Andescavage Nickie N, Limperopoulos Catherine
Division of Neonatology, Children's National Health System, Washington, DC, USA.
Department of Pediatrics, George Washington University School of Medicine, Washington, DC, USA.
Transl Pediatr. 2021 Aug;10(8):2148-2156. doi: 10.21037/tp-20-347.
Congenital heart disease (CHD) remains the most common birth defect in infants, and critical CHD is associated with significant rates of morbidity and mortality. With the advent of powerful yet noninvasive advanced fetal imaging, it is becoming increasingly evident that the presence of CHD in utero disrupts typical development and contributes to the lifelong morbidity in this population. Across healthy and high-risk populations, intrauterine influences can permanently alter fetal development that may manifest in complex morbidities later in life, the so-called fetal-onset-of-adult-disease (FOAD) phenomenon. The placenta plays a critical role in not only supporting fetal development, but also by adapting to specific intrauterine conditions. The role of placental health, adaptation and dysfunction, however, in CHD is not well understood. In this article, we will review current evidence relating placental health in CHD, appraise existing knowledge-gaps in the field and highlight promising new avenues to better understand the impact of placental function on fetal well-being. We will review evidence of human placental studies that describe abnormal placental findings in pregnancies complicated by CHD, as well evidence for assessments of the human placenta. While overall clinical assessments of placental development are rather limited, we will also review emerging evidence from advanced quantitative and functional magnetic resonance imaging that are bringing new insights into placental structure and function throughout gestation. By providing novel information about placental development, we can now explore the maternal-fetal-placental connection in greater detail, and better understand the multi-factorial mechanisms that may contribute to adverse outcomes seen in survivors of CHD.
先天性心脏病（CHD）仍是婴儿中最常见的出生缺陷，严重的先天性心脏病与较高的发病率和死亡率相关。随着强大且无创的先进胎儿成像技术的出现，越来越明显的是，子宫内先天性心脏病的存在会干扰典型发育，并导致该人群的终身发病。在健康和高危人群中，子宫内的影响会永久性地改变胎儿发育，这可能在以后的生活中表现为复杂的疾病，即所谓的成人疾病胎儿起源（FOAD）现象。胎盘不仅在支持胎儿发育方面起着关键作用，而且还能适应特定的子宫内环境。然而，胎盘健康、适应和功能障碍在先天性心脏病中的作用尚未得到充分了解。在本文中，我们将回顾目前有关先天性心脏病中胎盘健康的证据，评估该领域现有的知识空白，并强调有前景的新途径，以更好地理解胎盘功能对胎儿健康的影响。我们将回顾人类胎盘研究的证据，这些研究描述了患有先天性心脏病的妊娠中胎盘异常的发现，以及对人类胎盘评估的证据。虽然对胎盘发育的总体临床评估相当有限，但我们还将回顾先进的定量和功能磁共振成像的新证据，这些证据为整个妊娠期胎盘的结构和功能带来了新的见解。通过提供有关胎盘发育的新信息，我们现在可以更详细地探索母胎胎盘连接，并更好地理解可能导致先天性心脏病幸存者出现不良后果的多因素机制。
