Absence of Increase in Carotid Artery Intima-Media Thickness in Infants of Diabetic Mothers

Atabek, Mehmet Emre; Çağan, Havva Hasret; Eklioğlu, Beray Selver; Oran, Bülent

doi:10.4274/jcrpe.v3i3.28

Cited by 12 publications

(16 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the other study, non-breastfed children on formulas with higher protein content during their first year of life had a lower CIMT (SMD −0.21 (95% CI: −0.45 to 0.04)) compared to children on lower protein formulas [ 63 ]. Scarce evidence, reported in 1 study, existed for other factors, such as cardio-metabolic and inflammatory factors, for instance, blood pressure [ 81 ], cord blood cholesterol [ 55 ], cortisol [ 69 ], and epigenetic changes, such as DNA methylation levels following exposure to air pollution [ 56 , 57 ] (Tables 1 and S6 ).…”

Section: Resultsmentioning

confidence: 98%

Risk factors during first 1,000 days of life for carotid intima-media thickness in infants, children, and adolescents: A systematic review with meta-analyses

et al. 2020

View full text Add to dashboard Cite

Background The first 1,000 days of life, i.e., from conception to age 2 years, could be a critical period for cardiovascular health. Increased carotid intima-media thickness (CIMT) is a surrogate marker of atherosclerosis. We performed a systematic review with meta-analyses to assess (1) the relationship between exposures or interventions in the first 1,000 days of life and CIMT in infants, children, and adolescents; and (2) the CIMT measurement methods. Methods and findings Systematic searches of Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica database (EMBASE), and Cochrane Central Register of Controlled Trials (CENTRAL) were performed from inception to March 2019. Observational and interventional studies evaluating factors at the individual, familial, or environmental levels, for instance, size at birth, gestational age, breastfeeding, mode of conception, gestational diabetes, or smoking, were included. Quality was evaluated based on study methodological validity (adjusted Newcastle–Ottawa Scale if observational; Cochrane collaboration risk of bias tool if interventional) and CIMT measurement reliability. Estimates from bivariate or partial associations that were least adjusted for sex were used for pooling data across studies, when appropriate, using random-effects meta-analyses. The research protocol was published and registered on the International Prospective Register of Systematic Reviews (PROSPERO; CRD42017075169). Of 6,221 reports screened, 50 full-text articles from 36 studies (34 observational, 2 interventional) totaling 7,977 participants (0 to 18 years at CIMT assessment) were retained. Children born small for gestational age had increased CIMT (16 studies, 2,570 participants, pooled standardized mean difference (SMD): 0.40 (95% confidence interval (CI): 0.15 to 0.64, p: 0.001), I2: 83%). When restricted to studies of higher quality of CIMT measurement, this relationship was stronger (3 studies, 461 participants, pooled SMD: 0.64 (95% CI: 0.09 to 1.19, p: 0.024), I2: 86%). Only 1 study evaluating small size for gestational age was rated as high quality for all methodological domains. Children conceived through assisted reproductive technologies (ART) (3 studies, 323 participants, pooled SMD: 0.78 (95% CI: −0.20 to 1.75, p: 0.120), I2: 94%) or exposed to maternal smoking during pregnancy (3 studies, 909 participants, pooled SMD: 0.12 (95% CI: −0.06 to 0.30, p: 0.205), I2: 0%) had increased CIMT, but the imprecision around the estimates was high. None of the studies evaluating these 2 factors was rated as high quality for all methodological domains. Two studies evaluating the effect of nutritional interventions starting at birth did not show an effect on CIMT. Only 12 (33%) studies were at higher quality across all domains of CIMT reliability. The degree of confidence in results is limited by the low number of high-quality studies, the relatively small sample sizes, and the high between-study heterogeneity. Conclusions In our meta-analyses, we found several risk factors in the first 1,000 days of life that may be associated with increased CIMT during childhood. Small size for gestational age had the most consistent relationship with increased CIMT. The associations with conception through ART or with smoking during pregnancy were not statistically significant, with a high imprecision around the estimates. Due to the large uncertainty in effect sizes and the limited quality of CIMT measurements, further high-quality studies are needed to justify intervention for primordial prevention of cardiovascular disease (CVD).

show abstract

Section: Resultsmentioning

confidence: 98%

Risk factors during first 1,000 days of life for carotid intima-media thickness in infants, children, and adolescents: A systematic review with meta-analyses

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Smaller arterial lumen diameters (LDs) and reduced microvasculature have also been reported in this population. 22 In LGA neonates, both increased 23,24 and appropriate 25 IMTs have been reported. This suggests a nonlinear U-shaped association between intrauterine body and arterial growth.…”

Section: See Editorial By Gardiner See Clinical Perspectivementioning

confidence: 99%

Neonatal Arterial Morphology Is Related to Body Size in Abnormal Human Fetal Growth

