Fetal cardiovascular remodeling persists at 6 months in infants with intrauterine growth restriction

Cruz‐Lemini, M.; Crispi, F.; Valenzuela-Alcaráz, Brenda; Figueras, F.; Sitges, Marta; Bijnens, Bart; Gratacós, E.

doi:10.1002/uog.15767

Cited by 91 publications

(108 citation statements)

References 46 publications

(65 reference statements)

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“…The shape alteration might not have an important influence on the wall stresses at rest, but we think it would alter the response to a pressure challenge. The results of the present study are in line with previous studies demonstrating more globular hearts with impaired longitudinal motion and relaxation in FGR fetuses, 5,19 infants, 20 and children. 3 Our data are also partially in agreement with recent reports in late childhood, 8,21 adolescence, 9 and youth, 10,11 suggesting smaller cardiovascular dimensions and mass with preserved cardiac function (assessed by 2D and Doppler) in FGR.…”

Section: Discussionsupporting

confidence: 93%

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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Section: Discussionsupporting

confidence: 93%

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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“…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: Introductionmentioning

confidence: 89%

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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“…As mentioned previously, increased isovolumetric relaxation time-which represents poor myocardial relaxation-suggests diastolic functional impairment following IUGR (10,26,37). Diastolic function can also be assessed by the E/A ratio, which represents the ratio between passive diastolic ventricular filling and additional active filling during atrial contraction (E-and A-wave on Doppler signal).…”

Section: Diastolic Dysfunctionmentioning

confidence: 99%

“…They are however more likely to result from increased afterload in relation to high placental resistance, since most growth-restricted fetuses are capable of maintaining their cardiac output (7,48,50) and the majority of studies also report normal postnatal systolic function (10,(36)(37)(38)(39)(40)(41)51). Fractional shortening and ejection fraction, both measurements that give an indication of left ventricular pump function, have been found to be similar in growth-restricted and AGA neonates and infants (10,(36)(37)(38)(39)(40)(41). In most studies, cardiac output of neonates and infants born growth restricted has also been found comparable to controls (36)(37)(38)40,51).…”

mentioning

confidence: 99%

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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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Fetal cardiovascular remodeling persists at 6 months in infants with intrauterine growth restriction

Cited by 91 publications

References 46 publications

Persistence of Cardiac Remodeling in Preadolescents With Fetal Growth Restriction

Persistence of Cardiac Remodeling in Preadolescents With Fetal Growth Restriction

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

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

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