Cardiovascular programming in children born small for gestational age and relationship with prenatal signs of severity

Crispi, F.; Figueras, F.; Cruz‐Lemini, M.; Bartrons, Joaquim; Bijnens, Bart; Gratacós, Eduard

doi:10.1016/j.ajog.2012.05.011

Cited by 153 publications

(153 citation statements)

References 34 publications

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“…Our results reveal FGR as the strongest predictor of cardiac sphericity in childhood. These data are in line with the reported cardiac shape changes in fetuses and children with FGR (4,5,11). In addition, breastfeeding was independently associated to more elongated (less remodeled) hearts, suggesting a potential beneficial effect of breastfeeding on cardiac structure in childhood.…”

Section: Discussionsupporting

confidence: 80%

Influence of breastfeeding and postnatal nutrition on cardiovascular remodeling induced by fetal growth restriction

et al. 2015

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ArticlesBackground: Our aim was to determine the influence of breastfeeding and postnatal nutrition on cardiovascular remodeling induced by fetal growth restriction (FGR). Methods: A cohort study including 81 children with birthweight <10th centile (FGR) and 121 with adequate fetal growth for gestational age (AGA) was conducted. Cardiovascular endpoints were left ventricular sphericity index (LVSI), carotid intima-media thickness (cIMT), and blood pressure (BP) at 4-5 y of age. The combined effect of FGR and postnatal variablesincluding breastfeeding, fat dietary intake, and BMI-on cardiovascular endpoints was assessed by linear and robust regressions. results: FGR was the strongest predictor of cardiovascular remodeling in childhood, leading to lower LVSI and increased cIMT and BP as compared with AGA. Breastfeeding >6 mo (coefficient: 0.0982) and healthy-fat dietary intake (coefficient: −0.0128) showed an independent beneficial effect on LVSI and cIMT, respectively. Overweight/obesity induced an additional increment of 1 SD on cIMT in FGR children (interaction coefficient: 0.0307) when compared with its effect in AGA. BMI increased systolic BP (coefficient: 0.7830) while weight catchup increased diastolic BP (coefficient: 4.8929). conclusions: Postnatal nutrition ameliorates cardiovascular remodeling induced by FGR. Breastfeeding and healthy-fat dietary intake improved while increased BMI worsened cardiovascular endpoints, which opens opportunities for targeted postnatal interventions from early life. t here is consistent epidemiological evidence that low birth weight is inversely associated with cardiovascular mortality in adulthood (1,2). The most common cause of low birth weight is fetal growth restriction (FGR) due to placental insufficiency (3). FGR fetuses present cardiovascular remodeling already in utero that persist into childhood (4,5). This effect is thought to contribute to their subsequent long-term cardiovascular risk (6). One of the most prominent signs of cardiac remodeling associated with FGR in fetal life and childhood is a more spherical heart measured by lower values on left ventricular sphericity index (LVSI) (5). Likewise, children who suffered FGR have signs of vascular dysfunction, including increased blood pressure (BP) (7) and carotid intima-media thickness (cIMT) (5) which are well-known cardiovascular risk factors.Nutrition and body weight have a strong effect on cardiovascular development during childhood (8). Therefore, the effects of intrauterine environment on cardiovascular remodeling should be influenced by postnatal factors. Epidemiological studies suggest that obesity in childhood or accelerated postnatal growth could worsen the cardiovascular risk associated with impaired intrauterine growth. Moreover, high dietary intake of polyunsaturated fatty acids (PUFA) has been associated with lower cIMT values in children with FGR (9). However, the deleterious or protective effects of nutrition and body weight on cardiovascular remodeling have not been evaluated longitudinally in a ...

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Section: Discussionsupporting

confidence: 80%

Influence of breastfeeding and postnatal nutrition on cardiovascular remodeling induced by fetal growth restriction

et al. 2015

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“…12 Human studies to date are few and remain conflicting. FGR children had a more globular heart, hypertension, and greater thickening of the carotid wall when compared to control participants born with an appropriate birth weight for their gestational age (AGA) 13,14 , and similar results have been identified in infants. 15 In contrast, other studies in children have shown that cardiac structure or function are not altered by preterm FGR; however, vascular stiffness is greater.…”

Section: Introductionsupporting

confidence: 62%

“…Low birth weight is associated with a high risk of hypertension and cardiovascular disease later in life. 5 Increased sympathetic drive, 10,40 permanent alterations in heart structure, 13,14 and increased vascular stiffness 41 have all been proposed as playing a role in the underlying etiology of later life cardiovascular disease. A novel aspect of this study was our inclusion of a preterm group with severe FGR allowing us to explore differential effects of preterm birth and FGR.…”

