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Placental Pathology Contributes to Impaired Volumetric Brain Development in Neonates With Congenital Heart Disease

Maaike Nijman1,2, Lotte E van der Meeren3,4, Peter G J Nikkels5

  • 1Department of Neonatology Wilhelmina Children's Hospital, University Medical Center Utrecht Utrecht the Netherlands.

Journal of the American Heart Association
|February 29, 2024
PubMed

Insights

Severe congenital heart disease in newborns is linked to placental problems that may impair brain development. This study found placental pathology is associated with reduced brain volumes in infants.

Area of Science:

  • Perinatology
  • Neurodevelopmental Pediatrics
  • Pathology

Background:

  • Congenital heart disease (CHD) in neonates poses risks for in utero brain development, leading to postnatal injury and long-term neurodevelopmental issues.
  • The placenta is crucial for fetal growth, making its pathology a potential factor in neurodevelopmental outcomes for infants with CHD.

Purpose of the Study:

  • To determine the incidence of placental pathology in fetuses with severe congenital heart disease.
  • To investigate the association between placental pathology and brain development markers, including total and regional brain volumes, gyrification, and brain injury.

Main Methods:

  • Prospective analysis of placentas from 96 term singleton pregnancies with severe fetal CHD for macroscopic and microscopic pathology.
  • Application of a placental pathology severity score to correlate placental abnormalities with neurological outcomes.
  • Postnatal, presurgical magnetic resonance imaging (MRI) to assess brain volumes, gyrification, and brain injuries.

Main Results:

  • Common placental abnormalities included maternal vascular malperfusion (46%), nucleated red blood cells (37%), chronic inflammation (35%), delayed maturation (30%), and low placental weight (28%).
  • Higher placental pathology severity scores correlated negatively with cortical gray matter, deep gray matter, brainstem, cerebellar, and total brain volumes (r=-0.25 to -0.31, P<0.05).
  • This association remained significant for cortical gray matter, cerebellar, and total brain volumes after adjusting for postmenstrual age at MRI (adjusted R²=0.25-0.47, P<0.05).

Conclusions:

  • Placental pathology is frequent in neonates with severe congenital heart disease.
  • The severity of placental pathology is associated with reduced postnatal brain volumes, specifically in cortical, cerebellar, and total brain regions.
  • These findings suggest placental pathology may contribute to impaired brain development in infants with severe CHD.
Abstract

Keywords:
brain developmentcongenital heart diseasefetusmagnetic resonance imagingneonateneuroplacentologyplacenta

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