Related Experiment Video
Updated: Dec 15, 2025
Fetal Echocardiography and Pulsed-wave Doppler Ultrasound in a Rabbit Model of Intrauterine Growth Restriction
Published on: June 29, 2013
Fetal Umbilical Arterial Pulsatility Correlates With 2-Year Growth and Neurodevelopmental Outcomes in Congenital
Jayani B Abeysekera1, Dora L Gyenes1, Joseph Atallah2
1Fetal & Neonatal Cardiology Program, University of Alberta, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Insights
In fetal transposition of the great arteries (d-TGA) and hypoplastic left heart syndrome (HLHS), elevated umbilical artery pulsatility index (UA-PI) in the third trimester is linked to poorer 2-year growth and neurodevelopmental outcomes. Middle cerebral artery pulsatility index (MCA-PI) did not show a significant correlation.
Area of Science:
- Perinatal medicine
- Pediatric cardiology
- Neurodevelopmental pediatrics
Background:
- Congenital heart disease (CHD) poses risks for long-term neurodevelopmental issues in children, potentially due to prenatal factors.
- Placental pathology and brain-sparing effects (altered fetal middle cerebral artery flow) are observed in fetuses with CHD.
- This study examines the link between fetal arterial flow patterns and neurodevelopmental outcomes in specific CHD types.
Purpose of the Study:
- To investigate the association between umbilical artery (UA) and middle cerebral artery (MCA) pulsatility indices (PIs) in fetuses with d-TGA and HLHS.
- To determine the relationship between these flow patterns and growth and neurodevelopmental outcomes at 2 years of age.
Main Methods:
- Retrospective analysis of third-trimester fetal echocardiograms in children with d-TGA and HLHS (2004-2014).
- Measurement of UA and MCA pulsatility indices (PIs).
- Assessment of 2-year growth (head circumference z-score) and neurodevelopmental outcomes (Bayley III scores).
Main Results:
- In multivariate analysis, higher UA-PI was significantly associated with reduced length, weight, and cognitive scores at 2 years.
- No statistically significant correlation was found between MCA-PI and the measured growth or neurodevelopmental outcomes.
- Children with d-TGA and HLHS showed specific growth and neurodevelopmental score ranges at 2-year follow-up.
Conclusions:
- Elevated third-trimester UA-PI, indicative of placental insufficiency, is associated with adverse 2-year growth and neurodevelopmental outcomes in fetal d-TGA and HLHS.
- MCA-PI was not found to be a significant predictor of these outcomes in this cohort.
- UA-PI may serve as a potential marker for monitoring fetal well-being and predicting neurodevelopmental trajectories in CHD.
Background:
Children with congenital heart disease (CHD) are at risk of adverse long-term neurodevelopmental outcomes, believed to be, in part, secondary to prenatal insults. Placental pathology and altered fetal middle cerebral arterial (MCA) flow suggestive of brain sparing have been documented in fetal CHD. In the present study we investigated the relationship between MCA and umbilical arterial (UA) flow patterns in fetal transposition of the great arteries (d-TGA) and hypoplastic left heart syndrome (HLHS) and growth and 2-year neurodevelopmental outcomes.
Methods:
We included children with d-TGA and HLHS who had third-trimester fetal echocardiograms between 2004 and 2014, at which time umbilical artery (UA) and MCA pulsatility indices (PIs) were measured, and who underwent 2-year growth and neurodevelopmental assessments.
Results:
We identified 24 children with d-TGA and 36 with HLHS. Mean age at fetal echocardiography was 33.8 ± 3.5 weeks. At 2-year follow-up, head circumference z score (standard deviation [SD]) was -0.09 (1.07) and 0.17 (1.7) for the d-TGA and HLHS groups, respectively. Bayley III mean (SD) cognitive, language, and motor scores were 97.7 (10.8), 94.7 (13.4), and 98.6 (8.6) for the d-TGA group and 90.3 (13.9), 87.2 (17.5), and 85.3 (16.2) for the HLHS group. On multivariate linear regression analysis, UA-PI was associated (effect sizes [95% CI]) with length (-1.45 [-2.7, -0.17], P = 0.027), weight (-1.46 [-2.6 to -0.30], P = 0.015) and cognitive scores (-14.86 [-29.95 to 0.23], P = 0.05) at 2 years of age. MCA PI showed no statistically significant correlation.
Conclusions:
In fetal d-TGA and HLHS, a higher UA-PI in the third trimester, suggestive of placental insufficiency-but not MCA-PI-is associated with worse 2-year growth and neurodevelopment.
Related Concept Videos
01:14Fetal Circulation
Two umbilical arteries transport blood from the fetus to the placenta. At the placenta, the blood absorbs oxygen and nutrients while simultaneously eliminating waste products. This oxygen-enriched and nutrient-rich blood then returns to the fetus through one...
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation