Changes in Central and Peripheral Circulation in Intrauterine Growth-Restricted Fetuses at Different Stages of Umbilical Artery Flow Deterioration: New Fetal Cardiac and Brain Parameters

Benavides-Serralde, Andrés; Scheier, M.; Cruz‐Martínez, R.; Crispi, F.; Figueras, Fransesc; Gratacós, Eduard; Hernández‐Andrade, Edgar

doi:10.1159/000323548

Cited by 54 publications

(52 citation statements)

References 51 publications

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“…Global cardiac performance can be assessed on echocardiography by the myocardial performance index (MPI), also known as the Tei index. An increase of this index, representing diminished systolic and/ or diastolic function, has been reported in fetuses, with even mild IUGR (7,44,45). The MPI has been shown to progressively increase with fetal deterioration (7) and it appears to have a negative association with perinatal outcome (including 5-min Apgar score, cord pH, and perinatal mortality) (7,46).…”

Section: Global Cardiac Functionmentioning

confidence: 99%

Intrauterine growth restriction: impact on cardiovascular development and function throughout infancy

et al. 2016

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Intrauterine growth restriction (IUGR) refers to the situation where a fetus does not grow according to its genetic growth potential. One of the main causes of IUGR is uteroplacental vascular insufficiency. Under these circumstances of chronic oxygen and nutrient deprivation, the growth-restricted fetus often displays typical circulatory changes, which in part represent adaptations to the suboptimal intrauterine environment. These fetal adaptations aim to preserve oxygen and nutrient supply to vital organs such as the brain, the heart, and the adrenals. These prenatal circulatory adaptations are thought to lead to an altered development of the cardiovascular system and "program" the fetus for life long cardiovascular morbidities. In this review, we discuss the alterations to cardiovascular structure, function, and control that have been observed in growth-restricted fetuses, neonates, and infants following uteroplacental vascular insufficiency. We also discuss the current knowledge on early life surveillance and interventions to prevent progression into chronic disease. Intrauterine growth restriction (IUGR) refers to the situation where a fetus does not grow according to its genetic growth potential. The main cause of IUGR in developed countries is uteroplacental vascular insufficiency (1), which drives the fetus to redistribute its cardiac output to preserve oxygen and nutrient supply to the brain, heart, and adrenals. Although these adaptive circulatory changes are beneficial during intrauterine life, they are thought to cause dysfunctional development of the cardiovascular system and "program" the fetus for life long cardiovascular morbidities (2). This is also known as the Developmental Origins of Health and Disease hypothesis, which postulates that insults during intrauterine and early postnatal development can permanently change the body's structure, function, and metabolism and influence susceptibility to adult noncommunicable diseases (2). Despite their increased risk of cardiovascular disease, infants born growth restricted usually do not receive long-term cardiovascular follow-up. Depending on the definition used, IUGR can occur in up to 10% of pregnancies, and as cardiovascular disease is the number one cause of death worldwide (3), early identification of cardiovascular risk factors and targeted interventions in this high-risk population are of major clinical importance. In this review, we discuss the alterations of cardiovascular structure, function, and control that have been observed in infants born growth restricted and their implications for surveillance and intervention to prevent progression into chronic disease. CHALLENGES IN IDENTIFYING IUGRThe current literature uses many different definitions of IUGR, which may explain some of the contradicting findings discussed in this review. Traditionally, and most commonly, IUGR is defined as a birth weight below the 10th percentile for gestational age on the normative population growth curve (4). This definition, however, merely describes those who ...

