Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2020

Open Access 01-12-2020 | Research article

Cerebral hemodynamic response to short-term maternal hyperoxygenation in fetuses with borderline small left hearts

Authors: Shi Zeng, Jiawei Zhou, Qinghai Peng, Wen Deng, Qichang Zhou

Published in: BMC Pregnancy and Childbirth | Issue 1/2020

Login to get access

Abstract

Background

Hypoxia delays brain maturation and contributes to neurodevelopmental morbidity in fetuses with congenital heart defects (CHDs). Maternal hyperoxygenation (MH) can, in theory, promote oxygen/nutrient delivery to the fetal brain, owing to an improved heart structure/function and increased fetal oxygen content. We aimed to determine whether MH alters fetal cerebral hemodynamics in fetuses with CHD.

Methods

Twenty-eight fetuses with borderline small left hearts and 28 age-matched normal fetuses were enrolled and subdivided by gestational age (GA): 23+ 0 ~ 27+ 6 weeks and 28+ 0 ~ 36+ 6 weeks. The middle cerebral artery pulsatility index (MCA-PI), vascular index (VI), flow index (FI) and vascular/flow index (VFI) were measured with baseline room air, after 10 min of MH and after 10 min of recovery for all subjects.

Results

MCA-PI, VI, FI and VFI did not differ with MH in the normal fetuses. In fetuses with borderline small left hearts, MCA-PI increased and VI, FI and VFI significantly decreased during the 3rd trimester (from 1.44 ± 0.27, 3.19 ± 0.87, 56.91 ± 9.19, and 1.30 ± 0.33 at baseline to 1.62 ± 0.15, 2.37 ± 0.37, 45.73 ± 4.59, and 0.94 ± 0.15 during MH, respectively, P < 0.05), but this response was not apparent during mid-gestation (p > 0.05). These parameters returned to the baseline levels during the recovery phase. The change in cerebral perfusion depended on the baseline MCA-PI and increased the combined cardiac index (CCOi).

