Department of Obstetrics and Prenatal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands.
Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK.
Acta Obstet Gynecol Scand. 2019 Dec;98(12):1595-1602. doi: 10.1111/aogs.13687. Epub 2019 Aug 24.
Congenital heart defects are associated with neurodevelopmental delay. It is hypothesized that fetuses affected by congenital heart defect have altered cerebral oxygen perfusion and are therefore prone to delay in cortical maturation. The aim of this study was to determine the difference in fetal brain age between consecutive congenital heart defect cases and controls in the second and third trimester using ultrasound.
Since 2014, we have included 90 isolated severe congenital heart defect cases in the Heart And Neurodevelopment (HAND)-study. Every 4 weeks, detailed neurosonography was performed in these fetuses, including the recording of a 3D volume of the fetal brain, from 20 weeks onwards. In all, 75 healthy fetuses underwent the same protocol to serve as a control group. The volumes were analyzed by automated age prediction software which determines gestational age by the assessment of cortical maturation.
In total, 477 volumes were analyzed using the age prediction software (199 volumes of 90 congenital heart defect cases; 278 volumes of 75 controls). Of these, 16 (3.2%) volume recordings were excluded because of imaging quality. The age distribution was 19-33 weeks. Mixed model analysis showed that the age predicted by brain maturation was 3 days delayed compared with the control group (P = .002).
This study shows that fetuses with isolated cases of congenital heart defects show some delay in cortical maturation as compared with healthy control cases. The clinical relevance of this small difference is debatable. This finding was consistent throughout pregnancy and did not progress during the third trimester.
先天性心脏缺陷与神经发育迟缓有关。据推测，患有先天性心脏缺陷的胎儿大脑氧灌注发生改变，因此皮质成熟延迟的风险较高。本研究旨在通过超声检查确定连续先天性心脏缺陷病例与对照组胎儿在第二和第三孕期大脑年龄的差异。
自 2014 年以来，我们已经将 90 例孤立性严重先天性心脏缺陷病例纳入心脏和神经发育（HAND）研究中。这些胎儿每 4 周进行一次详细的神经超声检查，包括从 20 周开始记录胎儿大脑的 3D 容积。共有 75 名健康胎儿接受了相同的方案作为对照组。使用自动年龄预测软件分析容积，该软件通过评估皮质成熟度来确定胎龄。
共使用年龄预测软件分析了 477 个容积（90 例先天性心脏缺陷病例的 199 个容积；75 例对照组的 278 个容积）。其中，由于成像质量，有 16 个（3.2%）容积记录被排除。年龄分布为 19-33 周。混合模型分析显示，与对照组相比，大脑成熟预测的年龄延迟了 3 天（P=0.002）。
本研究表明，与健康对照组相比，孤立性先天性心脏缺陷胎儿的皮质成熟存在一定延迟。这种微小差异的临床意义尚存在争议。这一发现贯穿整个孕期，在第三个孕期没有进展。
