Fetal Umbilical Arterial Pulsatility Correlates With 2-Year Growth and Neurodevelopmental Outcomes in Congenital Heart Disease

ABSTRACT Background Children with congenital heart disease (CHD) are at risk of adverse long-term neurodevelopmental outcomes believed in part secondary to prenatal insults. Placental pathology and altered fetal middle cerebral arterial (MCA) flow suggestive of brain sparing have been documented in fetal CHD. Methods We included children with d-TGA and HLHS who had a 3rd trimester fetal echocardiogram between 2004 and 2014 at which time UA and MCA pulsatility indices (PI) were measured. All underwent 2-year growth and neurodevelopmental assessments. Results We identified 24 children with d-TGA and 36 with HLHS. Mean age at fetal echocardiography was 33.8 ± 3.5 weeks. At 2-year follow-up, head circumference z-score(SD) was -0.09(1.07) and 0.17(1.7) for the d-TGA and HLHS groups, respectively. The Bayley III mean(SD) cognitive, language and motor scores were 97.7(10.8), 94.7(13.4) and 98.6(8.6) for the d-TGA group; and 90.3(13.9), 87.2(17.5) and 85.3(16.2) for the HLHS group. On multivariate linear regression analysis, UA-PI was associated (effect sizes (95% CI)) with length (-1.45 (-2.7, -0.17), p=0.027), weight (-1.46 (-2.6 to -0.30), p=0.015) and cognitive scores (-14.86 (-29.95 to 0.23), p=0.05) at 2 years of age. MCA PI showed no statistically significant correlation. Conclusions In fetal d-TGA and HLHS, a higher UA-PI in the 3rd trimester, suggestive of placental insufficiency, but not MCA-PI, is associated with worse 2-year growth and neurodevelopment.