Fetal somatic growth trajectory differs by type of congenital heart disease

Area of Science:

• Perinatology
• Fetal Medicine
• Cardiology

Background:

• Fetal growth trajectories for estimated fetal weight (EFW), head circumference (HC), and abdominal circumference (AC) in fetuses with congenital heart disease (CHD) are not well-defined across different cardiac lesions.
• Understanding these growth patterns is crucial for managing pregnancies complicated by fetal CHD.

Purpose of the Study:

• To investigate and describe the in utero growth trajectories of fetuses with different categories of CHD.
• To test the hypothesis that fetuses with CHD exhibit differential growth and that specific CHD categories have unique growth curves.

Main Methods:

• Retrospective observational cohort study of pregnancies with diagnosed fetal CHD between January 2000 and June 2013.
• Infants categorized into single ventricle (SV), biventricular conotruncal defects, d-transposition of great arteries (d-TGA), septal defects (SD), and other categories.
• Analysis of EFW and HC growth curves throughout gestation using z-scores.

Main Results:

• Significant differential EFW growth was observed in all CHD types except d-TGA, with initial low z-scores improving mid-gestation before diverging again.
• Single ventricle (SV) and septal defect (SD) groups showed significant, linearly progressing negative z-scores for HC growth starting early in gestation.
• Head circumference (HC) and abdominal circumference (AC) growth patterns differed across major CHD categories.

Conclusions:

• Fetal growth curves throughout gestation differ significantly among major congenital heart disease categories.
• Even "simple" conditions like septal defects (SD) demonstrate significant differential fetal growth.
• These findings highlight the importance of individualized fetal growth monitoring in pregnancies with CHD.