3 years ago

The Effect of Fetal Hemodynamics on Fetal Growth in Single Ventricle and Transposition of The Great Arteries

Mounira Habli, Tarek Alsaied, Allison Divanovic, Eileen King, Stephanie Tseng, James Cnota, Eunice Hahn
Introduction As birth weight is a critical predictor of neonatal congenital heart defect (CHD) outcomes, the common problem of poor fetal growth in this population is clinically important but not well understood. The impact of fetal hemodynamics on fetal growth and birth weight in CHD has not been assessed. Combined cardiac output (CCO) has been used to evaluate patients with structurally normal heart but rarely in CHD. Middle cerebral artery and umbilical artery pulsatility indices (PIs) have been used to evaluate the relative distribution of circulation in patients with CHD. In this study we sought to evaluate the impact of CCO and PIs on fetal growth in different subgroups of CHD and to study the effects of fetal hemodynamics on late gestation weight gain. We hypothesized that fetuses with CHD will have lower CCO and will be smaller at birth. Methods A retrospective review of fetal echocardiograms from 109 fetuses was performed. The diagnosis was hypoplastic left heart syndrome (HLHS, n=30), non-HLHS single ventricle (non-HLHS SV, n=20), transposition of the great arteries (D-TGA, n=17) and normal controls (n= 42). CCO was calculated using valvar area, velocity time integral and heart rate and indexed to estimated fetal weight. PIs were calculated using systolic, diastolic and mean velocities. Anthropometric measures were recorded. Regression models were used to study CCO, PIs and fetal anthropometric trends over gestational age. To evaluate fetal weight gain in late gestation, z-scores were compared between estimated fetal weight at 30 weeks and birth weight. Regression analysis was used to determine the association of CCO, indexed CCO and PIs at 30 weeks with birth weight, length and head circumference z-scores in addition to weight gain late in gestation. The 30 weeks gestational age was chosen based on previous studies that suggested an evidence of poor weight gain late in gestation in CHD starting around 30 weeks. Results CCO increased in all 4 groups through gestation but the rate slowed in HLHS and SV at the end of gestation. Middle cerebral artery PI values were lower in HLHS compared to non-HLHS SV through gestation suggesting a different cerebral blood distribution. At the end of gestation, fetal weight gain rate slowed in HLHS and SV (similar to CCO curves) and head circumference rate also slowed in all groups but controls. CCO, indexed CCO and PIs did not correlate with any of the birth measurements or with weight gain late in gestation in CHD. Conclusions We found no association of CCO or pulsatility indices with late gestation weight gain or birth anthropometrics in CHD. This does not support fetal hemodynamics as the primary driver of suboptimal fetal growth in SV. Future research may further explain genetic and placental abnormalities that may affect fetal growth in CHD.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1002/uog.18936

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