Background
Fetuses with congenital heart disease are at increased risk of perinatal morbidity
and mortality, which is highly influenced by their prenatal health. Placental function
is vital for the health of the fetus, but increased rates of pathologic lesions of
the placenta have been observed in pregnancies complicated by fetal congenital heart
disease.
Objective
This study aimed to determine the prevalence of both gross and histologic placental
pathologies in a cohort of pregnancies complicated by fetal congenital heart disease
vs healthy controls using the Amsterdam Placental Workshop Group Consensus Statement
sampling and definitions of placental lesions.
Study Design
This single-center retrospective cohort study included placental examinations from
pregnancies diagnosed prenatally with fetal congenital heart disease between 2010
and 2019; moreover, control placentas were collected from pregnancies without maternal
or fetal complications. Placentas were sampled and evaluated according to the Amsterdam
Placental Workshop Group Consensus Statement and gross and histopathologic diagnoses
determined.
Results
Approximately 80% of fetuses diagnosed with congenital heart disease (n=305) had a
placental examination for comparison with controls (n=40). Of note, 239 placentas
(78%) in the group with fetal congenital heart disease had at least 1 gross or histopathologic
lesion compared with 11 placentas (28%) in the control group (P<.01). One-third of placentas complicated by fetal congenital heart disease met the
criteria for small for gestational age, and 48% of placentas had one or more chronic
lesions, including maternal vascular malperfusion (23% vs 0%; P<.01), villitis of unknown etiology (22% vs 0%; P<.01), fetal vascular malperfusion (20% vs 0%; P<.01), and other chronic lesions (16% vs 0%; P<.01). Acute inflammation was equally present in both the group with fetal congenital
heart disease and the control group (28% vs 28%; P=1.00). Although gestational age and birthweight z score were similar between the 2 groups, birth head circumference was 1.5 cm less
in pregnancies complicated by fetal congenital heart disease with a significantly
lower z score compared with the control group (−0.52±1.22 vs 0.06±0.69; P<.01).
Conclusion
Vascular malperfusion lesions and chronic forms of inflammation occur at markedly
higher rates in placentas complicated by fetal congenital heart disease, which may
contribute to the decreased head circumference at birth. Further work in neuroplacentology
is needed to explore connections among cardiac defects, placental vascular malperfusion
lesions, and fetal brain development.
Key words
- cardiac neurodevelopment
- chorangiosis
- congenital heart defect
- deciduitis
- endothelial cushions
- fetal brain
- intrauterine
- neuroplacentology
- placental hemodynamics
- placental histopathology
- placental hypoplasia
- placental inflammation
- placental pathology
- syncytial knots
- villitis
- villous edema
- villous maturation
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References
- The incidence of congenital heart disease.J Am Coll Cardiol. 2002; 39: 1890-1900
- Outcomes following surgery for congenital heart disease in low-birthweight infants.J Paediatr Child Health. 2007; 43: 370-375
- Cardiac surgery in infants with low birth weight is associated with increased mortality: analysis of the Society of Thoracic Surgeons Congenital Heart Database.J Thorac Cardiovasc Surg. 2008; 135: 546-551
- Placental pathology: a neglected link between basic disease mechanisms and untoward pregnancy outcome.Curr Opin Obstet Gynecol. 1995; 7: 10-15
- The clinical implications of placental diagnoses.Semin Perinatol. 2015; 39: 2-8
- Congenital heart defects and indices of placental and fetal growth in a nationwide study of 924 422 liveborn infants.Circulation. 2016; 134: 1546-1556
- Evidence for uteroplacental malperfusion in fetuses with major congenital heart defects.PLoS One. 2020; 15e0226741
- Non-invasive placental perfusion imaging in pregnancies complicated by fetal heart disease using velocity-selective arterial spin labeled MRI.Sci Rep. 2017; 716126
- Characterization of the placenta in the newborn with congenital heart disease: distinctions based on type of cardiac malformation.Pediatr Cardiol. 2018; 39: 1165-1171
- Sampling and definitions of placental lesions: Amsterdam placental workshop group consensus statement.Arch Pathol Lab Med. 2016; 140: 698-713
- Practice guideline for examination of the placenta: developed by the Placental Pathology Practice Guideline Development Task Force of the College of American Pathologists.Arch Pathol Lab Med. 1997; 121: 449-476
- Impact of multiple placental pathologies on neonatal death, bronchopulmonary dysplasia, and neurodevelopmental impairment in preterm infants.Pediatr Res. 2020; 87: 885-891
