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Prenatal Congenital Heart Disease and Placental Phenotypes: Preserved Neonatal Weight Despite Small Placentas
Angela Desmond1,2, Helia Imany-Shakibai2, Deanna Wong2,3
1Division of Neonatology, Department of Pediatrics, University of California-Los Angeles, Los Angeles, California, USA.
Insights
Infants with congenital heart disease (CHD) often have smaller placentas and more placental pathology, indicating reduced placental efficiency despite normal birth weight and head circumference. This suggests potential prenatal diagnostic value in assessing placental growth.
Area of Science:
- Perinatology
- Pediatric Cardiology
- Developmental Biology
Background:
- Congenital heart disease (CHD) affects 8 in 1,000 live births, leading to significant postnatal complications.
- The developing placenta and fetal heart are closely linked, with CHD pregnancies often showing placental abnormalities and discordant growth.
- The fetal-placental-cardiac axis is crucial for understanding CHD development and its implications.
Purpose of the Study:
- To investigate the relationship between neonatal birth weight (BW), head circumference, placental weight (PW), and placental pathology in pregnancies with CHD.
- To utilize the PW to BW ratio as a measure of placental efficiency in various CHD phenotypes.
- To explore the potential of placental examination for prenatal diagnosis in CHD.
Main Methods:
- Retrospective analysis of 139 singleton live births with confirmed CHD and placental pathology.
- Evaluation of infant BW, head circumference, and placental characteristics.
- Categorization of CHD into septal defects, right-sided defects, left-sided defects, conotruncal anomalies, and others.
Main Results:
- Median birth weight and head circumference percentiles were 33 and 35, respectively.
- Placental pathology was observed in 37% of cases.
- A significant majority (78%) had PW:BW ratios below the 10th percentile, with 54% below the 3rd percentile, irrespective of CHD category.
Conclusions:
- Infants with CHD exhibit preserved birth weight and head circumference despite smaller placentas and increased placental pathology, suggesting altered placental efficiency.
- Abnormal placental growth detection may offer prenatal diagnostic value for CHD.
- Discordant placental and neonatal growth might indicate underlying vascular anomalies predisposing to CHD.
Background:
Congenital heart disease (CHD) affects 8 in 1,000 live births with significant postnatal implications including growth failure, neurodevelopmental delay, and mortality. The placenta develops concomitantly with the fetal heart. High rates of placental pathology and discordant growth in pregnancies affected by CHD highlight the significance of the fetal-placental-cardiac axis.
Objectives:
This study aimed to characterize the relationship between neonatal birthweight (BW), head circumference, placental weight (PW), and placental pathology in pregnancies affected by CHD. PW:BW provides a surrogate to assess placental efficiency, or nutrient exchange and delivery by the placenta, across CHD phenotypes.
Methods:
Retrospective cohort of 139 live-born singletons with postnatally confirmed CHD with placental pathology. Placental examination, infant BW, head circumference, and CHD categories (septal defects, right-sided defects, left-sided defects, conotruncal anomalies, and others) were included. Chi-square, Fisher's exact, or Kruskall-Wallis tests and multinomial logistic regressions, as appropriate.
Results:
Median birthweight and head circumference percentile was 33 and 35, respectively. Placental pathology was documented in 37% of cases. PW to BW ratios were <10th percentile for 78% and <3rd percentile for 54% of the cohort, with no difference between CHD categories (P = 0.39 and P = 0.56, respectively).
Conclusions:
Infants with CHD have preserved BW and head circumferences in the setting of small placentas and increased prevalence of placental pathology, suggesting placental efficiency. Detection of abnormal placental growth could add prenatal diagnostic value. Placental and neonatal discordant growth may allude to a vascular anomaly predisposing fetuses to developing CHD. Further studies are needed to explore fetal nutrient delivery and utilization efficiency.
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