Related Experiment Video
Updated: Sep 15, 2025
Fetal Mouse Cardiovascular Imaging Using a High-frequency Ultrasound 30/45MHZ System
Published on: May 5, 2018
Fetal Cerebrovascular Response to Maternal Hyperoxia Testing and Association With Brain Growth and Postnatal Brain
Mariam Taleb1, Jing Liu1, Duan Xu1
1University of California San Francisco San Francisco CA USA.
Insights
Fetal cerebrovascular response to maternal hyperoxia (MH) in congenital heart disease (CHD) predicts brain growth and white matter injury. Lack of response is linked to smaller brain volumes and increased injury risk in infants with hypoplastic left heart syndrome.
Area of Science:
- Neonatal Neurology
- Pediatric Cardiology
- Fetal Medicine
Background:
- Congenital heart disease (CHD) significantly impacts neurodevelopmental outcomes.
- Cerebrovascular response to maternal hyperoxia (MH) varies in fetuses with CHD, potentially indicating in utero brain health.
- Investigating this response may reveal associations with adverse neurologic outcomes.
Purpose of the Study:
- To examine the link between absent cerebrovascular reactivity to MH and neurologic outcomes in fetuses with CHD.
- To assess brain growth and the risk of postnatal white matter injury in relation to MH response.
Main Methods:
- Prospective cohort study of pregnant individuals with fetuses diagnosed with CHD requiring neonatal surgery.
- Fetal echocardiograms with MH, fetal brain MRI, and postnatal brain MRI were utilized.
- Reactivity to MH was defined by a ≥5% change in middle cerebral artery pulsatility index; brain volumes and white matter injury were assessed.
Main Results:
- Among fetuses with hypoplastic left heart syndrome (HLHS), responders had significantly greater total brain volumes compared to non-responders.
- This association between MH response and brain volume was not observed in d-transposition of the great arteries (dTGA).
- Postnatal white matter injury was less prevalent in fetuses who demonstrated cerebrovascular reactivity to MH.
Conclusions:
- Absence of fetal cerebrovascular response to MH correlates with reduced brain volume in utero for HLHS cases.
- Non-responders to MH exhibit a higher incidence of postnatal white matter injury.
- MH testing can identify fetuses with CHD, especially those with HLHS, at elevated risk for adverse neurologic outcomes.
Background:
Neurodevelopmental outcomes are impaired in significant congenital heart disease (CHD) with prenatal origins. The cerebrovascular response to maternal hyperoxia (MH) varies in fetuses with CHD, which may reflect brain health in utero. We investigated the association between lack of cerebrovascular reactivity with MH and adverse neurologic outcomes in CHD measured as brain growth and risk of postnatal white matter injury.
Methods:
This is a prospective cohort study of pregnant participants whose fetuses had CHD requiring a neonatal operation. We performed fetal echocardiograms with MH, fetal brain magnetic resonance imaging (MRI), and postnatal preoperative brain MRI. A ≥5% change in middle cerebral artery pulsatility index with MH defined reactivity. Total brain volume was measured on MRIs. The neonatal MRI was assessed for white matter injury. Regression analyses compared responders versus nonresponders, then stratified by hypoplastic left heart syndrome and d-transposition of the great arteries groups.
Results:
Fifty-five participants underwent fetal imaging. Forty-nine neonates underwent brain MRI. Among subjects with hypoplastic left heart syndrome, at each gestational week, total brain volume was 17.8 mL greater in responders (95% CI, 3.3-32.3; P=0.02). This pattern was not seen in d-transposition of the great arteries. Postnatal white matter injury was less common in responders.
Conclusions:
Lack of fetal cerebrovascular response to MH is associated with smaller total brain volume beginning in utero in hypoplastic left heart syndrome. Postnatal white matter injury is more common among nonresponders. MH testing can help identify individual fetuses with CHD at highest risk for adverse neurologic outcomes, particularly those with hypoplastic left heart syndrome.
