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. 2017 Aug;37(8):953-957.
doi: 10.1038/jp.2017.59. Epub 2017 May 4.

An antenatal marker of neurodevelopmental outcomes in infants with congenital heart disease

S Siddiqui  1 , W P Fifer  1   2   3 , M Ordonez-Retamar  3 , J D Nugent  3 , I A Williams  1   3
Affiliations

An antenatal marker of neurodevelopmental outcomes in infants with congenital heart disease

S Siddiqui et al. J Perinatol. 2017 Aug.

Abstract

Objective: Prenatal exposures are known to alter fetal neurodevelopment and autonomic control. We aimed to explore the correlation between fetal autonomic activity, measured by fetal heart rate variability, and 18-month developmental outcome in subjects with congenital heart disease.

Study design: From 2010 to 2013, 5 fetuses with hypoplastic left heart syndrome, 9 with transposition of the great arteries and 9 with tetralogy of Fallot were included in this prospective cohort study. A maternal abdominal fetal electrocardiogram monitor recorded fetal heart rate at 34 to 38 weeks gestational age. We assessed associations between fetal heart rate parameters including interquartile range and s.d. of the fetal RR intervals and 18-month Bayley Scales of Infant Development-III scores using Pearson's correlation coefficient. Multivariable regression modeling identified predictors of neurodevelopmental scores.

Results: Fetal heart rate variability parameters at 34 to 38 weeks gestational age correlated with 18-month Cognition (r=0.47, P=0.03) and Motor scores (r=0.66, P=0.001). The interquartile range of the fetal RR intervals predicted Cognition (β=0.462, P=0.028, R2=0.282) and Motor (β=0.637, P<0.001, R2=0.542) scores.

Conclusions: In fetuses with congenital heart disease, low heart rate variability at 34 to 38 weeks gestational age predicts diminished 18-month Cognitive and Motor performance. Prenatal autonomic activity may serve as a marker of early childhood development in these high-risk patients.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest relevant to this article to disclose.

Figures

Figure 1
Figure 1
Sample of Monica AN24 abdominal monitor raw signal. This sample demonstrates the raw fetal ECG data obtained from the monitor with each color representing output from a different electrode.
Figure 2
Figure 2
Correlation between fetal heart rate variability at 34–38 weeks gestational age and 18-month Bayley Scales of Infant Development-III Cognition Scores. The interquartile range of the fetal RR intervals correlated significantly with 18-month cognition scores (p=0.03, r=0.47).
Figure 3
Figure 3
Correlation between fetal heart rate variability at 34–38 weeks gestational age and 18-month Bayley Scales of Infant Development-III Motor Scores. The interquartile range of the fetal RR intervals significantly correlated with 18-month motor scores (p=0.001, r=0.66).
See this image and copyright information in PMC

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