Background-Fetal growth restriction (FGR) affects 5% to 10% of newborns and is associated with increased cardiovascular mortality in adulthood. The most commonly accepted hypothesis is that fetal metabolic programming leads secondarily to diseases associated with cardiovascular disease, such as obesity, diabetes mellitus, and hypertension. Our main objective was to evaluate the alternative hypothesis that FGR induces primary cardiac changes that persist into childhood. Methods and Results-Within a cohort of fetuses with growth restriction identified in fetal life and followed up into childhood, we randomly selected 80 subjects with FGR and compared them with 120 normally grown fetuses, matched for gender, birth date, and gestational age at birth. Cardiovascular assessment was performed in childhood (mean age of 5 years). Compared with control subjects, children with FGR had a different cardiac shape, with increased transversal diameters and more globular cardiac ventricles. Although left ejection fraction was similar among the study groups, stroke volume was reduced significantly, which was compensated for by an increased heart rate to maintain output in severe FGR. This was associated with subclinical longitudinal systolic dysfunction (decreased myocardial peak velocities) and diastolic changes (increased E/EЈ ratio and E deceleration time). Children with FGR also had higher blood pressure and increased intima-media thickness. For all parameters evaluated, there was a linear increase with the severity of growth restriction. Conclusions-These findings suggest that FGR induces primary cardiac and vascular changes that could explain the increased predisposition to cardiovascular disease in adult life. If these results are confirmed, the impact of strategies with beneficial effects on cardiac remodeling should be explored in children with FGR. (Circulation. 2010;121:2427-2436.)Key Words: remodeling Ⅲ pregnancy Ⅲ pediatrics Ⅲ cardiomyopathy Ⅲ hypoxia C ardiovascular disease is the main cause of death in adults. Most factors that lead to chronic cardiovascular disease are already present in childhood. 1,2 Epidemiological evidence has long suggested a link between low birth weight and increased cardiovascular mortality in adulthood. 3 This association is essentially mediated through fetal growth restriction (FGR), 4 a condition defined as a birth weight below the 10th percentile for gestational age that affects 5% to 10% of all newborns. 5 The mechanistic pathways underlying the relationship between FGR and cardiovascular risk are poorly understood. 6 A number of studies support that it might be explained in part by fetal metabolic programming leading to diseases associated with cardiovascular disease, such as obesity, diabetes mellitus, and hypertension 6 ; however, it remains unclear whether FGR induces primary changes in the heart that might predispose to cardiovascular dysfunction later in life. Clinical Perspective on p 2436It has long been known that intrauterine growth retardation is associated with dilated ...

A ssisted reproductive technologies (ARTs), mainly standard in vitro fertilization or intracytoplasmic sperm injection, permit childbirth in many infertile couples and nowadays represent 1% to 4% of births in developed countries.1 Although these technologies are generally considered safe, the potential association of ART with poorer pregnancy outcomes has long been investigated. There is evidence that ART is associated with increased risk for adverse perinatal outcome and congenital malformations.2 This notwithstanding, it is not possible to separate ART-related risks from those secondary to the underlying reproductive pathology of the infertile couple. [3][4][5] In this scenario, preliminary evidence has recently suggested that ART could be associated with long-term cardiovascular changes. Ceelen et al 6 first suggested the presence of increased blood pressure in late childhood after ART conception. More recently, another study demonstrated the presence of signs of systemic and pulmonary vascular dysfunction in 12-year-old children conceived by ART. Editorial see p 1398 Clinical Perspective on p 1450Background-Assisted reproductive technologies (ARTs) have been shown to be associated with general vascular dysfunction in late childhood. However, it is unknown whether cardiac remodeling is also present and if these changes already manifest in prenatal life. Our aim was to assess fetal and infant (6 months of age) cardiovascular function in ART pregnancies. Methods and Results-This prospective cohort study included 100 fetuses conceived by ART and 100 control pregnancies.ART fetuses showed signs of cardiovascular remodeling, including a more globular heart with thicker myocardial walls, decreased longitudinal function (tricuspid ring displacement in controls: median, 6.

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Objective Among late-onset small fetuses, a combination of estimated fetal weight (EFW), cerebroplacental ratio (CPR) and mean uterine artery ( (mean ± SD: controls, 8.2 ± 1.1; SGA, 7.4 ± 1.2; and IUGR,6.9 ± 1.1; P < 0.001) and increased left myocardial performance index (mean ± SD: controls, 0.45 ± 0.14; SGA, 0.51 ± 0.08; and IUGR, 0.57 ± 0.1; P < 0.001).Conclusions Despite a perinatal outcome comparable to that of normal fetuses, the population of so-defined SGA fetuses showed signs of prenatal cardiac dysfunction. This supports the concept that at least a proportion of them are not 'constitutionally small' and that further research is needed.

Objectives To evaluate the associations between congenital heart disease (CHD)

Background-Isolated complete atrioventricular block in the fetus is a rare but potentially lethal condition in which the effect of steroid treatment on outcome is unclear. The objective of this work was to study risk factors associated with death and the influence of steroid treatment on outcome. Methods and Results-We studied 175 fetuses diagnosed with second-or third-degree atrioventricular block (2000 -2007) retrospectively in a multinational, multicenter setting. In 80% of 162 pregnancies with documented antibody status, atrioventricular block was associated with maternal anti-Ro/SSA antibodies. Sixty-seven cases (38%) were treated with fluorinated corticosteroids for a median of 10 weeks (1-21 weeks). Ninety-one percent were alive at birth, and survival in the neonatal period was 93%, similar in steroid-treated and untreated fetuses, regardless of degree of block and/or presence of anti-Ro/SSA. Variables associated with death were gestational age Ͻ20 weeks, ventricular rate Յ50 bpm, fetal hydrops, and impaired left ventricular function at diagnosis. The presence of Ն1 of these variables was associated with a 10-fold increase in mortality before birth and a 6-fold increase in the neonatal period independently of treatment. Except for a lower gestational age at diagnosis in treated than untreated (23.4Ϯ2.9 versus 24.9Ϯ4.9 weeks; Pϭ0.02), risk factors were distributed equally between treatment groups. Two-thirds of survivors had a pacemaker by 1 year of age; 8 children developed cardiomyopathy. Conclusions-Risk factors associated with a poor outcome were gestation Ͻ20 weeks, ventricular rate Յ50 bpm, hydrops, and impaired left ventricular function. No significant effect of treatment with fluorinated corticosteroids was seen. (Circulation.

Objectives Fetal aortic valvuloplasty (FV) aims to prevent fetal aortic valve stenosis progressing into hypoplastic left heart syndrome (HLHS), which results in postnatal univentricular (UV) circulation. Despite increasing numbers of FVs performed worldwide, the natural history of the disease in fetal life

Objective To evaluate the accuracy of four-dimensional (4D) spatiotemporal image correlation (STIC) echocardiography for the diagnosis of fetal congenital heart disease (CHD) in a selected high-risk population. Methods 91.6, 94.9, 88.1, 89.7 and 94.0%, respectively