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Fetal Growth and Neurodevelopmental Outcome in Congenital Heart Disease

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Abstract

We evaluated differences in growth between fetuses with and without congenital heart disease (CHD) and tested associations between growth and early childhood neurodevelopment (ND). In this prospective cohort study, fetuses with hypoplastic left heart syndrome (HLHS), transposition of the great arteries (TGA), and tetralogy of Fallot (TOF) and controls had biparietal diameter (BPD), head (HC) and abdominal circumference (AC), femur length (FL), and estimated fetal weight (EFW) recorded serially during pregnancy at 18–26 weeks GA (F1), at 27–33 weeks GA (F2), and at 34–40 weeks GA (F3). CHD subjects underwent Bayley Scales of Infant Development-III ND testing at 18 months. Differences between CHD fetuses and controls were assessed using t tests and generalized linear modeling. Correlations between biometry and ND informed regression modeling. We enrolled 41 controls and 68 fetuses with CHD (N = 24 HLHS, N = 21 TGA, N = 23 TOF), 46 of whom had ND scores available. At 18–26 weeks, CHD fetuses were smaller than controls in all biometric parameters. Differences in growth rates were observed for HC, BPD, and AC, but not for FL or EFW. Cognitive score correlated with HC/AC at F2 (r = −0.33, P = 0.04) and mean HC/AC across gestation (r = −0.35, P = 0.03). Language correlated with FL/BPD at F2 (r = 0.34, P = 0.04). In stepwise linear regression, mean HC/AC predicted Cognition (B = −102, P = 0.026, R 2 = 0.13) and FL/BPD at F2 predicted Language score (B = 127, P = 0.03, R 2 = 0.12). Differences in growth between CHD fetuses and controls can be measured early in pregnancy. In CHD fetuses, larger abdominal relative to head circumference is associated with better 18-month neurodevelopment.

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Acknowledgments

I.A. Williams received support from Grant No. 1K23HD061601 from the National Institute of Child Health & Human Development of the National Institutes of Health and from the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant Number UL1 TR000040. The contents of this paper are solely the responsibility of the authors and do not necessarily represent the official views of the National Institute of Child Health & Human Development.

Conflict of interest

The authors declare that they have no conflicts of interest or relationships to disclose beyond those listed above.

Ethical standard

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Authors and Affiliations

  1. Division of Pediatric Cardiology, Department of Pediatrics, Morgan Stanley Children’s Hospital of New York-Presbyterian, Columbia University Medical Center, 3959 Broadway, New York, NY, 10032, USA

    Ismée A. Williams & William P. Fifer

  2. Department of Developmental Psychobiology, New York State Psychiatric Institute, New York, NY, USA

    William P. Fifer

  3. Department of Biostatistics, Mailman School of Public Health, New York, NY, USA

    Howard Andrews

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  1. Ismée A. Williams
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  2. William P. Fifer
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  3. Howard Andrews
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Correspondence to Ismée A. Williams.

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Williams, I.A., Fifer, W.P. & Andrews, H. Fetal Growth and Neurodevelopmental Outcome in Congenital Heart Disease. Pediatr Cardiol 36, 1135–1144 (2015). https://doi.org/10.1007/s00246-015-1132-6

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  • DOI: https://doi.org/10.1007/s00246-015-1132-6

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