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The Relationship Between Placental Pathology and Neurodevelopmental Outcomes in Complex Congenital Heart Disease

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Abstract

Complex congenital heart disease (CCHD) is associated with impaired neurodevelopmental outcomes. Peri- and post-operative factors are known contributors while the impact of the prenatal environment is not yet delineated. Variations in fetal circulation, seen in transposition of the great arteries (TGA) and single ventricular physiology (SVP), are associated with placenta abnormalities. These abnormalities may be associated with placental insufficiency, a risk factor for poor neurodevelopmental outcomes. We hypothesized there is a correlation between placental pathology and impaired neurodevelopmental outcomes in patients with CCHD. We performed a single center retrospective cohort study with patients with TGA and SVP from 2010 to 2017 at Children’s Wisconsin. Patient variables were obtained from the medical record. Bayley Scales of Infant Development Third Edition standard scores for cognitive, motor, and language performance were collected from neurodevelopmental visits. Placenta pathology reports were reviewed with tabulation of predetermined anatomical and pathological characteristics. We identified 79 patients in our cohort and 61 (77.2%) had abnormal placentas. There was no significant difference between the two groups in any demographic or clinical variables. For cognitive and motor performance, without adjusting for the covariates, infants with placental abnormalities had significantly lower scores compared to infants without (p = 0.026, p = 0.045 respectively). Conversely, there was no significant difference in language scores between the two groups (p = 0.12). Placenta abnormalities are common in patients with CCHD, and placenta abnormalities are associated with impaired neurodevelopmental outcomes. These results underscore the complex causal pathways of neurodevelopmental impairment in infants with CCHD and offer opportunities for targeted postnatal developmental interventions after discharge.

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Acknowledgements

Statistical support was provided through the Division of Quantitative Health Sciences. We would like to thank the Divisions of Pediatric Cardiology and Neonatology for their support as well as the Master’s in Clinical and Translational Research program through the Medical College of Wisconsin and the Clinical and Translational Science Institute of Southeast Wisconsin.

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No funding was utilized for this study.

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Authors and Affiliations

  1. 8915 W Connell Ct, Milwaukee, WI, 53226-3067, USA

    David E. Segar, Jian Zhang, Ke Yan, Aidan Reid, Michele Frommelt & Susan Cohen

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  1. David E. Segar
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  2. Jian Zhang
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  3. Ke Yan
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  4. Aidan Reid
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  5. Michele Frommelt
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  6. Susan Cohen
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Contributions

DS was the primary author of the manuscript text and prepared figures 1-2 and the tables. JZ and KY performed the statistical analysis and data for tables 1-4 and prepared figure 3. AR contributed to data analysis. M.F developed the project. SC contributed to drafting of the manuscript and provided supervision in all aspects throughout the project. All authors reviewed the manuscript

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Correspondence to David E. Segar.

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This was a retrospective study for which no data was generated, and a waiver of consent was approved by our IRB.

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Segar, D.E., Zhang, J., Yan, K. et al. The Relationship Between Placental Pathology and Neurodevelopmental Outcomes in Complex Congenital Heart Disease. Pediatr Cardiol 44, 1143–1149 (2023). https://doi.org/10.1007/s00246-022-03018-4

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