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Mid-gestation brain Doppler and head biometry in fetuses with congenital heart disease predict abnormal brain
N Masoller1, M Sanz-CortéS1, F Crispi1
1BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
Insights
Fetal brain Doppler and head measurements can predict abnormal brain development in fetuses with congenital heart disease (CHD). These findings may improve prenatal counseling and interventions for affected newborns.
Area of Science:
- Prenatal medicine
- Fetal neurology
- Cardiology
Background:
- Congenital heart disease (CHD) is associated with abnormal fetal brain development.
- This prenatal brain development may lead to adverse neurodevelopmental outcomes in childhood.
Purpose of the Study:
- To determine if fetal brain Doppler, head biometry, and CHD clinical type can predict prenatal brain development.
- To evaluate the association between these factors and abnormal brain development in fetuses with CHD.
Main Methods:
- Prospective cohort study of 58 fetuses with CHD and 58 controls.
- Measurements included fetal head circumference (HC), middle cerebral artery pulsatility index (MCA-PI), and cerebroplacental ratio (CPR) at diagnosis (20-24 weeks' gestation).
- Fetal MRI was performed at 36-38 weeks' gestation to assess brain development.
Main Results:
- MCA-PI, CPR, and HC were independent predictors of abnormal prenatal brain development.
- Abnormal brain development was defined by MRI findings including reduced brain volume or abnormal fissure depth.
- The clinical type of CHD did not predict abnormal brain development.
Conclusions:
- Fetal brain Doppler and head biometry are reliable predictors of abnormal brain development in fetuses with CHD.
- These measurements can be integrated into algorithms for improved prenatal counseling and targeted interventions.
- Early prediction allows for timely management strategies to mitigate neurodevelopmental risks.
Objectives:
Fetuses with congenital heart disease (CHD) show evidence of abnormal brain development before birth, which is thought to contribute to adverse neurodevelopment during childhood. Our aim was to evaluate whether brain development in late pregnancy can be predicted by fetal brain Doppler, head biometry and the clinical form of CHD at the time of diagnosis.
Methods:
This was a prospective cohort study including 58 fetuses with CHD, diagnosed at 20-24 weeks' gestation, and 58 normal control fetuses. At the time of diagnosis, we recorded fetal head circumference (HC), biparietal diameter, middle cerebral artery pulsatility index (MCA-PI), cerebroplacental ratio (CPR) and brain perfusion by fractional moving blood volume. We classified cases into one of two clinical types defined by the expected levels (high or low) of placental (well-oxygenated) blood perfusion, according to the anatomical defect. All fetuses underwent subsequent 3T-magnetic resonance imaging (MRI) at 36-38 weeks' gestation.
Results:
Abnormal prenatal brain development was defined by a composite score including any of the following findings on MRI: total brain volume < 10(th) centile, parietoccipital or cingulate fissure depth < 10(th) centile or abnormal metabolic profile in the frontal lobe. Logistic regression analysis demonstrated that MCA-PI (odds ratio (OR), 12.7; P = 0.01), CPR (OR, 8.7; P = 0.02) and HC (OR, 6.2; P = 0.02) were independent predictors of abnormal neurodevelopment; however, the clinical type of CHD was not.
Conclusions:
Fetal brain Doppler and head biometry at the time of CHD diagnosis are independent predictors of abnormal brain development at birth, and could be used in future algorithms to improve counseling and targeted interventions. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
