(548) Small for gestational age is not associated with maternal vascular malperfusion in congenital heart disease

Thursday, February 9, 2023

4:00 PM – 5:30 PM

Objective: Maternal congenital heart disease (CHD) in pregnancy is associated with poor fetal growth and increased risk for small for gestational age (SGA) infants, plausibly through abnormal placental development and vascular function. We aimed to elucidate the relationship between SGA and placental pathology in pregnancies affected by maternal CHD.

Study Design: Retrospective cohort study of 53 pregnant patients with maternal CHD that delivered at a single quaternary care center. Demographic and clinical information were abstracted from the electronic medical record and placentas underwent histopathological evaluation. Chi square (Fisher’s exact) test, and Student’s T-test were used to compare demographics, clinical characteristics, and placental histopathological findings between pregnancies with and without SGA.

Results:

53 placentas underwent histopathological evaluation. 28 placentas (52.8%) showed evidence of maternal vascular malperfusion. The most common findings of maternal vascular malperfusion were infarction (17%), subchorionic hematoma (15.1%), and placental abruption (11.6%). 12 participants (23%) had fetuses with SGA. Pregnancies with SGA were more likely to have lower birth weight to placental weight ratios (BW:PW < 3^rd%ile p=0.048; BW:PW < 10^th%ile p=0.009) on histopathologic evaluation compared with those without SGA. Pregnancies with or without SGA did not demonstrate a significant difference in maternal vascular malperfusion (p=0.34). There were similar rates of infarction (p=0.41), thrombosis (p=0.07), chorangiosis (p=0.55), hypomature villus (p=1.00), subchorionic hematoma (p=1.00), and placental abruption (p=0.61).

Conclusion: SGA was common among pregnancies with maternal CHD, but was not associated with maternal vascular malperfusion. Instead, alternative factors, including maternal hemodynamics and hypoxia, require further investigation as potential etiologies for SGA in pregnancies with maternal CHD.

Primary & Presenting Author(s)

Marie Altendahl, BA
Medical Student
University of California, Los Angeles
Los Angeles, California, United States

Coauthor(s)

Thalia Mok, MD
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles
Los Angeles, California, United States
EA
Ekene Adinkpayah, N/A
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles (UCLA)
Los Angeles, California, United States
JG
Jeffrey Goldstein, MD
Department of Pathology, University of California, Los Angeles (UCLA)
Los Angeles, California, United States
Jeannette Lin, MD (she/her/hers)
Associate Clinical Professor of Medicine
Adult Congenital Heart Disease Center, Division of Cardiology, Department of Medicine, University of California, Los Angeles
Los Angeles, California, United States
Yalda Afshar, MD, PhD (she/her/hers)
Assistant Professor
University of California, Los Angeles
Los Angeles, California, United States