Placental vascular malperfusion lesions in fetal congenital heart disease

Leon, Rachel L.; Sharma, Kavita; Mir, Imran; Herrera, Christina L.; Brown, Steven L.; Spong, Catherine Y.; Chalak, Lina F.

doi:10.1016/j.ajog.2022.05.038

Cited by 22 publications

(14 citation statements)

References 39 publications

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“…The high rate of placental abnormalities in our cohort of neonates with CHD is in concordance with previous studies, which showed similar lesions, including maternal vascular malperfusion lesions, delayed villous maturation, chorangiosis, chronic inflammation, and reduced placental weight. 16 , 17 , 18 , 19 , 20 , 21 , 22 Comparable to these previous studies, maternal vascular malperfusion lesions were the most prevalent pathology in our cohort, occurring in 46% of cases. Maternal vascular malperfusion lesions are the result of inadequate spiral artery remodeling and affect the oxygen tension and perfusion of the intervillous space.…”

Section: Discussionsupporting

confidence: 71%

“… 14 , 15 In addition, fetal CHD was found to correlate with low placental weight and pathologies such as thrombosis, infarction, delayed villous maturation, and chorangiosis. 16 , 17 , 18 , 19 , 20 , 21 , 22 Such pathologies alter the structure and function of the placenta, which in turn, might additionally affect the developing brain, next to the detrimental effects caused by CHD itself. 19 , 21 , 23 Yet, the pathophysiologic mechanisms of altered placental development in CHD and its impact on other organs, such as the brain, remain poorly understood.…”

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confidence: 99%

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Placental Pathology Contributes to Impaired Volumetric Brain Development in Neonates With Congenital Heart Disease

Nijman,

van der Meeren,

Nikkels

et al. 2024

JAHA

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Background Neonates with congenital heart disease are at risk for impaired brain development in utero, predisposing children to postnatal brain injury and adverse long‐term neurodevelopmental outcomes. Given the vital role of the placenta in fetal growth, we assessed the incidence of placental pathology in fetal congenital heart disease and explored its association with total and regional brain volumes, gyrification, and brain injury after birth. Methods and Results Placentas from 96 term singleton pregnancies with severe fetal congenital heart disease were prospectively analyzed for macroscopic and microscopic pathology. We applied a placental pathology severity score to relate placental abnormalities to neurological outcome. Postnatal, presurgical magnetic resonance imaging was used to analyze brain volumes, gyrification, and brain injuries. Placental analyses revealed the following abnormalities: maternal vascular malperfusion lesions in 46%, nucleated red blood cells in 37%, chronic inflammatory lesions in 35%, delayed maturation in 30%, and placental weight below the 10th percentile in 28%. Severity of placental pathology was negatively correlated with cortical gray matter, deep gray matter, brainstem, cerebellar, and total brain volumes ( r =−0.25 to −0.31, all P <0.05). When correcting for postmenstrual age at magnetic resonance imaging in linear regression, this association remained significant for cortical gray matter, cerebellar, and total brain volume (adjusted R 2 =0.25–0.47, all P <0.05). Conclusions Placental pathology occurs frequently in neonates with severe congenital heart disease and may contribute to impaired brain development, indicated by the association between placental pathology severity and reductions in postnatal cortical, cerebellar, and total brain volumes.

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Section: Discussionsupporting

confidence: 71%

mentioning

confidence: 99%

Placental Pathology Contributes to Impaired Volumetric Brain Development in Neonates With Congenital Heart Disease

Nijman,

van der Meeren,

Nikkels

et al. 2024

JAHA

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“…Our cohort confirms those findings with 90% of stroke patients having at least one placental abnormality. This is similarly high to the rate of placental lesions in a cohort of patients we recently studied with congenital heart disease (78%) ( 39 ). Placental inflammatory conditions seem to play a prominent role in perinatal stroke pathophysiology ( 38 ), and our cohort has similar findings with 80% showing acute and/or chronic inflammation of the placenta.…”

