Patterns of prenatal growth among infants with cardiovascular malformations: possible fetal hemodynamic effects.

This study characterized fetal growth differences among control infants (n= 276) and infants with d-transposition of the great arteries (TGA) (n = 69), tetralogy of Fallot (n = 66), hypoplastic left heart syndrome (n = 51), and coarctation of the aorta (n = 65), thus permitting assessment of competing theories about the relation between these cardiovascular malformations and fetal growth disturbance. Subjects were liveborn singletons without genetic or extra-cardiovascular structural abnormalities sampled from the Baltimore-Washington Infant Study. Multivariate analysis of covariance was performed: birth weight, birth length, newborn head circumference, and two nonlinear functions of these measures were regressed jointly on a diagnostic class variable and covariates. Differences in the vectors of dependent variable means across diagnostic groups were striking (p < 0.0001). Infants with TGA had normal birth weight, but lesser head volume relative to birth weight. Infants with tetralogy of Fallot were smaller in all measured dimensions, but they were shaped normally. Infants with hypoplastic left heart syndrome were smaller in all measured dimensions, and head volume was disproportionately small relative to birth weight. Infants with coarctation of the aorta had lower birth weight, shorter birth length, and greater head volume relative to birth weight. These findings suggest that fetal circulatory abnormalities may predict abnormal patterns of fetal growth.