The Association of Fetal Cyanotic Versus Non-Cyanotic Cardiac Malformations and Placental Vascular Malperfusion

Placental abnormalities are frequently observed in congenital heart disease (CHD) pregnancies, yet detailed histopathological evaluations are limited. This study investigated placental vascular lesions in CHD cases, with comparisons between cyanotic and non-cyanotic subtypes.

Term singleton pregnancies with prenatally diagnosed moderate-to-severe CHD were compared to gestational age-matched controls. Placentas were assessed using standardized histopathological criteria, and CHD cases were stratified based on cyanosis.

Among 60 placentas analyzed (40 CHD and 20 control), fetal vascular malperfusion (FVM) was significantly more frequent in the CHD group (P = .003). Other lesions, including maternal vascular malperfusion and inflammation-related findings, showed no statistically significant differences. In subgroup analysis, no clear differences emerged between cyanotic and non-cyanotic groups.

CHD is strongly associated with placental FVM, indicating a possible fetal circulatory disturbance. While histological patterns were similar across CHD subtypes, the presence of FVM may provide important insights for neonatal risk assessment and management.