Neonatal Arterial Morphology Is Related to Body Size in Abnormal Human Fetal Growth

Abstract

Background-Restriction in fetal growth is associated with cardiovascular disease in adulthood. It is unclear whether abnormal intrauterine growth influences arterial morphology during the fetal or neonatal stage. The objective was to study the regional arterial morphology with respect to gestational age and abnormal fetal body size. Methods and Results-We studied body anthropometrics and arterial morphology and physiology in 174 neonates born between 31 and 42 weeks of gestation, including neonates with birth weights appropriate, small, and large for age, with very high resolution vascular ultrasound (35-55 MHz). In simple linear regressions, parameters of body size (body weight, body surface area, and organ circumference) and gestational age were statistically significantly associated with common carotid, brachial, femoral arterial parameters (lumen diameter [LD], wall layer thickness [intima-media thickness and intima-media-adventitia thickness], and carotid artery wall stress [CAWS]). Male sex was statistically significantly associated with LD and CAWS. In multiple linear regression models, body size, gestational age, and sex explained a large proportion of the arterial variance (R 2 range, 0.37-0.47 for LD; 0.09-0.35 for intima-media thickness; 0.21-0.41 for intima-media-adventitia thickness; and 0.23 for CAWS; all models P<0.001). Arterial wall layer thickness, LDs, and CAWS were independently and strongly predicted by body size, and no effect of maternal disease was observed when added to the models. Gestational age and male sex were also independently but more weakly associated with arterial LDs and CAWS (P<0.01), but not with arterial wall layers. Conclusions-These results indicate that the intrauterine growth of fetal arterial LD and wall layer thickness are primarily attributed to body growth overall. LD and CAWS show weaker association with gestational age and sex. (Circ Cardiovasc Imaging. 2016;9:e004657.

Risk factors during first 1,000 days of life for carotid intima-media thickness in infants, children, and adolescents: A systematic review with meta-analyses

“…In the other study, nonbreastfed children on formulas with higher protein content during their first year of life had a lower CIMT (SMD −0.21 (95% CI: −0.45 to 0.04)) compared to children on lower protein formulas [63]. Scarce evidence, reported in 1 study, existed for other factors, such as cardio-metabolic and inflammatory factors, for instance, blood pressure [81], cord blood cholesterol [55], cortisol [69], and epigenetic changes, such as DNA methylation levels following exposure to air pollution [56,57] (Tables 1 and S6). (Table 3; Fig 4B).…”

Differences in cardiac geometry in relation to body size among neonates with abnormal prenatal growth and body size at birth

“…The aims of this study were to determine to what extent cardiac geometry is dependent on body size in preterm and term neonates with restricted or excessive prenatal growth and how this is affected by adiposity. We have reported previously on the relationships between fetal body size and peripheral arterial morphology in the same study population 15 .…”

A Womb With a View

“…The article by Olander et al 4 in this issue of Circulation: Cardiovascular Imaging has used higher frequency ultrasound than previously described (between 35 and 55 Hz) to image the vascular walls of neonates and reached different conclusions, finding no evidence of increased IMT or intimamedia adventitial thickness (IMAT) in babies born SGA. This raises the question whether IMT or IMAT has been reliably characterized in small babies using lower frequency ultrasound, particularly as an abnormal finding may have resulted in increased surveillance in childhood or perhaps the offer of early preventative treatment.…”

“…It would, therefore, be advantageous to assess body composition using other techniques, such as magnetic resonance imaging, to allow more granular interpretation of the results. 20 Olander et al 4 report that body surface area was an independent predictor of IMT and IMAT, but the body composition of the individual groups remains unknown, and it is difficult to infer a pathophysiological process.…”