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Section: Global Cardiac Functionmentioning

confidence: 99%

Intrauterine growth restriction: impact on cardiovascular development and function throughout infancy

et al. 2016

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“…MPI in IUGR fetuses has been evaluated in a number of different studies by conventional and tissue Doppler [6,11,30,31,32,33,34,83,84,85,86,87,88]. In fetuses followed longitudinally, MPI was identified as one of the earliest Doppler parameters affected and remained elevated throughout the different stages of deterioration with a steeper curve of deterioration compared with other Doppler indices (aortic isthmus and ductus venosus pulsatility indices) [34,87].…”

Section: Clinical Application Of Mpimentioning

confidence: 99%

“…An increased IRT is generally accompanied by a reduced ET, with the ICT the most stable MPI parameter [4]. The MPI has been used to demonstrate fetal cardiac dysfunction in a number of pathologies including maternal diabetes [11,12,13,14,15,16], TTTS [7,17,18,19,20,21,22], congenital heart malformations [23,24,25,26,27,28], pre-eclampsia [29], IUGR [11,30,31,32,33,34], and other fetal conditions [35,36,37,38]. Several studies have proposed methods to improve the repeatability of fetal MPI by defining fixed machine settings [39] and using the clicks of the aortic and mitral valves as landmarks to delineate the constituent time intervals [9,40,41].…”

Section: Introductionmentioning

confidence: 99%

The (Pulsed-Wave) Doppler Fetal Myocardial Performance Index: Technical Challenges, Clinical Applications and Future Research

et al. 2015

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Functional cardiovascular assessment is becoming an increasingly important tool in the study of fetal pathology. The myocardial performance index (MPI) is a parameter measuring global myocardial function. Since its introduction, several studies have proposed methods to improve its reproducibility and have constructed normative reference ranges. Fetal heart evaluation using the MPI is technically challenging, requiring specific training and expertise, and a consensus has yet to be reached on the method of delineating the time periods used to calculate the index. Despite these limitations, it has been shown to be a useful and highly sensitive parameter of dysfunction in a number of fetal pathologies. Further research is warranted into the effect of pathology on MPI, parameters of unilateral cardiac strain that utilise MPI, and automation of the MPI to encourage incorporation of the MPI as a useful tool in clinical practice.

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“…Recent studies have focused on indices of fetal blood sampling (e.g. acidosis), abnormal fetal blood flow indices, cortisol and leptin levels in cord or neonatal blood, and modified insulin sensitivity testing [11][12][13].…”

Section: Importance Of Feeding In the First Periods Of Life: The Pretmentioning

confidence: 99%

Ghrelin and feeding behaviour in preterm infants

Savino¹,

Lupica²,

Liguori³

et al. 2012

Early Human Development

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a b s t r a c t a r t i c l e i n f o Available online xxxx Keywords: Ghrelin Feeding behaviour Preterm infantThe importance of early life events in the development of metabolic diseases is well recognized. Early postnatal environment, including nutrition, is key to future health, and this is particularly true for preterm infants. It is important that these infants receive sufficient nutrients to prevent growth restriction and promote neurodevelopment, while minimizing predisposition to metabolic diseases later in life. Feeding habits are the fundamental elements of nutrition and are influenced by many factors, including personal and familial habits, socioeconomic status, and cultural environment. In the last decades, there has been an important scientific interest toward the comprehension of the molecular and neural mechanisms regulating appetite. In these networks, act many peptide hormones produced in brain or gut, among which ghrelin is important because of its action in the short-term regulation of food intake and the long-term regulation of body weight. Ghrelin stimulates appetite and plays a role in regulating feeding behaviour. Ghrelin levels vary from fetal life through to early adulthood, with the highest levels observed in the very early years. Cord ghrelin levels have been evaluated in term and preterm newborns and high ghrelin levels have been observed in smallfor-gestational age newborns and in newborns with intrauterine growth restriction. Moreover, ghrelin has been detected in term and preterm human breast milk, suggesting that it may play a role in the development of neuroendocrine pathways regulating appetite and energy homeostasis in early life. However, more research is required to better define ghrelin's role in breast milk and on feeding behaviour.

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Changes in Central and Peripheral Circulation in Intrauterine Growth-Restricted Fetuses at Different Stages of Umbilical Artery Flow Deterioration: New Fetal Cardiac and Brain Parameters

Cited by 54 publications

References 51 publications

Intrauterine growth restriction: impact on cardiovascular development and function throughout infancy

Intrauterine growth restriction: impact on cardiovascular development and function throughout infancy

The (Pulsed-Wave) Doppler Fetal Myocardial Performance Index: Technical Challenges, Clinical Applications and Future Research

Ghrelin and feeding behaviour in preterm infants

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