Cardiovascular and Cerebrovascular Implications of Growth Restriction: Mechanisms and Potential Treatments

Abstract

Fetal growth restriction (FGR) is a common complication of pregnancy, resulting in a fetus that fails to reach its genetically determined growth potential. Whilst the fetal cardiovascular response to acute hypoxia is well established, the fetal defence to chronic hypoxia is not well understood due to experiment constraints. Growth restriction results primarily from reduced oxygen and nutrient supply to the developing fetus, resulting in chronic hypoxia. The fetus adapts to chronic hypoxia by redistributing cardiac output via brain sparing in an attempt to preserve function in the developing brain. This review highlights the impact of brain sparing on the developing fetal cardiovascular and cerebrovascular systems, as well as emerging long-term effects in offspring that were growth restricted at birth. Here, we explore the pathogenesis associated with brain sparing within the cerebrovascular system. An increased understanding of the mechanistic pathways will be critical to preventing neuropathological outcomes, including motor dysfunction such as cerebral palsy, or behaviour dysfunctions including autism and attention-deficit/hyperactivity disorder (ADHD).

Maternal propionate supplementation ameliorates glucose and lipid metabolic disturbance in hypoxia-induced fetal growth restriction

“…1 Hypoxic stress in pregnancy is one of the most common conditions and occurs in various scenarios such as high-altitude pregnancy, maternal smoking, pulmonary diseases, preeclampsia, placental insufficiency, and others. 2,3 Antenatal maternal hypoxia has been shown to cause altered cardiac growth and neonatal vascular function, 4,5 pulmonary arterial dysfunction 6 and fetal growth restriction. 7 Fetal growth restriction or intrauterine growth retardation (IUGR) is one of the major complications of pregnancy and is one of the main leading causes of perinatal death.…”

“…11 In addition to the abnormal organic growth of the fetus, it can also induce long-term diseases including respiratory diseases (e.g. bronchopulmonary dysplasia), 6 cardiovascular diseases, 5 and metabolic syndrome. 12,13 The liver is the major organ related to the general body metabolism.…”

Relationship between Abnormal Placenta and Obstetric Outcomes: A Meta-Analysis

“…However, the present systematic review found that none of the studies focused on the relationship between abnormal placenta and fetal anomaly. Our study revealed that circumvallate placenta was associated with increased rate of FGR (OR 3.53, 95%CI 1.63–7.62), and FGR has been correlated with adverse effects on neurological [ 74 , 75 , 76 ] and cardiovascular development [ 77 , 78 ] of the fetus depending on its severity. Therefore, circumvallate placenta can potentially be associated with adverse effects on neurological and cardiovascular development.…”

Is acidemia at birth a risk factor for functional gastrointestinal disorders?

“…The relationship between alterations in intestinal perfusion and oxygenation after fetal hypoxia and the development of feeding intolerance and NEC has been examined in several studies. It is known that the fetus responds to hypoxia by redistributing blood flow to essential vascular beds, a process known as brain sparing [25].…”