The placenta in fetal congenital heart disease

Abstract

Improvements in prenatal diagnostics and neonatal care have increased survival rates for newborns with congenital heart defects (CHD), shifting focus to long-term neurodevelopment. Neurodevelopmental delays, often present in utero, are linked to abnormal placental development in CHD pregnancies. Chapter 1 introduces this topic, while Chapter 2 reviews literature on fetal CHD and placental development, highlighting placental abnormalities and altered gene expression in CHD cases. Chapter 3 presents a pilot study comparing placental characteristics in CHD and healthy cases, revealing delayed maturation, maternal vascular malperfusion, and fetal hypoxia in CHD placentas. Chapter 4, a prospective study, confirms more placental abnormalities in CHD cases, even in less severe defects. These findings suggest that placental issues are not solely due to hemodynamic changes but may result from early embryological developmental defects. Chapter 5 discusses mRNA expression of genes related to hypoxia and angiogenesis, but no direct correlation with CHD is found. Chapter 6 explores causes of fetal demise in CHD cases, identifying placental insufficiency as a contributing factor. Chapters 7 and 8 highlight the higher incidence of pregnancy complications in CHD cases, with placental issues playing a major role. Chapter 9 describes an animal model for further research. Finally, Chapter 10 discusses the clinical implications and future research directions.