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Patterns of prenatal growth among infants with cardiovascular malformations: possible fetal hemodynamic effects
1Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
Insights
Fetal growth patterns differ significantly among infants with congenital heart defects. Specific cardiovascular malformations like d-transposition of the great arteries and hypoplastic left heart syndrome are linked to distinct fetal growth disturbances.
Area of Science:
- Pediatric Cardiology
- Developmental Biology
- Medical Genetics
Background:
- Congenital heart defects (CHDs) are common birth abnormalities.
- The relationship between specific CHDs and fetal growth patterns is not fully understood.
- Existing theories on CHD and fetal growth require further investigation.
Purpose of the Study:
- To characterize and compare fetal growth patterns in infants with specific CHDs.
- To assess the association between different CHDs and fetal growth disturbances.
- To evaluate competing theories linking cardiovascular malformations to altered fetal development.
Main Methods:
- Analysis of fetal growth parameters (birth weight, length, head circumference) in liveborn singletons.
- Comparison of infants with d-transposition of the great arteries (TGA), tetralogy of Fallot, hypoplastic left heart syndrome, coarctation of the aorta, and controls.
- Multivariate analysis of covariance to assess differences in growth vectors across diagnostic groups.
Main Results:
- Significant differences in fetal growth vectors were observed across CHD groups (p < 0.0001).
- Infants with TGA showed normal birth weight but reduced head volume relative to weight.
- Infants with hypoplastic left heart syndrome had smaller overall dimensions and disproportionately small head volume.
- Infants with tetralogy of Fallot were smaller in all dimensions but normally proportioned.
- Infants with coarctation of the aorta exhibited lower birth weight, shorter length, and increased head volume relative to weight.
Conclusions:
- Fetal circulatory abnormalities associated with CHDs correlate with specific patterns of fetal growth disturbance.
- These findings support the hypothesis that prenatal circulatory issues influence fetal development.
- Distinct CHDs are associated with unique fetal growth profiles, aiding in understanding disease mechanisms.
Abstract:
This study characterized fetal growth differences among control infants (n= 276) and infants with d-transposition of the great arteries (TGA) (n = 69), tetralogy of Fallot (n = 66), hypoplastic left heart syndrome (n = 51), and coarctation of the aorta (n = 65), thus permitting assessment of competing theories about the relation between these cardiovascular malformations and fetal growth disturbance. Subjects were liveborn singletons without genetic or extra-cardiovascular structural abnormalities sampled from the Baltimore-Washington Infant Study. Multivariate analysis of covariance was performed: birth weight, birth length, newborn head circumference, and two nonlinear functions of these measures were regressed jointly on a diagnostic class variable and covariates. Differences in the vectors of dependent variable means across diagnostic groups were striking (p < 0.0001). Infants with TGA had normal birth weight, but lesser head volume relative to birth weight. Infants with tetralogy of Fallot were smaller in all measured dimensions, but they were shaped normally. Infants with hypoplastic left heart syndrome were smaller in all measured dimensions, and head volume was disproportionately small relative to birth weight. Infants with coarctation of the aorta had lower birth weight, shorter birth length, and greater head volume relative to birth weight. These findings suggest that fetal circulatory abnormalities may predict abnormal patterns of fetal growth.