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Neonatal Follow-up

NICU Follow Up and Neurodevelopment 3: Impact of the Prenatal Environment on Development and Outcomes

224 - Abnormal Placental Pathology is Associated with Worse Neurodevelopmental Outcomes in Children with Congenital Heart Disease

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 224
Publication Number: 224.143

Kelly L. Meyer, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Clare B. O'Hare, Cleveland Clinic Children's, Cleveland, OH, United States; Mai He, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Avihu Z. Gazit, Washington University in St. Louis School of Medicine, St Louis, MO, United States; Gillian S. Sloane Mayersohn, St. Louis Children's Hospital, St. Louis, MO, United States; Anthony Odibo, Washington University in St. Louis School of Medicine, Saint Louis, MO, United States; Cynthia Ortinau, Washington University in St. Louis School of Medicine, St. Louis, MO, United States

Presenting Author(s)

Kelly L. Meyer, MD (she/her/hers)

Neonatology Fellow
Washington University in St. Louis School of Medicine
St. Louis, Missouri, United States

Background: Neurodevelopmental impairments are common for children with congenital heart disease (CHD). Many postnatal medical and surgical factors contribute to neurodevelopment, but prenatal contributors are still poorly understood. Placental abnormalities increase risk of adverse neurodevelopmental outcomes in other neonatal populations, thus may be important for CHD.

Objective: Associate placental vascular abnormalities with neurodevelopmental outcomes in children with CHD.

Design/Methods:

A single center retrospective cohort study was performed. Singleton term infants born March 2013-July 2019 with a prenatal diagnosis of moderate to severe CHD were included. Exclusion criteria were lack of placental pathology data, unknown gestational age at birth, and multi-gestation pregnancy. Placental vascular abnormalities were classified as maternal vascular malperfusion (MVM), fetal vascular malperfusion (FVM), or delayed villous maturation (DVM) using the Amsterdam criteria. The primary outcomes were composite cognitive, language, and motor scores on the Bayley Scales of Infant and Toddler Development – Third Edition (Bayley-III) with secondary analysis performed on scaled sub-scores. Multivariable regression models with a backward stepwise approach were used to evaluate the association between placental vascular abnormalities and neurodevelopmental outcomes.

Results: Fifty infants were included in the study with placental pathology and Bayley-III data. Cohort characteristics are summarized in Table 1. The mean age at Bayley testing was 21 months with a range of 12-40 months. Mean (standard deviation) composite scores were: cognitive 87.8 (17.1), language 86.5 (19), and motor 86 (19.1). In the multivariable regression models, placental vascular abnormalities were associated with a 13.4 point lower language composite score and a 12.6 point lower motor composite score (Table 2). A number of maternal and infant characteristics predicted lower Bayley-III scores, with final models explaining 22-39% of the variance in outcome across domains.

Conclusion(s): This study is the first to demonstrate that placental pathology predicts neurodevelopmental outcomes in children with CHD. Placental vascular abnormalities relate to lower language and motor outcomes even after adjusting for maternal and infant factors. Longer term neurodevelopmental follow up may prove more insightful for associations with cognitive development.