Fetal major cardiac defects and placental dysfunction at 11-13 weeks' gestation

Objectives: To investigate the relationship between fetal major cardiac defects and markers of placental perfusion and function.

Methods: This was a prospective screening study in singleton pregnancies at 11-13 weeks’ gestation. Uterine artery pulsatility index (UTPI), serum pregnancy associated plasma protein-A (PAPP-A) and placental growth factor (PLGF) were measured and the values were converted into multiples of the normal median (MoM). Median MoM values in fetuses with isolated major cardiac defects were compared to those in fetuses without major defects.

Results: The 50,094 singleton pregnancies fulfilling the entry criteria included 49,898 pregnancies with a normal cardiac anatomy and 196 (0.39%) with major congenital cardiac defects; 73 (37.2%) with conotruncal defects, 63 (32.1%) with left ventricular outflow tract (LVOT) defects and 60 (30.6%) with valvular defects. In the group of cardiac defects, compared to controls, there was lower median PAPP-A MoM (0.81 vs 1.00, p<0.0001) and PLGF MoM (0.78 vs 1.00, p<0.0001) but no significant difference in UTPI MoM (1.01 vs 1.00, p=0.162).

Conclusions: In pregnancies with isolated major cardiac defects there is evidence of placental dysfunction in the absence of impaired placental perfusion.

Fetal Medicine Foundation. Grant Number: 1037116