Moray Amol A, Robertson Charlene M T, Bond Gwen Y, Abeysekera Jayani B, Mohammadian Parsa, Dinu Irina A, Atallah Joseph, Switzer Heather N, Hornberger Lisa K
Fetal & Neonatal Cardiology Program, University of Alberta, Edmonton, AB, Canada.
Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
Pediatr Cardiol. 2023 Apr;44(4):816-825. doi: 10.1007/s00246-022-03062-0. Epub 2023 Mar 11.
Major congenital heart disease (CHD) is associated with impaired neurodevelopment (ND), partly from prenatal insults. In this study we explore associations between 2nd and 3rd trimester umbilical (UA) and middle cerebral artery (MCA) pulsatility index (PI = systolic-diastolic velocities/mean velocity) in fetuses with major CHD and 2-year ND and growth outcomes. Eligible patients included those with a prenatal diagnosis of CHD from 2007 to 2017 without a genetic syndrome who underwent previously defined cardiac surgeries and 2-year biometric and ND assessments in our program. UA and MCA-PI Z-scores at fetal echocardiography were examined for relationships with 2-year Bayley Scales of Infant and Toddler Development and biometric Z-scores. Data from 147 children was analyzed. Second and 3rd trimester fetal echocardiograms were performed at 22.4 ± 3.7 and 34.7 ± 2.9 weeks (mean ± SD), respectively. Multivariable regression analysis showed an inverse relationship between 3rd trimester UA-PI for all CHD and cognitive - 1.98 (- 3.37, - 0.59), motor - 2.57 (- 4.15, - 0.99), and language - 1.67 (- 3.3, - 0.03) (effect size and 95th confidence interval) ND domains (p < 0.05), with the strongest relationships in the single ventricle and hypoplastic left heart syndrome subgroups. No association was found for 2nd trimester UA-PI or any trimester MCA-PI and ND or between UA or MCA-PI and 2-year growth parameters. Increased 3rd trimester UA-PI, reflecting an altered late gestation fetoplacental circulation, relates to worse 2-year ND in all domains.
重大先天性心脏病（CHD）与神经发育（ND）受损有关，部分原因是产前受到损伤。在本研究中，我们探讨了患有重大CHD的胎儿在孕中期和孕晚期的脐动脉（UA）和大脑中动脉（MCA）搏动指数（PI =收缩期 - 舒张期速度/平均速度）与2岁时的神经发育和生长结局之间的关联。符合条件的患者包括2007年至2017年间产前诊断为CHD且无遗传综合征、接受过先前定义的心脏手术以及在我们项目中进行了2年生物特征和神经发育评估的患者。检查胎儿超声心动图时的UA和MCA - PI Z评分与2岁时贝利婴幼儿发育量表及生物特征Z评分之间的关系。对147名儿童的数据进行了分析。孕中期和孕晚期胎儿超声心动图检查分别在22.4±3.7周和34.7±2.9周（均值±标准差）进行。多变量回归分析显示，所有CHD患者孕晚期UA - PI与认知（效应量和95%置信区间为 - 1.98（- 3.37，- 0.59））、运动（- 2.57（- 4.15，- 0.99））和语言（- 1.67（- 3.3，- 0.03））神经发育领域呈负相关（p < 0.05），在单心室和左心发育不全综合征亚组中关系最强。未发现孕中期UA - PI或任何孕周的MCA - PI与神经发育之间存在关联，也未发现UA或MCA - PI与2年生长参数之间存在关联。孕晚期UA - PI升高反映了妊娠晚期胎儿 - 胎盘循环改变，与所有领域2年神经发育较差有关。
