Abstract
Background:
Fetal growth abnormalities in hypoplastic left heart syndrome (HLHS) have been documented primarily by birth measurements. Fetal growth trajectory has not been described. We hypothesized that fetal growth trajectory declines across late gestation in this population.
Methods:
Infants with a prenatal diagnosis of HLHS and no history of prematurity or a genetic syndrome were identified. Fetal ultrasound measurements and birth anthropometrics were obtained from clinical records. z-Scores for estimated fetal weight (EFWz) and birth weight (BWTz) were compared. BWTz for three neonatal standards were compared.
Results:
Paired fetal and neonatal data were identified in 33 cases of HLHS. Mean gestational age at ultrasound and birth were 27 and 38 wk, respectively. BWTz was lower than EFWz by a mean of 0.82 (SD: 0.72, P < 0.0001), with 64% of subjects demonstrating a decrease in z-score of >0.5. Umbilical artery (UA) Doppler found no evidence of significant placental insufficiency. Modest differences in BWTz were seen across BWT standards in this cohort.
Conclusion:
The majority of fetuses with HLHS demonstrate decreased growth velocity during later pregnancy, suggesting growth abnormalities manifest in utero. The potential relationship to future clinical outcomes warrants further study.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Curzon CL, Milford-Beland S, Li JS, et al. Cardiac surgery in infants with low birth weight is associated with increased mortality: analysis of the Society of Thoracic Surgeons Congenital Heart Database. J Thorac Cardiovasc Surg 2008;135:546–51.
Karamlou T, McCrindle BW, Blackstone EH, et al. Lesion-specific outcomes in neonates undergoing congenital heart surgery are related predominantly to patient and management factors rather than institution or surgeon experience: A Congenital Heart Surgeons Society Study. J Thorac Cardiovasc Surg 2010;139:569–77 e1.
Gaynor JW, Wernovsky G, Jarvik GP, et al. Patient characteristics are important determinants of neurodevelopmental outcome at one year of age after neonatal and infant cardiac surgery. J Thorac Cardiovasc Surg 2007;133:1344–53, 1353.e1–3.
Atz AM, Travison TG, Williams IA, et al.; Pediatric Heart Network Investigators. Prenatal diagnosis and risk factors for preoperative death in neonates with single right ventricle and systemic outflow obstruction: screening data from the Pediatric Heart Network Single Ventricle Reconstruction Trial(*). J Thorac Cardiovasc Surg 2010;140:1245–50.
Williams RV, Ravishankar C, Zak V, et al.; Pediatric Heart Network Investigators. Birth weight and prematurity in infants with single ventricle physiology: pediatric heart network infant single ventricle trial screened population. Congenit Heart Dis 2010;5:96–103.
Freathy RM, Mook-Kanamori DO, Sovio U, et al.; Genetic Investigation of ANthropometric Traits (GIANT) Consortium; Meta-Analyses of Glucose and Insulin-related traits Consortium; Wellcome Trust Case Control Consortium; Early Growth Genetics (EGG) Consortium. Variants in ADCY5 and near CCNL1 are associated with fetal growth and birth weight. Nat Genet 2010;42:430–5.
Knight B, Shields BM, Turner M, Powell RJ, Yajnik CS, Hattersley AT . Evidence of genetic regulation of fetal longitudinal growth. Early Hum Dev 2005;81:823–31.
Blumenshine P, Egerter S, Barclay CJ, Cubbin C, Braveman PA . Socioeconomic disparities in adverse birth outcomes: a systematic review. Am J Prev Med 2010;39:263–72.
Bloomfield FH, Oliver MH, Harding JE . The late effects of fetal growth patterns. Arch Dis Child Fetal Neonatal Ed 2006;91:F299–304.
van Batenburg-Eddes T, de Groot L, Steegers EA, et al. Fetal programming of infant neuromotor development: the generation R study. Pediatr Res 2010;67:132–7.
Verburg BO, Steegers EA, De Ridder M, et al. New charts for ultrasound dating of pregnancy and assessment of fetal growth: longitudinal data from a population-based cohort study. Ultrasound Obstet Gynecol 2008;31:388–96.
Marsál K, Persson PH, Larsen T, Lilja H, Selbing A, Sultan B . Intrauterine growth curves based on ultrasonically estimated foetal weights. Acta Paediatr 1996;85:843–8.
Oken E, Kleinman KP, Rich-Edwards J, Gillman MW . A nearly continuous measure of birth weight for gestational age using a United States national reference. BMC Pediatr 2003;3:6.
