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Maternal-Fetal Environment and Neurodevelopment in Patients with Single Ventricle Heart Disease
Samantha A Holmes1, Krista Young1, Kelly R Wolfe1
1Division of Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Denver, CO.
Insights
An impaired maternal-fetal environment (MFE) is linked to poorer cognitive and language development in children with single ventricle heart disease (SVHD). Early monitoring for adverse prenatal exposures is crucial for these infants.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Pediatrics
- Maternal-Fetal Medicine
Background:
- Single ventricle heart disease (SVHD) presents complex challenges for affected children.
- The maternal-fetal environment (MFE) may significantly influence early neurodevelopmental trajectories.
- Understanding MFE's impact is crucial for optimizing care in SVHD populations.
Purpose of the Study:
- To investigate the association between an impaired MFE and neurodevelopmental outcomes in infants with SVHD.
- To identify specific prenatal risk factors within the MFE affecting child development.
- To evaluate the influence of clinical and socioeconomic factors on these associations.
Main Methods:
- Retrospective analysis of 160 SVHD patients diagnosed prenatally (2011-2022).
- Impaired MFE defined by in utero exposure to diabetes, pre-eclampsia, tobacco, or hypertension.
- Neurodevelopmental assessment using Bayley Scales of Infant and Toddler Development (BSID-III/IV) between 12-36 months.
Main Results:
- Exposure to an impaired MFE was associated with lower cognitive and language scores in SVHD patients.
- These associations were attenuated after adjusting for clinical covariates and socioeconomic factors (Child Opportunity Index).
- No significant differences were found in motor scores, neonatal complications, or mortality/transplantation rates.
Conclusions:
- An impaired MFE is associated with deficits in cognitive and language development among children with SVHD.
- Clinical and socioeconomic factors play a role in mediating the impact of MFE on outcomes.
- Early identification and monitoring of infants with SVHD exposed to adverse prenatal conditions are recommended.
Objective:
To assess the role of the maternal-fetal environment (MFE) on early neurodevelopmental and clinical outcomes in children with single ventricle heart disease (SVHD).
Study Design:
We performed a retrospective, single-center study of patients with a prenatal diagnosis of SVHD from 2011-2022. Impaired MFE was defined as exposure to diabetes, pre-eclampsia, tobacco, or chronic or gestational hypertension in utero. Neurodevelopmental outcomes were assessed using the Bayley Scales of Infant and Toddler Development-III and 4 between 12 and 36 months of age.
Results:
Among 160 patients with SVHD (117 hypoplastic left heart and 43 hypoplastic right heart), 78 completed neurodevelopmental testing. Exposure to an impaired MFE was associated with lower cognitive scores (P = .030), although this association became nonsignificant after adjustment for clinical covariates. Impaired MFE was also associated with lower language and receptive communication scores after clinical adjustment (P = .023 and P = .040, respectively) but became nonsignificant after further adjustment for the Child Opportunity Index. No significant differences were observed in fine or gross motor scores, neonatal complications, hospital or intensive care unit stay, and 1-year mortality or transplantation between groups.
Conclusions:
Among patients with SVHD, exposure to an impaired MFE was associated with lower cognitive and language outcomes, although these associations were attenuated after accounting for clinical and socioeconomic factors. These findings highlight the importance of early identification and monitoring of children with adverse prenatal exposures.
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