Conclusions

MH alters the cerebral hemodynamics of fetuses with borderline small left hearts during the third trimester. Further investigation is needed to determine whether MH may benefit brain growth and neurodevelopment in this high-risk population.
Literature
1.
Zeng S, Zhou QC, Zhou JW, Li M, Long C, Peng QH. Volume of intracranial structures on three-dimensional ultrasound in fetuses with congenital heart disease. Ultrasound Obstet Gynecol. 2015;46(2):174–81.PubMedCrossRef
2.
Ruiz A, Cruz-Lemini M, Masoller N, Sanz-Cortes M, Ferrer Q, Ribera I, et al. Longitudinal changes in fetal biometry and cerebroplacental hemodynamics in fetuses with congenital heart disease. Ultrasound Obstet Gynecol. 2017;49(3):379–86.PubMedCrossRef
3.
Sun LQ, Macgowan CK, Sled JG, Yoo SJ, Manlhiot C, Porayette P, et al. Reduced fetal cerebral oxygen consumption is associated with smaller brain size in fetuses with congenital heart disease. Circulation. 2015;131(15):1313–23.PubMedPubMedCentralCrossRef
4.
Szwast A, Tian Z, McCann M, Donaghue D, Rychik J. Vasoreactive response to maternal hyperoxygenation in the fetus with hypoplastic left heart syndrome. Circ Cardiovasc Imaging. 2010;3(2):172–8.PubMedCrossRef
5.
Channing A, Szwast A, Natarajan S, Degenhardt K, Tian Z, Rychik J. Maternal hyperoxygenation improves left heart filling in fetuses with atrial septal aneurysm causing impediment to left ventricular inflow. Ultrasound Obstet Gynecol. 2015;45(6):664–9.PubMedCrossRef
6.
Enzensberger C, Axt-Fliedner R, Degenhardt J, Kawecki A, Tenzer A, Kohl T, et al. Pulmonary Vasoreactivity to Materno-fetal Hyperoxygenation testing in fetuses with Hypoplastic left heart. Ultraschall Med. 2016;37(2):195–200.PubMed
7.
Kohl T. Chronic intermittent Materno-fetal Hyperoxygenation in late gestation may improve on Hypoplastic cardiovascular structures associated with cardiac malformations in human fetuses. Pediatr Cardiol. 2010;31(2):250–63.PubMedCrossRef
8.
Zeng S, Zhou JW, Peng QH, Deng W, Zhang M, Zhao YL, et al. Sustained maternal hyperoxygenation improves aortic arch dimensions in fetuses with coarctation. Sci Rep-Uk. 2016;16:6.
9.
Lara DA, Morris SA, Maskatia SA, Challman M, Nguyen M, Feagin DK, et al. Pilot study of chronic maternal hyperoxygenation and effect on aortic and mitral valve annular dimensions in fetuses with left heart hypoplasia. Ultrasound Obstet Gynecol. 2016;48(3):365–72.PubMedCrossRef
10.
Zeng S, Zhou JW, Peng QH, Deng W, Zang M, Wang T, et al. Sustained chronic maternal Hyperoxygenation increases myocardial deformation in fetuses with a small aortic isthmus at risk for Coarctation. J Am Soc Echocardiogr. 2017;30(10):992–1000.PubMedCrossRef
11.
Nicolaides KH, Campbell S, Bradley RJ, Bilardo CM, Soothill PW, Gibb D. Maternal oxygen therapy for intrauterine growth retardation. Lancet. 1987;1(8539):942–5.PubMedCrossRef
12.
Hickey EJ, Caldarone CA, McCrindle BW. Left ventricular hypoplasia: a spectrum of disease involving the left ventricular outflow tract, aortic valve, and aorta. J Am Coll Cardiol. 2012;59(1 Suppl):S43–54.PubMedCrossRef
13.
Bolin ECW, Garuba O, Altman C, Ayres N, Morris S. Risk factors for postnatal surgery in the fetus with borderline small left heart. Circulation. 2013;128:A15552.
14.
Dubin J, Wallerson DC, Cody RJ, Devereux RB. Comparative accuracy of Doppler echocardiographic methods for clinical stroke volume determination. Am Heart J. 1990;120(1):116–23.PubMedCrossRef
15.
Zeng S, Zhou J, Peng Q, Tian L, Xu G, Zhao Y, et al. Assessment by three-dimensional power Doppler ultrasound of cerebral blood flow perfusion in fetuses with congenital heart disease. Ultrasound Obstet Gynecol. 2015;45(6):649–56.PubMedCrossRef
16.
Bartha JL, Moya EM, Hervias-Vivancos B. Three-dimensional power Doppler analysis of cerebral circulation in normal and growth-restricted fetuses. J Cereb Blood Flow Metab. 2009;29(9):1609–18.PubMedCrossRef
17.
Rasanen J, Wood DC, Debbs RH, Cohen J, Weiner S, Huhta JC. Reactivity of the human fetal pulmonary circulation to maternal hyperoxygenation increases during the second half of pregnancy: a randomized study. Circulation. 1998;97(3):257–62.PubMedCrossRef
