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Longitudinal changes in fetal head biometry and fetoplacental circulation in fetuses with congenital heart defects
Polán Ordás1, Roberto Rodríguez1, Beatriz Herrero1
1Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, University Hospital La Paz, Madrid, Spain.
Insights
Fetuses with congenital heart defects often have smaller head sizes and altered blood flow patterns. The head growth rate during pregnancy is also impacted, particularly in cases with reduced oxygen supply to the brain.
Area of Science:
- Fetal Medicine
- Cardiology
- Perinatology
Background:
- Congenital heart defects (CHDs) can impact fetal development and well-being.
- Understanding the effects of CHDs on fetal growth and circulation is crucial for prenatal management.
Purpose of the Study:
- To analyze changes in fetal cephalic biometry and fetoplacental circulation throughout pregnancy in fetuses with CHDs.
- To compare these parameters between fetuses with different types of CHDs and healthy controls.
Main Methods:
- Prospective study involving 71 fetuses with isolated CHDs across three tertiary referral hospitals.
- Fetal biometry and Doppler parameters were assessed between 25-30 and 34-40 weeks of gestation.
- Data were analyzed using Z scores and general linear modeling, comparing CHDs groups (based on CNS oxygen supply) with controls.
Main Results:
- Fetuses with CHDs exhibited significantly smaller head and abdominal circumferences and lower estimated fetal weight compared to controls.
- Group I CHDs (low oxygen supply) showed smaller head sizes than Group II.
- Elevated umbilical artery pulsatility index and reduced cerebroplacental ratio were observed in fetuses with CHDs.
Conclusions:
- Fetuses with CHDs are at risk for reduced head size and altered Doppler parameters, indicating potential circulatory compromise.
- The growth rate of the fetal head is diminished throughout pregnancy in fetuses with CHDs.
- These findings are primarily linked to CHDs associated with expected low oxygen supply to the central nervous system.
Introduction:
Objectives were to analyze changes in fetal cephalic biometry and fetoplacental circulation throughout pregnancy in fetuses with congenital heart defects.
Material And Methods:
Prospective study conducted on three university tertiary referral hospitals. Fetuses with the diagnosis of isolated congenital heart defects attending between 2014 and 2018 were included. Congenital heart defects were divided into two groups according to the oxygen supply to the central nervous system: group I (expected low placental blood content and low oxygen delivery to the brain) and group II (expected intermediate and high placental blood content). Fetal biometry and Doppler parameters were collected between 25-30 weeks of gestation and 34-40 weeks of gestation and transformed into Z scores. The results were compared with healthy controls. Finally, general linear modeling was performed to analyze repeated measurements.
Results:
In all, 71 fetuses met the inclusion criteria. Fetuses with congenital heart defects had significantly smaller head (biparietal diameter [p < 0.001], head circumference [p = 0.001]) and abdominal circumference (p < 0.001), and lower estimated fetal weight (p < 0.001) than controls. When analyzing according to congenital heart defects type, head size was significantly smaller in group I compared with group II (p = 0.04). Regarding Doppler parameters, fetuses with congenital heart defects showed higher umbilical artery pulsatility index (p < 0.001) and lower cerebroplacental ratio (p = 0.044) than controls. In group I, umbilical artery pulsatility index was above the 95th centile in 15.4% of fetuses compared with 6.7% in group II and 1.9% in controls (p < 0.001); moreover, middle cerebral artery pulsatility index was below the 5th centile in 5.4% of group I fetuses compared with 0% in group II and 1.2% in controls (p = 0.011). General linear model for two measurements showed significant longitudinal changes in biometric parameters. Growth rate of fetal head through pregnancy (head circumference Z score) was lower in fetuses with congenital heart defects compared with controls (p = 0.043). In group I, the head circumference Z score longitudinal decrease was significantly higher than in group II (p < 0.001).
Conclusions:
Fetuses with congenital heart defects are at risk of smaller head size and Doppler changes. Growth rate of fetal head throughout pregnancy is also affected. These findings are mainly associated with cardiac defects with expected low oxygen supply to the central nervous system.
