The Association of Fetal Congenital Cardiac Defects and Placental Vascular Malperfusion

Abstract

Objectives Abnormal early angiogenesis appears to impact both placental disorders and fetal congenital heart defects (CHD). We sought to assess the association of placental perfusion defects (PPD) and fetal (CHD). Methods Singleton pregnancies with isolated severe fetal CHD were compared to controls without congenital anomalies or maternal malperfusion (MVM) risk factors. CHD was categorized into group 1: single left ventricle morphology and transposition of the great vessels (TGA) and group 2: single right ventricle and two ventricle morphology. Malperfusion was defined as fetal vascular malperfusion (FVM), MVM, and both FVM and MVM. Results PPD was increased for all CHD (n = 47), CHD with or without risk factors, and CHD groups compared to controls (n = 92). Overall CHD cases and CHD with risk factors had an increased risk of FVM (30% and 80% vs 14%), and MVM (43% and 50% vs 21%), respectively. MVM rates were similar in CHD with and without maternal risk factors. FVM (38% vs 14%) and MVM (44% vs 21%) were increased in Group 1. MVM (42% vs 21%) and both FVM and MVM (16% vs 3%) were increased in Group 2. Conclusions PPD risk is increased in severe isolated fetal CHD. The highest risk is seen in fetal CHD with maternal risk factors.

Birthweight of children with isolated congenital heart disease—A sibling analysis study

“…The second hypothesis is that reduced BW in fetal CHD is caused by abnormal placental development. Signs of impaired placentation, such as placental thrombosis, infarction and delayed maturation, 41–44 are frequently reported in CHD even in the absence of maternal risk factors 44,45 . Furthermore, a reduced placenta‐BW ratio is found in fetal CHD 41,43,46 as well as an increased risk of PE 47–50 and altered angiogenetic biomarkers in fetal CHD, 48,51,52 all suggesting placental dysfunction and hypoxia in this population.…”

“…Signs of impaired placentation, such as placental thrombosis, infarction and delayed maturation, [41][42][43][44] are frequently reported in CHD even in the absence of maternal risk factors. 44,45 Furthermore, a reduced placenta-BW ratio is found in fetal CHD 41,43,46 as well as an increased risk of PE [47][48][49][50] and altered angiogenetic biomarkers in fetal CHD, 48,51,52 all suggesting placental dysfunction and hypoxia in this population. These findings are similar to pregnancies with FGR, 53 implying a placental explanation for the decreased BW in CHD.…”

Prenatal Diagnosis of Congenital Heart Diseases and Associations with Serum Biomarkers of Aneuploidy: A Multicenter Prospective Cohort Study

“… 24 25 26 In addition, severe isolated fetal CHDs have been found to be more likely associated with placental vascular malperfusion, which were consistent with the result of this study. 27 28 …”

Congenital heart diseases: frequency, causes, predictors of placental and fetal disorders

“…Доведено, що важливе значення в процесі ангіогенезу, необхідного для розвитку судинної стінки та формування плаценти, відіграє система судинно-ендотеліальних факторів, до яких належать фактор росту плаценти (PIGF), судинний фактор (VEGF), розчинна форма fms-подібної тирозинкінази-1 (sFlt-1) [32]. У зв'язку формування системи «мати-плацента-плід» рівень ангіогенних факторів росту плаценти зростає з настанням вагітності [33].…”