Olsen IE, Groveman SA, Lawson ML, Clark RH, Zemel BS . New intrauterine growth curves based on United States data. Pediatrics 2010;125:e214–24.
Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M . A United States national reference for fetal growth. Obstet Gynecol 1996;87:163–8.
Kuczmarski RJ, Ogden CL, Guo SS, et al. 2000 CDC Growth Charts for the United States: methods and development. Vital Health Stat 11 2002;246:1–190.
de Onis M, Garza C, Victora CG, Onyango AW, Frongillo EA, Martines J . The WHO Multicentre Growth Reference Study: planning, study design, and methodology. Food Nutr Bull 2004;25:Suppl 1:S15–26.
Cnota JF, Gupta R, Michelfelder EC, Ittenbach RF . Congenital heart disease infant death rates decrease as gestational age advances from 34 to 40 weeks. J Pediatr 2011;159:761–5.
Costello JM, Polito A, Brown DW, et al. Birth before 39 weeks’ gestation is associated with worse outcomes in neonates with heart disease. Pediatrics 2010;126:277–84.
Shillingford AJ, Ittenbach RF, Marino BS, et al. Aortic morphometry and microcephaly in hypoplastic left heart syndrome. Cardiol Young 2007;17:189–95.
Hinton RB, Andelfinger G, Sekar P, et al. Prenatal head growth and white matter injury in hypoplastic left heart syndrome. Pediatr Res 2008;64:364–9.
Barbu D, Mert I, Kruger M, Bahado-Singh RO . Evidence of fetal central nervous system injury in isolated congenital heart defects: microcephaly at birth. Am J Obstet Gynecol 2009;201:43.e1–7.
Donofrio MT, Bremer YA, Schieken RM, et al. Autoregulation of cerebral blood flow in fetuses with congenital heart disease: the brain sparing effect. Pediatr Cardiol 2003;24:436–43.
Berg C, Gembruch O, Gembruch U, Geipel A . Doppler indices of the middle cerebral artery in fetuses with cardiac defects theoretically associated with impaired cerebral oxygen delivery in utero: is there a brain-sparing effect? Ultrasound Obstet Gynecol 2009;34:666–72.
Hangge PT, Cnota JF, Woo JG, et al. Microcephaly is associated with early adverse neurologic outcomes in hypoplastic left heart syndrome. Pediatr Res 2013; e-pub ahead of print 10 April 2013.
de Onis M, Garza C, Onyango AW, Borghi E . Comparison of the WHO child growth standards and the CDC 2000 growth charts. J Nutr 2007;137:144–8.
Fry AG, Bernstein IM, Badger GJ . Comparison of fetal growth estimates based on birth weight and ultrasound references. J Matern Fetal Neonatal Med 2002;12:247–52.
Ben-Haroush A, Yogev Y, Bar J, et al. Accuracy of sonographically estimated fetal weight in 840 women with different pregnancy complications prior to induction of labor. Ultrasound Obstet Gynecol 2004;23:172–6.
Hadlock FP, Harrist RB, Carpenter RJ, Deter RL, Park SK . Sonographic estimation of fetal weight. The value of femur length in addition to head and abdomen measurements. Radiology 1984;150:535–40.
Hadlock FP, Harrist RB, Sharman RS, Deter RL, Park SK . Estimation of fetal weight with the use of head, body, and femur measurements–a prospective study. Am J Obstet Gynecol 1985;151:333–7.
Burnham N, Ittenbach RF, Stallings VA, et al. Genetic factors are important determinants of impaired growth after infant cardiac surgery. J Thorac Cardiovasc Surg 2010;140:144–9.
Rychik J, Ayres N, Cuneo B, et al. American Society of Echocardiography guidelines and standards for performance of the fetal echocardiogram. J Am Soc Echocardiogr 2004;17:803–10.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cnota, J., Hangge, P., Wang, Y. et al. Somatic growth trajectory in the fetus with hypoplastic left heart syndrome. Pediatr Res 74, 284–289 (2013). https://doi.org/10.1038/pr.2013.100
Received:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/pr.2013.100
This article is cited by
-
Application of the INTERGROWTH-21st chart compared to customized growth charts in fetuses with left heart obstruction: late trimester biometry, cerebroplacental hemodynamics and perinatal outcome
Archives of Gynecology and Obstetrics (2019)
-
Fetal somatic growth trajectory differs by type of congenital heart disease
Pediatric Research (2018)
-
In Utero Evidence of Impaired Somatic Growth in Hypoplastic Left Heart Syndrome
Pediatric Cardiology (2017)
