Mid‐gestational fetal placental blood flow is diminished in the fetus with congenital heart disease

Abstract

Objective: Data suggest fetuses with congenital heart disease (CHD) have placental abnormalities. Their abnormal placental vasculature may affect fetal placental blood flow, which has not previously been explored. Method: We performed a retrospective cross-sectional study comparing umbilical venous volume flow (UVVF) of single ventricle, D-transposition of the great arteries, and tetralogy of Fallot fetuses with fetuses without CHD. UVVF and combined cardiac output (CCO) were calculated from fetal echocardiography and compared using t tests, χ 2 and Fisher's exact tests. Results: Mean gestational age and fetal weight were greater in CHD fetuses (26.5 weeks, 1119.4 g; n = 81, P < .001) compared to controls (23.1 weeks, 675 g; n = 170, P < .001). UVVF/fetal weight was nevertheless decreased among cases (99.8 vs 115.3 mL/min/kg, P < .001). Subgroup analysis of 20-to 25-week fetuses demonstrated no significant differences in case and control baseline characteristics. In CHD fetuses (n = 31) compared to controls (n = 144), absolute UVVF (50.8 vs 62.1 mL/min, P = .006), and UVVF/fetal weight (98.8 vs 118.5 mL/min/kg, P < .001) were decreased. Findings were similar in single ventricle (n = 24) and hypoplastic left heart syndrome (n = 14). Conclusion: Mid-gestational placental blood flow in CHD fetuses is decreased compared to controls. Further study is needed to explore the relationship between UVVF and placental pathology, and impact on outcomes.

Model‐Informed Vancomycin Dosing Optimization to Address Delayed Renal Maturation in Infants and Young Children with Critical Congenital Heart Disease

“…12,13 Although the etiology of CCHD in children is poorly understood, abnormal circulatory physiology in fetuses with CCHD may contribute to poor growth and preterm labor. 14,15 Children with CCHD often require multiple staged surgeries depending on the disease condition and age. After cardiac surgery, these patients are at high risk for acute kidney injury resulting from various factors, such as low cardiac output syndrome, venous congestion, and reduced renal blood flow.…”

“…Neonates with CCHD have a higher risk of low birth weight, premature birth, and low body weight at gestational age 12,13 . Although the etiology of CCHD in children is poorly understood, abnormal circulatory physiology in fetuses with CCHD may contribute to poor growth and preterm labor 14,15 …”

Double Jeopardy: Prematurity and Congenital Heart Disease—What's Known and Why It's Important

“…20 Compared to healthy controls, fetal placental blood flow may be diminished in those with CHD, perhaps due to impaired angiogenesis. 21 Researchers are seeking to untangle the complex relationships that contribute to an adverse “maternal-fetal environment” that is present in approximately one quarter of fetal maternal dyads when CHD is present. These include maternal-placental factors such as gestational hypertension, preeclampsia, and placental abruption, and fetal factors such as in utero growth restriction and gestational age at birth.…”

Evaluation of umbilical venous flow volume measured using ultrasound compared to circuit flow volume in the EXTra‐uterine Environment for Neonatal Development (EXTEND) system in fetal sheep

“…Examples of conditions where it may be of great value include through gauging alterations in UVFV in fetal growth restriction and other at-risk pregnancies, 17 or in predicting development, or measuring efficacy of treatment response, to laser therapy in twin-twin transfusion syndrome. 18 Placental pathology and dysfunction is now well recognized in association with congenital heart disease 19,20 and alterations in UVFV may be associated with outcomes, 21 making it a potentially useful tool to incorporate into the prenatal ultrasound assessments.…”