Williams Ismée A, Fifer William P, Andrews Howard
Division of Pediatric Cardiology, Department of Pediatrics, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, 3959 Broadway, New York, NY, 10032, USA,
Pediatr Cardiol. 2015 Aug;36(6):1135-44. doi: 10.1007/s00246-015-1132-6. Epub 2015 Mar 10.
We evaluated differences in growth between fetuses with and without congenital heart disease (CHD) and tested associations between growth and early childhood neurodevelopment (ND). In this prospective cohort study, fetuses with hypoplastic left heart syndrome (HLHS), transposition of the great arteries (TGA), and tetralogy of Fallot (TOF) and controls had biparietal diameter (BPD), head (HC) and abdominal circumference (AC), femur length (FL), and estimated fetal weight (EFW) recorded serially during pregnancy at 18-26 weeks GA (F1), at 27-33 weeks GA (F2), and at 34-40 weeks GA (F3). CHD subjects underwent Bayley Scales of Infant Development-III ND testing at 18 months. Differences between CHD fetuses and controls were assessed using t tests and generalized linear modeling. Correlations between biometry and ND informed regression modeling. We enrolled 41 controls and 68 fetuses with CHD (N = 24 HLHS, N = 21 TGA, N = 23 TOF), 46 of whom had ND scores available. At 18-26 weeks, CHD fetuses were smaller than controls in all biometric parameters. Differences in growth rates were observed for HC, BPD, and AC, but not for FL or EFW. Cognitive score correlated with HC/AC at F2 (r = -0.33, P = 0.04) and mean HC/AC across gestation (r = -0.35, P = 0.03). Language correlated with FL/BPD at F2 (r = 0.34, P = 0.04). In stepwise linear regression, mean HC/AC predicted Cognition (B = -102, P = 0.026, R (2) = 0.13) and FL/BPD at F2 predicted Language score (B = 127, P = 0.03, R (2) = 0.12). Differences in growth between CHD fetuses and controls can be measured early in pregnancy. In CHD fetuses, larger abdominal relative to head circumference is associated with better 18-month neurodevelopment.
我们评估了患有和未患有先天性心脏病（CHD）的胎儿之间的生长差异，并测试了生长与幼儿神经发育（ND）之间的关联。在这项前瞻性队列研究中，患有左心发育不全综合征（HLHS）、大动脉转位（TGA）和法洛四联症（TOF）的胎儿及对照组在妊娠18 - 26周龄（F1）、27 - 33周龄（F2）和34 - 40周龄（F3）期间，连续记录双顶径（BPD）、头围（HC）、腹围（AC）、股骨长度（FL）和估计胎儿体重（EFW）。患有CHD的受试者在18个月时接受贝利婴幼儿发育量表第三版的ND测试。使用t检验和广义线性模型评估CHD胎儿与对照组之间的差异。生物测量与ND之间的相关性为回归模型提供了依据。我们纳入了41名对照组和68名患有CHD的胎儿（N = 24例HLHS，N = 21例TGA，N = 23例TOF），其中46例有ND评分。在18 - 26周时，CHD胎儿在所有生物测量参数上均小于对照组。观察到HC、BPD和AC的生长速率存在差异，但FL或EFW没有差异。认知评分与F2时的HC/AC相关（r = -0.33，P = 0.04）以及整个妊娠期的平均HC/AC相关（r = -0.35，P = 0.03）。语言能力与F2时的FL/BPD相关（r = 0.34，P = 0.04）。在逐步线性回归中，平均HC/AC预测认知能力（B = -102，P = 0.026，R (2) = 0.13），F2时的FL/BPD预测语言评分（B = 127，P = 0.03，R (2) = 0.12）。CHD胎儿与对照组之间的生长差异在妊娠早期即可测量。在CHD胎儿中，相对于头围较大的腹围与18个月时更好的神经发育相关。
