Key result
Maternal hyperoxygenation alters fetal cerebral and pulmonary flow in CHD, supporting physiological assessment rather than therapy.
Why the study?
Does maternal hyperoxygenation alter fetal hemodynamics in fetuses with congenital heart disease?
Meta-Analysis
Does maternal hyperoxygenation alter fetal hemodynamics in fetuses with congenital heart disease?
Maternal hyperoxygenation induces consistent cerebral Doppler changes and pulmonary flow adaptations in fetuses with CHD, supporting its role as a physiological assessment tool.
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Avoid therapeutic maternal hyperoxygenation in fetal CHD; confirms utility as physiological assessment tool.
OBJECTIVES: To evaluate the effects of maternal hyperoxygenation (MH) on fetal hemodynamic parameters assessed by ultrasound and fetal echocardiography in pregnancies complicated by congenital heart disease (CHD). METHODS: A systematic review and single-arm meta-analysis were conducted according to PRISMA guidelines and registered in PROSPERO (CRD420251274436). PubMed, EMBASE, and Cochrane Central were searched for studies evaluating fetal hemodynamic changes before and during MH in fetuses with prenatally diagnosed CHD. Continuous outcomes were pooled as mean changes using inverse-variance random-effects models. Risk of bias was assessed with ROBINS-I and Joanna Briggs Institute tools, and the certainty of evidence was graded using GRADE. Middle cerebral artery Z-score (MCA-Z) was defined as the standardized deviation of the Doppler pulsatility index from gestational age-adjusted reference values. Pulmonary velocity time integral (VTI) was measured by Doppler at the level of the fetal pulmonary artery to estimate pulmonary flow. RESULTS: Overall, MH was associated with reduced MCA-Z score and increased pulmonary VTI, indicating cerebral circulatory adaptation and augmented pulmonary flow parameters among the nine observational studies included. Substantial heterogeneity was observed, mainly related to study design, confounding, and variability in MH protocols and Doppler methods. CONCLUSIONS: In fetuses with CHD, MH is associated with consistent cerebral Doppler changes and selected pulmonary flow adaptations. These findings support MH primarily as a physiological assessment tool rather than a routine therapeutic intervention. Further standardized studies are needed to clarify its clinical relevance.
Martin et al. (2026) conducted a meta-analysis in Congenital heart disease (CHD). Maternal hyperoxygenation vs. Before maternal hyperoxygenation (baseline) was evaluated on Fetal hemodynamic parameters (Middle cerebral artery Z-score and Pulmonary velocity time integral). Maternal hyperoxygenation in fetuses with congenital heart disease was associated with reduced middle cerebral artery Z-score and increased pulmonary velocity time integral across 9 studies.
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