4.7 Article

Regional Brain Growth Trajectories in Fetuses with Congenital Heart Disease

期刊

ANNALS OF NEUROLOGY
卷 89, 期 1, 页码 143-157

出版社

WILEY
DOI: 10.1002/ana.25940

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资金

  1. National Institutes of Health (NIH)
  2. National Institute of Neurological Disorders and Stroke [K23NS101120]
  3. National Heart, Lung, and Blood Institute [K23HL141602]
  4. National Institute of Biomedical Imaging and Bioengineering [R01EB013248, R01EB018988, R01NS106030]
  5. National Heart, Lung, and Blood Institute Pediatric Heart Network Scholar Award
  6. American Academy of Neurology Clinical Research Training Fellowship
  7. Brain and Behavior Research Foundation NARSAD Young Investigator Award
  8. Brain and Behavior Research Foundation NARSAD Distinguished Investigator Award
  9. McKnight Foundation Technological Innovations in Neuroscience Award
  10. Office of Faculty Development at Boston Children's Hospital Career Development Awards
  11. Mend A Heart Foundation

向作者/读者索取更多资源

The study found that fetuses with CHD showed a region-specific pattern of small brain volumes and impaired brain growth before 32 weeks gestation. Genetic or environmental factors related to CHD may also contribute to brain development.
Objective Congenital heart disease (CHD) is associated with abnormal brain development in utero. We applied innovative fetal magnetic resonance imaging (MRI) techniques to determine whether reduced fetal cerebral substrate delivery impacts the brain globally, or in a region-specific pattern. Our novel design included two control groups, one with and the other without a family history of CHD, to explore the contribution of shared genes and/or fetal environment to brain development. Methods From 2014 to 2018, we enrolled 179 pregnant women into 4 groups: HLHS/TGA fetuses with hypoplastic left heart syndrome (HLHS) or transposition of the great arteries (TGA), diagnoses with lowest fetal cerebral substrate delivery; CHD-other, with other CHD diagnoses; CHD-related, healthy with a CHD family history; and optimal control, healthy without a family history. Two MRIs were obtained between 18 and 40 weeks gestation. Random effect regression models assessed group differences in brain volumes and relationships to hemodynamic variables. Results HLHS/TGA (n = 24), CHD-other (50), and CHD-related (34) groups each had generally smaller brain volumes than the optimal controls (71). Compared with CHD-related, the HLHS/TGA group had smaller subplate (-13.3% [standard error = 4.3%], p < 0.01) and intermediate (-13.7% [4.3%], p < 0.01) zones, with a similar trend in ventricular zone (-7.1% [1.9%], p = 0.07). These volumetric reductions were associated with lower cerebral substrate delivery. Interpretation Fetuses with CHD, especially those with lowest cerebral substrate delivery, show a region-specific pattern of small brain volumes and impaired brain growth before 32 weeks gestation. The brains of fetuses with CHD were more similar to those of CHD-related than optimal controls, suggesting genetic or environmental factors also contribute. ANN NEUROL 2020

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