Altered placental development is present in all types of fetal congenital heart disease

BACKGROUND: Fetal congenital heart defects (CHD) are related to fetal growth restriction, pregnancy complications and placental abnormalities. We hypothesize that abnormal placental development in fetal CHD is not solely associated to the altered fetal circulation, but is also related to abnormalities in developmental pathways. OBJECTIVES: To assess placenta and umbilical cord histology in pregnancies with fetal CHD and relate this to cardiac development and fetal oxygenation and flow. STUDY DESIGN: Placental tissue from pregnancies with fetal CHD (n = 111) and healthy controls (n = 80) was obtained from a Dutch academic biobank. CHD cases were categorized based on fetal hemodynamics, embryological development and cardiac morphology. Placental histology and a placental severity scores were compared between CHD groups and controls. Pregnancies with genetic abnormalities, multiple gestations, fetal demise, or termination were excluded. RESULTS: CHD placentas showed significantly lower placental weight (