Section: Discussionmentioning

confidence: 99%

Sleep: A Window Into Autonomic Control in Children Born Preterm and Growth Restricted

Yiallourou

Wallace

Whatley

et al. 2017

Sleep

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Study Objectives: Preterm birth and fetal growth restriction (FGR) are both associated with risk of hypertension in adulthood. Mechanisms leading to this pathology are unclear. In children aged 5-12 years, who were born preterm and FGR, we used sleep as a tool to assess autonomic control with assessment of cardiovascular structure and function. Methods: Eighteen children born preterm and FGR, 15 children born preterm with appropriate birth weights for gestational age (AGA), and 20 AGA term-born children were studied. Children underwent overnight polysomnography with the addition of continuous noninvasive blood pressure (Finometer™). Spectral measures of heart rate variability (HRV), blood pressure variability (BPV), and baroreflex sensitivity were assessed and overnight urinary catecholamine levels measured. Echocardiographic studies (Vivid7, GE Healthcare) were performed and vascular compliance assessed (Miller Instruments™). Statistical comparisons were adjusted for age and body size. Results: Compared to term children, preterm AGA children had increased high frequency HRV (p < .05) and BPV (p < .05) during sleep, reflecting increased parasympathetic activation and blood pressure changes related to respiration. Preterm FGR children had smaller left ventricular lengths, ascending aorta, and left ventricular outflow tract diameter (p < .05 for all) and vascular compliance was positively correlated with gestational age (r 2 = 0.93, p < .05). Conclusions: FGR combined with preterm birth did not alter autonomic control but altered heart structure in children. In contrast, preterm birth alone altered autonomic control but had no change in heart structure. These changes in children born preterm and FGR may contribute, in part, to increased risk of cardiovascular disease later in life but by different mechanisms.

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“…These results are consistent with previous data in infancy demonstrating reduced longitudinal deformation 22 and in early childhood showing reduced longitudinal motion and increased myocardial thickening in FGR. 23 Finally, we could also demonstrate a higher prevalence of postsystolic shortening in FGR, reflecting regional differences in myocardial deformation. 24 Interestingly, in FGR, postsystolic shortening was found both in the LV basal septal and in the LV basal lateral wall.…”

Section: Discussionmentioning

confidence: 87%

Persistence of Cardiac Remodeling in Preadolescents With Fetal Growth Restriction

Sarvari

Rodríguez-López

Nuñez‐Garcia

et al. 2017

Circ: Cardiovascular Imaging

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Background— Fetal growth restriction (FGR) affects 5% to 10% of newborns and is associated with increased cardiovascular mortality in adulthood. We evaluated whether prenatal cardiovascular changes previously demonstrated in FGR persist into preadolescence. Methods and Results— A cohort study of 58 FGR (defined as birth weight below 10th centile) and 94 normally grown fetuses identified in utero and followed-up into preadolescence (8–12 years of age) by echocardiography and 3-dimensional shape computational analysis. Compared with controls, FGR preadolescents had a different cardiac shape, with more spherical and smaller hearts. Left ventricular ejection fraction was similar among groups, whereas FGR had decreased longitudinal motion (decreased mitral annular systolic peak velocities: control median, 0.11 m/s [interquartile range, 0.09–0.12] versus FGR median 0.09 m/s [interquartile range, 0.09–0.10]; P <0.01) and impaired relaxation (isovolumic relaxation time: control, 0.21 ms [interquartile range, 0.12–0.35] versus FGR, 0.35 ms [interquartile range, 0.20–0.46]; P =0.04). Global longitudinal strain was decreased (control mean, −22.4% [SD, 1.37] versus FGR mean, −21.5% [SD, 1.16]; P <0.001) compensated by an increased circumferential strain and with a higher prevalence of postsystolic shortening in FGR as compared with controls. These differences persisted after adjustment for parental ethnicity and smoking, prenatal glucocorticoid administration, preeclampsia, gestational age at delivery, days in intensive care unit, sex, age, and body surface area at evaluation. Conclusions— This study provides evidence that cardiac remodeling induced by FGR persists until preadolescence with findings similar to those reported in their prenatal life and childhood. The findings support the hypothesis of primary cardiac programming in FGR for explaining the association between low birth weight and cardiovascular risk in adulthood.

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Cardiovascular programming in children born small for gestational age and relationship with prenatal signs of severity

Cited by 153 publications

References 34 publications

Influence of breastfeeding and postnatal nutrition on cardiovascular remodeling induced by fetal growth restriction

Influence of breastfeeding and postnatal nutrition on cardiovascular remodeling induced by fetal growth restriction

Sleep: A Window Into Autonomic Control in Children Born Preterm and Growth Restricted

Persistence of Cardiac Remodeling in Preadolescents With Fetal Growth Restriction

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