Olander

Sundholm

Ojala

et al. 2016

Circ: Cardiovascular Imaging

View full text Add to dashboard Cite

Background-Restriction in fetal growth is associated with cardiovascular disease in adulthood. It is unclear whether abnormal intrauterine growth influences arterial morphology during the fetal or neonatal stage. The objective was to study the regional arterial morphology with respect to gestational age and abnormal fetal body size. Methods and Results-We studied body anthropometrics and arterial morphology and physiology in 174 neonates born between 31 and 42 weeks of gestation, including neonates with birth weights appropriate, small, and large for age, with very high resolution vascular ultrasound (35-55 MHz). In simple linear regressions, parameters of body size (body weight, body surface area, and organ circumference) and gestational age were statistically significantly associated with common carotid, brachial, femoral arterial parameters (lumen diameter [LD], wall layer thickness [intima-media thickness and intima-media-adventitia thickness], and carotid artery wall stress [CAWS]). Male sex was statistically significantly associated with LD and CAWS. In multiple linear regression models, body size, gestational age, and sex explained a large proportion of the arterial variance (R 2 range, 0.37-0.47 for LD; 0.09-0.35 for intima-media thickness; 0.21-0.41 for intima-media-adventitia thickness; and 0.23 for CAWS; all models P<0.001). Arterial wall layer thickness, LDs, and CAWS were independently and strongly predicted by body size, and no effect of maternal disease was observed when added to the models. Gestational age and male sex were also independently but more weakly associated with arterial LDs and CAWS (P<0.01), but not with arterial wall layers. Conclusions-These results indicate that the intrauterine growth of fetal arterial LD and wall layer thickness are primarily attributed to body growth overall. LD and CAWS show weaker association with gestational age and sex. (Circ Cardiovasc Imaging. 2016;9:e004657.

show abstract

“…Atabek et al demonstrated that there was no significant difference in the cIMT in neonates of diabetic mothers as compared to controls. 15 This study had a very small sample size and thus was heavily underpowered. The present study, despite being adequately powered, did not show a difference in cIMT between the two groups.…”

Section: Discussionmentioning

confidence: 99%

“…13,14 Based on these, a sample size of 65 children in each group for E/E 0 was calculated (using World Health Organisation sample size calculator version 2.0) to enable us to observe a 20% difference between the exposed and unexposed groups, with 90% power and 5% level of significance. This sample size would also be adequate to detect a difference in cIMT 15 based on the given assumptions.…”

mentioning

confidence: 99%

Is the child at risk? Cardiovascular remodelling in children born to diabetic mothers

et al. 2019

View full text Add to dashboard Cite

Objective:The objective of this study was to assess differences in myocardial systolic and diastolic function and vascular function in children 2−5 years of age born to diabetic as compared to non-diabetic mothers.Methods:This study was a retrospective cohort conducted in 2016 at The Aga Khan University Hospital, Karachi, Pakistan. It included children between 2 and 5 years of age born to mothers with and without exposure to diabetes in utero (n = 68 in each group) and who were appropriate for gestational age. Myocardial morphology and function using echocardiogram and carotid intima media thickness (cIMT) and pulse wave velocity was performed to evaluate cardiac function as well as macrovascular remodelling in these children. Multiple linear regression was used to compare the groups.Results:There was no significant difference in cardiac morphology, myocardial systolic and diastolic function, and macrovascular assessment between the exposed and unexposed groups of AGA children. Subgroup analysis demonstrated a significantly decreased mitral E/A ratio in children whose mothers were on medications as compared to those on dietary control (median [IQR] = 1.7 [1.6–1.9] and 1.56 [1.4–1.7], respectively, p = 0.02), and a higher cIMT in children whose mothers were on medication as compared to controls (0.48 [0.44–0.52] and 0.46 [0.44–0.50], respectively, p = 0.03).Conclusion:In utero exposure to uncontrolled maternal diabetes has an effect on the cardiovascular structure and function in children aged 2−5 years. However, future work requires long-term follow-up from fetal to adult life to assess these changes over the life course.

show abstract

Absence of Increase in Carotid Artery Intima-Media Thickness in Infants of Diabetic Mothers

Cited by 12 publications

References 25 publications

Risk factors during first 1,000 days of life for carotid intima-media thickness in infants, children, and adolescents: A systematic review with meta-analyses

Risk factors during first 1,000 days of life for carotid intima-media thickness in infants, children, and adolescents: A systematic review with meta-analyses

Neonatal Arterial Morphology Is Related to Body Size in Abnormal Human Fetal Growth

Is the child at risk? Cardiovascular remodelling in children born to diabetic mothers

Contact Info

Product

Resources

About