18.
Tomimatsu T, Pena JP, Longo LD. Fetal cerebral oxygenation: the role of maternal hyperoxia with supplemental CO2 in sheep. Am J Obstet Gynecol. 2007;196(4):359 e1–5.CrossRef
19.
Tomimatsu T, Pereyra Pena J, Hatran DP, Longo LD. Maternal oxygen administration and fetal cerebral oxygenation: studies on near-term fetal lambs at both low and high altitude. Am J Obstet Gynecol. 2006;195(2):535–41.PubMedCrossRef
20.
Almstrom H, Sonesson SE. Doppler echocardiographic assessment of fetal blood flow redistribution during maternal hyperoxygenation. Ultrasound Obstet Gynecol. 1996;8(4):256–61.PubMedCrossRef
21.
Simchen MJ, Tesler J, Azami T, Preiss D, Fedorko L, Goldszmidz E, et al. Effects of maternal hyperoxia with and without normocapnia in uteroplacental and fetal Doppler studies. Ultrasound Obstet Gynecol. 2005;26(5):495–9.PubMedCrossRef
22.
Prior T, Kumar S. The impact of maternal hyper-oxygenation on foeto-placental blood flow. J Matern-Fetal Neo M. 2017;30(13):1563–8.CrossRef
23.
Johnston AJ, Steine LA, Gupta AK, Menon DK. Cerebral oxygen vasoreactivity and cerebral tissue oxygen reactivity. Brit J Anaesth. 2003;90(6):774–86.PubMedCrossRef
24.
Limperopoulos C, Tworetzky W, McElhinney DB, Newburger JW, Brown DW, Robertson RL, et al. Brain volume and metabolism in fetuses with congenital heart disease evaluation with quantitative magnetic resonance imaging and spectroscopy. Circulation. 2010;121(1):26–33.PubMedCrossRef
25.
Szwast A, Putt M, Gaynor JW, Licht DJ, Rychik J. Cerebrovascular response to maternal hyperoxygenation in fetuses with hypoplastic left heart syndrome depends on gestational age and baseline cerebrovascular resistance. Ultrasound Obstet Gynecol. 2018;52(4):473–8.PubMedPubMedCentralCrossRef
26.
Brew N, Walker D, Wong FY. Cerebral vascular regulation and brain injury in preterm infants. Am J Phys Regul Integr Comp Phys. 2014;306(11):R773–86.
27.
Morin FC 3rd, Egan EA, Ferguson W, Lundgren CE. Development of pulmonary vascular response to oxygen. Am J Phys. 1988;254(3 Pt 2):H542–6.
28.
Blanco VM, Stern JE, Filosa JA. Tone-dependent vascular responses to astrocyte-derived signals. Am J Physiol Heart Circ Physiol. 2008;294(6):H2855–63.PubMedPubMedCentralCrossRef
29.
Vasicka A, Quilligan EJ, Aznar R, Lipsitz PJ, Bloor BM. Oxygen tension in maternal and fetal blood, amniotic fluid, and cerebrospinal fluid of the mother and the baby. Am J Obstet Gynecol. 1960;79:1041–7.PubMedCrossRef
30.
Raine-Fenning NJ, Nordin NM, Ramnarine KV, Campbell BK, Clewes JS, Perkins A, et al. Evaluation of the effect of machine settings on quantitative three-dimensional power Doppler angiography: an in-vitro flow phantom experiment. Ultrasound Obstet Gynecol. 2008;32(4):551–9.PubMedCrossRef
Metadata
Title
Cerebral hemodynamic response to short-term maternal hyperoxygenation in fetuses with borderline small left hearts
Authors
Shi Zeng
Jiawei Zhou
Qinghai Peng
Wen Deng
Qichang Zhou
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2020
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-020-03103-7

Other articles of this Issue 1/2020

BMC Pregnancy and Childbirth 1/2020 Go to the issue

Research article

“I have to provide for another life emotionally, physically and financially”: understanding pregnancy, motherhood and the future aspirations of adolescent mothers in KwaZulu-Natal South, Africa

Research article

The lived experience among Somali women of giving birth in Sweden: an interpretive phenomenological study

Research article

Evaluation of decision to delivery time interval and its effect on feto-maternal outcomes and associated factors in category-1 emergency caesarean section deliveries: prospective cohort study

Research article

The influence of experiential knowledge and societal perceptions on decision-making regarding non-invasive prenatal testing (NIPT)

Research article

Establishment of an antepartum predictive scoring model to identify candidates for vaginal birth after cesarean

Study protocol

Walking in pregnancy and prevention of insomnia in third trimester using pedometers: study protocol of Walking_Preg project (WPP). A randomized controlled trial