Neurological abnormalities tend to be more concentrated among infants with severe congenital heart disease (CHD) who were exposed to some placental lesions while in utero, a prospective single-center study shows. found.

The severity of placental pathology was negatively correlated with children’s cortical gray matter, cerebellum, and total brain volumes based on preoperative brain MRI taken at a median of 4 days after birth and 39.5 weeks postmenstrual.

Observed placental abnormalities included maternal vascular hypoperfusion lesions (46%), nucleated red blood cells (37%), chronic inflammatory lesions (35%), delayed maturation (30%), and It was reported that placenta weight (28%) was included. Manon Wenders, MD, PhD, Wilhelmina Children’s Hospital, Utrecht, Netherlands, and colleagues in the CHD Longevity Research Group.

“In summary, the placental abnormalities identified in this cohort indicate that the cause of placental pathology in CHD is likely multifactorial, including lesions of developmental origin and those resulting from altered maternal and fetal hemodynamics. ,” the authors write.inside American Heart Association Journal.

“Their data are the first to support the widespread hypothesis that placental abnormalities are intricately intertwined with brain development in CHD,” said Cynthia Ortinau, MD, of MSCI at Washington University in St. Louis and Boston’s writes Jane Neuberger, MD, MPH. Children’s Hospital and Harvard Medical School, in an accompanying editorial.

“Taken together, these data suggest that placental dysfunction has the greatest impact on brain regions that develop most rapidly during the third trimester, when metabolic requirements are higher than at other times.” two people commented.

Regarding brain injury in their study, Benders et al reported that the available scans did not show excessive ischemic or hemorrhagic brain injury with greater severity of placental pathology.

However, the editors suggested that this may be because the authors failed to account for some factors that may mediate the placenta-brain relationship. Exclusion criteria for this study included genetic or chromosomal disease, multiple pregnancy, gestational age <36 weeks at birth, or significant extracardiac abnormalities.

Previous studies have demonstrated that children with fetal congenital heart defects are at increased risk of postnatal brain damage and negative long-term neurodevelopmental outcomes. Despite continued improvements in treatments for severe CHD over the years, affected children “remain at risk for neurodevelopmental sequelae, including cognitive, motor, and behavioral problems. The reported incidence ranges from 20% to 60%,” Benders et al. noted. .

“While these neurological abnormalities are thought to be primarily due to brain vulnerability during the critical neonatal period following cardiac surgery, there is now evidence that brain abnormalities are already developing in utero. “is increasing,” the researchers wrote.

“Our findings highlight the importance of monitoring placental health and having the placenta evaluated by an experienced perinatal pathologist in pregnancies with fetal CHD,” said the Benders team. insisted. “Ultimately, targeting placental pathology may hold promise as a prenatal intervention to improve neurodevelopmental outcomes in CHD.”

For the study, Benders and colleagues collected placentas from 96 term singleton pregnancies in children who were diagnosed prenatally with severe isolated CHD and who were expected to undergo cardiac intervention within the first 6 months of life. was analyzed.

Most CHD cases included transposition of the aorta (31%), univentricular defect with aortic occlusion (24%), or biventricular defect with aortic arch occlusion (23%).

The babies’ placental pathology scores ranged from 0 to 33 with a median of 10, but the study authors acknowledged that they scored them according to an unvalidated scale.

Additionally, the lack of a control group precluded causal analysis.

“A myriad of complex and intersecting factors within the maternal and fetal environment can lead to abnormalities in placental and brain development, resulting in adverse postnatal neurological and developmental outcomes in CHD. “This may become more likely,” the editorialists warned.

“Whether the placental abnormalities reflect early developmental abnormalities due to genetic/epigenetic disorders that also cause defects in the fetal heart or brain, or whether the fetal heart defects may be caused by hemodynamic changes in the placenta and the fetal brain. “It is still unclear whether this causes abnormalities in CHD or whether additional pathways are involved. Typical development of the placenta and the entire brain is disrupted in CHD,” Ortinau and Neuberger write.