Funding outcome

Fetal echocardiography (FE), ultrasound of the heart, can assess the structure and function of the fetal heart after 10 weeks of pregnancy and is used routinely to identify abnormalities in the fetus. More recently, we have used very early FE to provide insight into the evolution of fetal heart function in the healthy fetus as early as 6-7 weeks of pregnancy, just after the heart is formed in the embryo, and even before heart structures can be fully visualized. In this very early stage of fetal development, as many as 10-15% of pregnancies end in fetal death, and 3-5% have chromosomal abnormalities that significantly impact the health of the fetus or the success of a pregnancy. Abnormal fetal heart rate has been associated with fetal loss and chromosomal anomalies. Few other diagnostic tests are available before 11 weeks of pregnancy to identify the fetus at risk for early loss or with a chromosomal abnormality. Since 2009, the University of Alberta Fetal & Neonatal Cardiology Program, through the collaboration of Dr Lisa Hornberger, the Director of the Program and Dr Venu Jain, a maternal-fetal medicine specialist at the Royal Alexandra Hospital, has prospectively recruited nearly 500 pregnancies at <14 weeks of gestation to examine fetal heart structure and function, all funded through a WCHRI innovation grant. Pregnancy outcomes have been documented. Thirty-seven of the pregnancies have ended in fetal demise at <20 weeks and another 16 have had confirmed chromosomal abnormalities. In the present study, Dora will investigate fetal heart function based on FE Doppler-based blood flow assessments at <14 weeks in pregnancies with early fetal demise or confirmed chromosomal abnormalities, and compare these findings with those in healthy uncomplicated pregnancies. We want to determine if there are differences in fetal heart function in pregnancies that end with an early fetal loss or have a fetal chromosomal abnormality. If we do find differences, these may allow early prediction of a high risk of these complications. Such information would allow for earlier counseling of affected couples and may provide insight into the mechanisms responsible for fetal loss in the absence and presence of chromosomal abnormalities. Dora is well poised to complete this work as she successfully investigated other aspects of early fetal heart function through last summer in nearly 200 pregnancies, work that is to be presented at the international conference for the American College of Cardiology in Chicago this year.