Section: Discussionsupporting

confidence: 53%

Placental pathologic lesions associated with stroke in term neonates

et al. 2022

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ObjectiveTo determine the birth prevalence of perinatal stroke in term born infants at our high-volume delivery center and assess the frequency of both gross and histologic placental pathologies associated with perinatal stroke using the Amsterdam Placental Workshop Group Consensus Statement guidelines and definitions.Study DesignA single-center retrospective cohort study spanning 2010-2020.ResultsThere were 129,759 live births at Parkland Hospital during the study period and a total of 18 term born infants leading to a birth prevalence of 1 in 6,829 infants. Perinatal risk factors were found in all but one patient, and 74% presented with seizures. Pathologic placental examination was available in 56% of the cohort and only one patient had normal placental examination. Acute histologic chorioamnionitis was described in five placentas (50%) and an additional two had isolated umbilical and/or chorionic plate vasculitis with or without funisitis compared to a rate of 28% with acute inflammation in a Control group. Chronic inflammation in the form of villitis of unknown etiology was described in three of the acutely inflamed placentas and was high-grade in each of those while none of the placentas from our Control group showed evidence of any chronic lesion.ConclusionBoth acute and chronic placental inflammation are common in perinatal stroke; placental examination should be considered an essential component to the diagnostic workup.

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“…In parallel, recent histopathological evidence has reported that placentas, in CHD, show a spectrum of pathological structural adaptations such as infarctions, chorangiosis, thrombosis and hypomature villi, suggesting vascular-related vulnerability and have been linked to the presence of postnatal brain injury, particularly in left ventricular outflow track obstruction heart lesion subtypes [ 7 , 8 , 9 , 10 , 11 ]. While these placental pathologies have been shown to correlate with newborn outcomes such as birthweight [ 8 ] and acquired postnatal brain injury, few direct associations have been found between placental abnormalities and neurodevelopmental outcomes in CHD.…”

Section: Introductionmentioning

confidence: 99%

Associations between Maternal Risk Factors and Intrinsic Placental and Fetal Brain Functional Properties in Congenital Heart Disease

Rajagopalan

Schmithorst

El-Ali

et al. 2022

IJMS

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The relationship between maternal risk factors (MRFs) (particularly pre-gravid obesity, diabetes, and hypertension) and congenital heart disease (CHD) to placental and fetal brain outcomes is poorly understood. Here, we tested the hypothesis that MRF and CHD would be associated with reduced intrinsic placental and fetal brain function using a novel non-invasive technique. Pregnant participants with and without MRF and fetal CHD were prospectively recruited and underwent feto-placental MRI. Using intrinsic properties of blood oxygen level dependent imaging (BOLD) we quantified spatiotemporal variance of placenta and fetal brain. MRFs and CHD were correlated with functional characteristics of the placenta and fetal brain. Co-morbid MRF (hypertension, diabetes, and obesity) reduced spatiotemporal functional variance of placenta and fetal brain (p < 0.05). CHD predicted reduced fetal brain temporal variance compared to non-CHD (p < 0.05). The presence of both MRF and CHD was associated with reduced intrinsic pBOLD temporal variance (p = 0.047). There were no significant interactions of MRFs and CHD status on either temporal or spatial variance of intrinsic brain BOLD. MRF and CHD reduced functional characteristic of placenta and brain in fetuses. MRF modification and management during pregnancy may have the potential to not only provide additional risk stratification but may also improve neurodevelopmental outcomes.

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Placental vascular malperfusion lesions in fetal congenital heart disease

Cited by 22 publications

References 39 publications

Placental Pathology Contributes to Impaired Volumetric Brain Development in Neonates With Congenital Heart Disease

Placental Pathology Contributes to Impaired Volumetric Brain Development in Neonates With Congenital Heart Disease

Placental pathologic lesions associated with stroke in term neonates

Associations between Maternal Risk Factors and Intrinsic Placental and Fetal Brain Functional Properties in Congenital Heart Disease

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