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Am J Perinatol 2025; 42(04): 462-470
DOI: 10.1055/a-2405-1621
Original Article

Vascular Placental Pathology and Cardiac Structure in Stillborn Fetuses

Alexa A. Freedman
1   Department of Obstetrics and Gynecology, NorthShore University Health System, Evanston, Illinois
,
Tess E.K. Cersonsky
2   Department of Obstetrics, Gynecology, and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
,
Halit Pinar
3   Department of Pathology, Alpert Medical School of Brown University, Providence, Rhode Island
,
Robert L. Goldenberg
4   Department of Obstetrics and Gynecology, Columbia University, New York, New York
,
Robert M. Silver
5   Department of Obstetrics and Gynecology, Maternal-Fetal Medicine, University of Utah, Salt Lake City, Utah
,
Linda M. Ernst
6   Department of Pathology, University of Chicago Pritzker School of Medicine, Chicago, Illinois
7   Department of Pathology and Laboratory Medicine, NorthShore University Health System, Evanston, Illinois
› Institutsangaben Funding This work is a secondary analysis of data previously collected as part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) SCRN. No specific funding was received to support the design, conduct, management, analysis, or interpretation of the results of this secondary analysis. However, the collection of the SCRN clinical, autopsy, and placental data was previously supported by grant funding from the NICHD: U10-HD045953 Brown University, RI; U10-HD045925 Emory University, GA; U10-HD045952 University of Texas Medical Branch at Galveston, TX; U10-HDO45955 University of Texas Health Sciences Center at San Antonio, TX; U10-HD045944 University of Utah Health Sciences Center, UT; and U01-HD045954 RTI International, RTP.
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Abstract

Objective Adverse pregnancy outcomes, including preterm birth and preeclampsia, are associated with worse cardiovascular outcomes for offspring. Examination of the placenta is important for understanding how the prenatal period shapes long-term cardiovascular health. We sought to investigate the association between placental vascular malperfusion and fetal cardiac structure.

Study Design Data obtained from the Stillbirth Collaborative Research Network included stillbirths with placental pathology and autopsy. Stillbirths were classified in two ways: based on the severity of placental maternal vascular malperfusion (MVM) and based on the cause of death (MVM, fetal vascular malperfusion [FVM], or acute infection/controls). Organ weight and heart measures were standardized by gestational age (GA) and compared across groups.

Results We included 329 stillbirths in the analysis by MVM severity and 76 in the analysis by cause of death (COD). While z-scores for most organ weights/heart measures were smaller when COD was attributed to MVM as compared with FVM or controls, heart weight and brain weight z-scores did not differ by COD (p > 0.05). In analyses accounting for body size, the difference between heart and body weight z-score was −0.05 (standard deviation [SD]: 0.53) among those with MVM as a COD and −0.20 (SD: 0.95) among those with severe MVM. Right and left ventricle thicknesses and tricuspid, pulmonary, mitral, and aortic valve circumferences were consistently as expected or larger than expected for GA and body weight. In the analysis investigating the severity of MVM, those with the most severe MVM had heart measures that were as expected or larger than expected for body weight while those with only mild to moderate MVM had heart measures that were generally small relative to body weight.

Conclusion When assessed as COD or based on severity, MVM was associated with heart measures that were as expected or larger than expected for GA and body weight, indicating possible heart sparing.

Key Points

  • Fetal deaths with MVM show smaller organ weights.

  • Heart weight sparing is seen with fetal death attributed to MVM.

  • Heart weight sparing is more pronounced with severe MVM.

Keywords

autopsy - maternal vascular malperfusion - fetal vascular malperfusion - heart - weight sparing - placental pathology


Publikationsverlauf

Eingereicht: 30. Januar 2024

Angenommen: 25. August 2024

Accepted Manuscript online:
29. August 2024

Artikel online veröffentlicht:
19. September 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
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