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Mid‐gestational fetal placental blood flow is diminished in the fetus with congenital heart disease
Author(s) -
Ho Deborah Y.,
Josowitz Rebecca,
Katcoff Hannah,
Griffis Heather M.,
Tian Zhiyun,
Gaynor J. William,
Rychik Jack
Publication year - 2020
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.5791
Subject(s) - fetus , medicine , gestational age , fetal echocardiography , ventricle , tetralogy of fallot , heart disease , placenta , cardiology , obstetrics , pregnancy , prenatal diagnosis , biology , genetics
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.