- Placental pathology is associated with severity of neonatal encephalopathy and adverse developmental outcomes following hypothermia.Am J Obstet Gynecol. 2015; 213: 849.e1-849.e7
- Fetal-placental crosstalk occurs through fetal cytokine synthesis and placental clearance.Placenta. 2018; 69: 1-8
- A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants.BMC Pediatr. 2013; 13: 59
- Neuroplacentology in congenital heart disease: placental connections to neurodevelopmental outcomes.Pediatr Res. 2022; 91: 787-794
- Abnormal brain development in newborns with congenital heart disease.N Engl J Med. 2007; 357: 1928-1938
- The impact of the maternal-foetal environment on outcomes of surgery for congenital heart disease in neonates.Eur J Cardiothorac Surg. 2018; 54: 348-353
- Reduced fetal cerebral oxygen consumption is associated with smaller brain size in fetuses with congenital heart disease.Circulation. 2015; 131: 1313-1323
- The association between severe fetal congenital heart defects and placental vascular malperfusion lesions.Prenat Diagn. 2019; 39: 962-967
- Placental characteristics of fetuses with congenital heart disease.J Ultrasound Med. 2017; 36: 965-972
- Possible common aetiology behind maternal preeclampsia and congenital heart defects in the child: a cardiovascular diseases in Norway project study.Paediatr Perinat Epidemiol. 2016; 30: 76-85
- Fetal vascular malperfusion, an update.APMIS. 2018; 126: 561-569
- Practice parameter: evaluation of the child with microcephaly (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society.Neurology. 2009; 73: 887-897
- Abnormalities of placental development and function are associated with the different fetal growth patterns of hypoplastic left heart syndrome and transposition of the great arteries.Placenta. 2020; 101: 57-65
- Brain volume and metabolism in fetuses with congenital heart disease: evaluation with quantitative magnetic resonance imaging and spectroscopy.Circulation. 2010; 121: 26-33
- Autoregulation of cerebral blood flow in fetuses with congenital heart disease: the brain sparing effect.Pediatr Cardiol. 2003; 24: 436-443
- Are there head volume alterations at 11 to 14 weeks in fetuses with congenital heart defects? A first trimester case series.AJP Rep. 2016; 6: e232-e238
- Placental features of fetal vascular malperfusion and infant neurodevelopmental outcomes at 2 years of age in severe fetal growth restriction.Am J Obstet Gynecol. 2021; 225: 413.e1-413.e11
- The immunological basis of villitis of unknown etiology - review.Placenta. 2013; 34: 846-855
- The placenta as the window to congenital heart disease.Curr Opin Cardiol. 2021; 36: 56-60
- Association between preeclampsia and congenital heart defects.JAMA. 2015; 314: 1588-1598
Wilson RL, Yuan V, Courtney J, Tipler A, Cnota J, Jones HN. Analysis of commonly expressed genes between first trimester fetal heart and placenta cell types in the context of congenital heart disease. bioRxiv. 2022. Available at: https://www.biorxiv.org/content/biorxiv/early/2022/01/06/2022.01.06.475249.full.pdf. Accessed January 12, 2022.
- Chromosome abnormalities in congenital heart disease.Am J Med Genet. 1997; 70: 292-298
- Genomic frontiers in congenital heart disease.Nat Rev Cardiol. 2022; 19: 26-42
- Genetic basis for congenital heart defects: current knowledge: a scientific statement from the American Heart Association Congenital Cardiac Defects Committee, Council on Cardiovascular Disease in the Young: endorsed by the American Academy of Pediatrics.Circulation. 2007; 115: 3015-3038
- Neurodevelopmental outcomes in children with congenital heart disease: evaluation and management: a scientific statement from the American Heart Association.Circulation. 2012; 126: 1143-1172
- Intravoxel incoherent motion MR imaging analysis for diagnosis of placenta accrete spectrum disorders: a pilot feasibility study.Magn Reson Imaging. 2021; 80: 26-32
- A retrospective segmentation analysis of placental volume by magnetic resonance imaging from first trimester to term gestation.Pediatr Radiol. 2018; 48: 1936-1944
- 3-D volumetric MRI evaluation of the placenta in fetuses with complex congenital heart disease.Placenta. 2015; 36: 1024-1030
Article Info
Publication History
Published online: May 21, 2022
Accepted:
May 18,
2022
Received in revised form:
April 29,
2022
Received:
February 1,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
The authors report no conflict of interest.
This study was supported by the Children’s Health Clinical Research Advisory Council , Dallas, Texas.
Cite this article as: Leon RL, Sharma K, Mir IN, et al. Placental vascular malperfusion lesions in fetal congenital heart disease. Am J Obstet Gynecol 2022;XX:x.ex–x.ex.
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