Placental Pathology and Neuroimaging Correlates in Neonates with Congenital Heart Disease

Sarah D Schlatterer,Linda White,Mary T Donofrio,Jonathan Murnick,Marni Jacobs,Catherine Limperopoulos

doi:10.1038/s41598-019-40894-y

Sarah D Schlatterer, Linda White + Show 4 more

Open Access

https://doi.org/10.1038/s41598-019-40894-y

Copy DOI

Abstract

Congenital heart disease (CHD) is an independent risk factor for brain injury, including stroke, and poor neurodevelopmental outcomes, and placental abnormalities may represent an additional risk factor for brain injury in neonates. The incidence and scope of placental pathology and relationship to fetal brain abnormalities in pregnancies complicated by fetal CHD has not been explored to our knowledge. In order to determine the prevalence of placental pathology findings and whether placental findings are associated with postnatal brain injury in pregnancies complicated by fetal CHD, we reviewed placental pathology reports for 51 pregnancies complicated by CHD and scored available postnatal, pre-operative brain MRI for brain pathology. Overall, 57% of CHD infants had abnormal placental pathology. Pregnancies complicated by CHD with aortic obstruction (AO) were significantly more likely than those with no obstruction to have abnormal placental pathology (79% vs. 44%). There was a trend toward more severe brain lesions amongst patients with brain lesions and placental abnormality (55% moderate/severe) compared to those without placental abnormality (11% moderate/severe). These data suggest that placental abnormalities are common in CHD and may have a compounding effect on brain lesions in this high-risk population.

Highlights

Given that Congenital heart disease (CHD) is an independent risk factor for stroke and poor neurodevelopmental outcomes and that placental abnormalities may represent a risk factor for neurologic abnormalities, we set out to explore the interplay www.nature.com/scientificreports/
We demonstrate that placental abnormalities are common in pregnancies complicated by CHD
We found that CHD lesions with aortic obstruction were 6.79 times more likely to have placental pathology

Summary

Introduction

Given that CHD is an independent risk factor for stroke and poor neurodevelopmental outcomes and that placental abnormalities may represent a risk factor for neurologic abnormalities, we set out to explore the interplay www.nature.com/scientificreports/. Male Female Gestational age (median) Birth weight (median) Head circumference (median) Placental Characteristics Placental weight (median) Placental weight percentile GA (n, %) < 3rd percentile ≥ 3rd percentile. Between congenital heart disease, placental pathology, and brain lesions in this hypothesis-generating study. In the context of a prospective observational study[10,11], we describe the prevalence and scope of placental pathology findings in a cohort of pregnancies with fetal CHD, describe the relationship of placental abnormalities to type of CHD lesion, and evaluate whether placental findings are associated with postnatal, pre-operative brain lesions in pregnancies complicated by fetal CHD

Methods

Results

Conclusion