Congenital Heart Disease Fetuses Have Decreased Mid-Gestational Placental Flow, Placental Malperfusion Defects, and Impaired Growth

Figures

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  Figure 1. Umbilical Venous Volume Flow/Wt Throughout Gestation in Congenital Heart Disease Fetuses UVVF/Wt (ml/min/kg) was measured from serial fetal echocardiograms across gestational age (GA) in CHD fetuses. 95% (p95), 50% (p50), and 5% (p5) are represented by solid lines using a quantile regression with linear and quadratic terms. p5 = 9.35∗GA - 0.20∗GA2 - 44.54. p50 = 14.68∗GA – 0.27∗GA2 - 100.97. p95 = 6.14∗GA – 0.15∗GA2 +83.73. Gray shading represents 95% confidence interval of the p50. Gray dashed lines represent the previously published 5% (p5 [ref]), 50% (p50 [ref]), and 95% (p95 [ref]) regression model of UVVF/Wt over gestation in healthy fetuses.23 Average UVVF/Wt for cases was decreased compared to the reference 50th percentile for healthy fetuses in the 2nd trimester, however continued to trend slightly lower than normal in later gestation. CHD = congenital heart disease; UVVF = umbilical venous volume flow.

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  Figure 2. Impaired Fetal Growth in Congenital Heart Disease Occurs Exclusively With Maternal Vascular Malperfusion Lesions (A) CHD fetuses but not controls demonstrate significantly decreased birth weight (3,480 g vs 3,130 g; P = 0.04) in the presence of PMP lesions. Decreased birth weight in CHD fetuses is seen only in the presence of MVM lesions (3,340 g vs 2,905 g; P < 0.001) (B), and not FVM lesions (3,140 g vs 3,160 g; P = 0.7) (C). FVM = fetal vascular malperfusion; MVM = maternal vascular malperfusion; PMP = placental malperfusion; other abbreviation as in Figure 1.

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  Central Illustration. Placental Malperfusion in Fetal Congenital Heart Disease Fetuses with CHD have decreased blood flow from the placenta to fetus through the umbilical vein, as measured in second trimester fetal echocardiograms by umbilical venous volume flow. In the setting of unchanged cardiac output, decreased umbilical flow is suggestive of increased placental resistance. These fetuses have a higher incidence of placental malperfusion lesions at birth. Placental maternal vascular malperfusion lesions, in particular, are associated with decreased fetal growth in CHD. Abbreviation as in Figure 1.