthweight rates did not vary between the subgroups. CONCLUSIONS: For second or higher generation US-born Mexican-American women, the rate of infant low birth weight does not exceed that of first generation US-born women; it actually approximates that of Mexican-born women across a broad range of sociodemographic characteristics.

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