Growth patterns and cerebroplacental hemodynamics in fetuses with congenital heart disease

M J Mebius; S A B Clur; A S Vink; E Pajkrt; W S Kalteren; E M W Kooi; A F Bos; G J du Marchie Sarvaas; C M Bilardo

doi:10.1002/uog.19102

Growth patterns and cerebroplacental hemodynamics in fetuses with congenital heart disease

M J Mebius, S A B Clur, A S Vink, E Pajkrt, W S Kalteren, E M W Kooi, A F Bos, G J du Marchie Sarvaas, C M Bilardo

Reproductive Origins of Adult Health and Disease (ROAHD)

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

OBJECTIVES: Congenital heart disease (CHD) has been associated with a reduced fetal head circumference (HC). The underlying pathophysiological background remains undetermined. We aimed to define trends in fetal growth and cerebroplacental Doppler flow, and to investigate the association between head growth and cerebro-placental flow in fetuses with CHD.

METHODS: Fetuses with CHD and serial measurements of HC, abdominal circumference (AC), middle cerebral artery pulsatility index (MCA-PI), umbilical artery pulsatility index (UA-PI), and cerebro-placental ratio (CPR) were included. CHD was categorized into 3 groups based on expected cerebral arterial oxygen saturation: normal, mild to moderately reduced, and severely reduced. Trends over time in Z-scores were analyzed using a linear mixed-effects model.

RESULTS: 181 fetuses fulfilled the inclusion criteria. Expected cerebral arterial oxygen saturation in CHD was classified as normal in 44, mild to moderately reduced in 84 and severely reduced in 53 cases. HC z-scores showed a tendency to decrease until 23 weeks, then to increase until 33 weeks, followed by a decrease again in the late third trimester. AC increased progressively with advancing gestation. MCA-PI and UA-PI showed significant trends throughout pregnancy, but CPR did not. There were no associations between expected cerebral arterial oxygen saturation and fetal growth. Average trends in MCA-PI were significantly different in the three subgroups (P=0.010), whereas average trends in UA-PI and CPR were similar (P=0.530 and P=0.285). Furthermore, there was no significant association between MCA-PI and HC (P=0.284).

CONCLUSIONS: Fetal biometry and Doppler flow patterns are within normal ranges in fetuses with CHD, but show trends over time. Fetal head growth is not associated with the cerebral blood flow pattern or placental function and HC is not influenced by the cerebral arterial oxygen saturation. This article is protected by copyright. All rights reserved.

Original language	English
Pages (from-to)	769-778
Number of pages	10
Journal	Ultrasound in Obstetrics and Gynaecology
DOIs	https://doi.org/10.1002/uog.19102
Publication status	Published - Jun-2019

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Growth patterns and cerebroplacental hemodynamics in fetuses with congenital heart diseaseFinal publisher's version, 1.53 MBLicence: CC BY-NC

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@article{5a383a7861b645e08881ba2048baaa83,

title = "Growth patterns and cerebroplacental hemodynamics in fetuses with congenital heart disease",

abstract = "OBJECTIVES: Congenital heart disease (CHD) has been associated with a reduced fetal head circumference (HC). The underlying pathophysiological background remains undetermined. We aimed to define trends in fetal growth and cerebroplacental Doppler flow, and to investigate the association between head growth and cerebro-placental flow in fetuses with CHD.METHODS: Fetuses with CHD and serial measurements of HC, abdominal circumference (AC), middle cerebral artery pulsatility index (MCA-PI), umbilical artery pulsatility index (UA-PI), and cerebro-placental ratio (CPR) were included. CHD was categorized into 3 groups based on expected cerebral arterial oxygen saturation: normal, mild to moderately reduced, and severely reduced. Trends over time in Z-scores were analyzed using a linear mixed-effects model.RESULTS: 181 fetuses fulfilled the inclusion criteria. Expected cerebral arterial oxygen saturation in CHD was classified as normal in 44, mild to moderately reduced in 84 and severely reduced in 53 cases. HC z-scores showed a tendency to decrease until 23 weeks, then to increase until 33 weeks, followed by a decrease again in the late third trimester. AC increased progressively with advancing gestation. MCA-PI and UA-PI showed significant trends throughout pregnancy, but CPR did not. There were no associations between expected cerebral arterial oxygen saturation and fetal growth. Average trends in MCA-PI were significantly different in the three subgroups (P=0.010), whereas average trends in UA-PI and CPR were similar (P=0.530 and P=0.285). Furthermore, there was no significant association between MCA-PI and HC (P=0.284).CONCLUSIONS: Fetal biometry and Doppler flow patterns are within normal ranges in fetuses with CHD, but show trends over time. Fetal head growth is not associated with the cerebral blood flow pattern or placental function and HC is not influenced by the cerebral arterial oxygen saturation. This article is protected by copyright. All rights reserved.",

author = "Mebius, {M J} and Clur, {S A B} and Vink, {A S} and E Pajkrt and Kalteren, {W S} and Kooi, {E M W} and Bos, {A F} and {du Marchie Sarvaas}, {G J} and Bilardo, {C M}",

year = "2019",

month = jun,

doi = "10.1002/uog.19102",

language = "English",

pages = "769--778",

journal = "Ultrasound in Obstetrics and Gynaecology",

issn = "1469-0705",

publisher = "Wiley",

}

TY - JOUR

T1 - Growth patterns and cerebroplacental hemodynamics in fetuses with congenital heart disease

