538 Placental dysfunction and congenital heart disease: investigating the placenta-heart axis

OBJECTIVE: Concurrent development of the placenta and heart during early gestation suggests a shared biological basis for the co-occurrence of abnormal placentation and congenital heart disease (CHD). This study investigated the association between placental vascular pathology and CHD type. METHODS: A retrospective study at two institutions included CHD (n = 521) and unaffected (n = 122) infants. CHDs were categorized into three groups (left and right ventricular outflow tract obstruction and mixed lesions) based on the anticipated effect of placental venous return streaming toward the fetal brain. Placental pathological findings were categorized by the Amsterdam criteria. The rate of placental pathology was compared between cases and controls and across the three CHD groups. RESULTS: CHD had higher rates of maternal vascular malperfusion (MVM) (0.31 vs. 0.05, p < 0.001). Comparison within CHD groups demonstrated similar rates of MVM, while fetal vascular malperfusion (FVM) was significantly higher in groups with reduced fetal cerebral oxygenation (p = 0.037). MVM was associated with low birth weight (OR = 0.28, p < 0.001), and FVM was associated with increased maternal age (OR = 1.07, p = 0.037). No significant associations were identified in other placental pathologies. CONCLUSION: This study offers valuable insights into the connection between placental dysfunction and CHD, identifying that MVM is significantly associated with CHD development.