Aortic Wall Thickness and Amniotic Fluid Albuminuria in Growth-Restricted Twin Fetuses

Abstract

Background and objective: Intrauterine growth restriction (IUGR) may be associated with significantly higher aortic intima-media thickening (aIMT) values. It is unknown if fetal aIMT is associated with glomerulosclerosis and amniotic albuminuria in utero. Design, setting, participants, and measurements: Fetal abdominal aIMT and amniotic albumin/creatinine ratio (ACR) were measured in 126 individual twin fetuses, recruited by the Obstetrics and Gynaecology Clinics of the University of Padua (Italy) Medical Center. The IUGR twin fetuses were classified into two groups: Group A were those fetuses whose estimated fetal weight (EFW) was <10th percentile with pulsatility index >2 SD and Group B were those fetuses whose EFW was <10th percentile and had no velocimetry abnormalities. Results: The median fetal aIMT was significantly different in the three groups (Group A = 0.9 mm; Group B = 0.7 mm; and appropriate for gestational age (AGA) = 0.5 mm; p < .0001). It was significantly higher in Group A than in the AGA group (p < .0001) and than in the Group B fetuses (p = .003), respectively. In addition, ACR was different in the three groups (Group A = 183,500 mg/g; Group B = 6,4720 mg/g; and AGA = 8,2750 mg/g; p = .0002). It was significantly higher in Group A than in the AGA group (p = .03) and than in Group B (p = .02), respectively. Conclusions: Growth-restricted twin fetuses with velocimetry abnormalities present are associated with aIMT and higher ACR levels in amniotic fluid, which could be possible markers in utero of preclinical atherosclerosis, and early glomerulosclerosis.

Cell free hemoglobin in the fetoplacental circulation: a novel cause of fetal growth restriction?

“…Although many cases lack an identifiable cause, FGR is strongly associated with fetal demise, and accompanies 50% of unexplained stillbirths (2). Positive correlations between low birth weight, increased risk of adult cardiovascular disease and stroke have been documented, with growing evidence of the latent consequences of adverse prenatal programming (3,4).…”

Fetal Growth Restriction Induces Heterogeneous Effects on Vascular Biomechanical and Functional Properties in Guinea Pigs (Cavia porcellus)

“…A comparable study in fetal sheep show similar changes in the biomechanical properties of the aorta from FGR, however, those changes were not paralleled by modifications in the vessel morphology and no data regarding the vasocontractile response is provided (Dodson et al, 2014). Compelling evidence in humans show that FGR is associated with an increased aortic intima-media thickness and decreased internal diameter (Skilton et al, 2005; Koklu et al, 2007; Visentin et al, 2013; Zanardo et al, 2013; Stergiotou et al, 2015) which can be evidenced even in utero (Cosmi et al, 2009; Gomez-Roig et al, 2015). Interestingly, the increase in aortic intima-media thickness in human FGR is associated with an increase in the umbilical artery pulsatility index (Cruz-Lemini et al, 2014) an effect also observed in this model (Herrera et al, 2016).…”