AU - Mebius, M J

AU - Clur, S A B

AU - Vink, A S

AU - Pajkrt, E

AU - Kalteren, W S

AU - Kooi, E M W

AU - Bos, A F

AU - du Marchie Sarvaas, G J

AU - Bilardo, C M

PY - 2019/6

Y1 - 2019/6

N2 - OBJECTIVES: Congenital heart disease (CHD) has been associated with a reduced fetal head circumference (HC). The underlying pathophysiological background remains undetermined. We aimed to define trends in fetal growth and cerebroplacental Doppler flow, and to investigate the association between head growth and cerebro-placental flow in fetuses with CHD.METHODS: Fetuses with CHD and serial measurements of HC, abdominal circumference (AC), middle cerebral artery pulsatility index (MCA-PI), umbilical artery pulsatility index (UA-PI), and cerebro-placental ratio (CPR) were included. CHD was categorized into 3 groups based on expected cerebral arterial oxygen saturation: normal, mild to moderately reduced, and severely reduced. Trends over time in Z-scores were analyzed using a linear mixed-effects model.RESULTS: 181 fetuses fulfilled the inclusion criteria. Expected cerebral arterial oxygen saturation in CHD was classified as normal in 44, mild to moderately reduced in 84 and severely reduced in 53 cases. HC z-scores showed a tendency to decrease until 23 weeks, then to increase until 33 weeks, followed by a decrease again in the late third trimester. AC increased progressively with advancing gestation. MCA-PI and UA-PI showed significant trends throughout pregnancy, but CPR did not. There were no associations between expected cerebral arterial oxygen saturation and fetal growth. Average trends in MCA-PI were significantly different in the three subgroups (P=0.010), whereas average trends in UA-PI and CPR were similar (P=0.530 and P=0.285). Furthermore, there was no significant association between MCA-PI and HC (P=0.284).CONCLUSIONS: Fetal biometry and Doppler flow patterns are within normal ranges in fetuses with CHD, but show trends over time. Fetal head growth is not associated with the cerebral blood flow pattern or placental function and HC is not influenced by the cerebral arterial oxygen saturation. This article is protected by copyright. All rights reserved.

AB - OBJECTIVES: Congenital heart disease (CHD) has been associated with a reduced fetal head circumference (HC). The underlying pathophysiological background remains undetermined. We aimed to define trends in fetal growth and cerebroplacental Doppler flow, and to investigate the association between head growth and cerebro-placental flow in fetuses with CHD.METHODS: Fetuses with CHD and serial measurements of HC, abdominal circumference (AC), middle cerebral artery pulsatility index (MCA-PI), umbilical artery pulsatility index (UA-PI), and cerebro-placental ratio (CPR) were included. CHD was categorized into 3 groups based on expected cerebral arterial oxygen saturation: normal, mild to moderately reduced, and severely reduced. Trends over time in Z-scores were analyzed using a linear mixed-effects model.RESULTS: 181 fetuses fulfilled the inclusion criteria. Expected cerebral arterial oxygen saturation in CHD was classified as normal in 44, mild to moderately reduced in 84 and severely reduced in 53 cases. HC z-scores showed a tendency to decrease until 23 weeks, then to increase until 33 weeks, followed by a decrease again in the late third trimester. AC increased progressively with advancing gestation. MCA-PI and UA-PI showed significant trends throughout pregnancy, but CPR did not. There were no associations between expected cerebral arterial oxygen saturation and fetal growth. Average trends in MCA-PI were significantly different in the three subgroups (P=0.010), whereas average trends in UA-PI and CPR were similar (P=0.530 and P=0.285). Furthermore, there was no significant association between MCA-PI and HC (P=0.284).CONCLUSIONS: Fetal biometry and Doppler flow patterns are within normal ranges in fetuses with CHD, but show trends over time. Fetal head growth is not associated with the cerebral blood flow pattern or placental function and HC is not influenced by the cerebral arterial oxygen saturation. This article is protected by copyright. All rights reserved.

U2 - 10.1002/uog.19102

DO - 10.1002/uog.19102

M3 - Article

C2 - 29808509

SN - 1469-0705

SP - 769

EP - 778

JO - Ultrasound in Obstetrics and Gynaecology

JF - Ultrasound in Obstetrics and Gynaecology

ER -

Growth patterns and cerebroplacental hemodynamics in fetuses with congenital heart disease

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