Placental vascular abnormality is associated with worse neurodevelopmental outcomes for infants with congenital heart disease and genetic abnormality

OBJECTIVE: Determine the association of placental vascular abnormality with neurodevelopment (ND) in toddlers with congenital heart disease (CHD) requiring intervention with cardiopulmonary bypass (CPB) in the first year of life. STUDY DESIGN: This single center retrospective cohort study included 69 singleton, term-born infants with prenatally diagnosed CHD requiring CPB in infancy who had placental pathology data and underwent ND follow-up assessment with the Bayley Scales of Infant and Toddler Development (Bayley). Infants with a clinically diagnosed genetic abnormality were included. Placental vascular abnormality was defined as maternal vascular malperfusion, fetal vascular malperfusion, or delayed villous maturation. Multivariable regression models were used to assess the association between placental vascular abnormality and Bayley scores. RESULTS: Placental vascular abnormality was present in 43 % (30/69) of the cohort and was associated with lower Bayley language and motor scores on univariate analysis. A significant interaction was identified between placental vascular abnormality and genetic abnormality, which occurred in 26 % (18/69) of the cohort. In multivariable models, compared to infants with genetic abnormality alone, infants with placental vascular abnormality and genetic abnormality had lower cognitive (group difference -18.4, 95 % CI -30.7, -6.1), language (group difference -27.5, 95 % CI -41.2, -13.9), and motor (group difference -27.6, 95 % CI -40.9, -14.2) composite scores. There was no association of placental vascular abnormality with ND scores for infants without genetic abnormality in multivariable models. CONCLUSION: Placental vascular abnormalities are associated with worse ND outcomes in infants with CHD when a genetic abnormality is also present.