Fetal Growth Restriction Results in Remodeled and Less Efficient Hearts in Children
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- 8 June 2010
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 121 (22), 2427-2436
- https://doi.org/10.1161/circulationaha.110.937995
Abstract
Background— Fetal growth restriction (FGR) affects 5% to 10% of newborns and is associated with increased cardiovascular mortality in adulthood. The most commonly accepted hypothesis is that fetal metabolic programming leads secondarily to diseases associated with cardiovascular disease, such as obesity, diabetes mellitus, and hypertension. Our main objective was to evaluate the alternative hypothesis that FGR induces primary cardiac changes that persist into childhood. Methods and Results— Within a cohort of fetuses with growth restriction identified in fetal life and followed up into childhood, we randomly selected 80 subjects with FGR and compared them with 120 normally grown fetuses, matched for gender, birth date, and gestational age at birth. Cardiovascular assessment was performed in childhood (mean age of 5 years). Compared with control subjects, children with FGR had a different cardiac shape, with increased transversal diameters and more globular cardiac ventricles. Although left ejection fraction was similar among the study groups, stroke volume was reduced significantly, which was compensated for by an increased heart rate to maintain output in severe FGR. This was associated with subclinical longitudinal systolic dysfunction (decreased myocardial peak velocities) and diastolic changes (increased E/E′ ratio and E deceleration time). Children with FGR also had higher blood pressure and increased intima-media thickness. For all parameters evaluated, there was a linear increase with the severity of growth restriction. Conclusions— These findings suggest that FGR induces primary cardiac and vascular changes that could explain the increased predisposition to cardiovascular disease in adult life. If these results are confirmed, the impact of strategies with beneficial effects on cardiac remodeling should be explored in children with FGR.This publication has 42 references indexed in Scilit:
- Noninvasive Assessment of Subclinical Atherosclerosis in Children and AdolescentsHypertension, 2009
- Does pre‐eclampsia influence fetal cardiovascular function in early‐onset intrauterine growth restriction?Ultrasound in Obstetrics & Gynecology, 2009
- Hypoxia Induces Dilated Cardiomyopathy in the Chick Embryo: Mechanism, Intervention, and Long-Term ConsequencesPLOS ONE, 2009
- Global left-ventricular function by tissue Doppler imaging in pediatric dialysis patientsPediatric Nephrology, 2008
- The Association of Birth Weight with Developmental Trends in Blood Pressure from Childhood through Mid-Adulthood: The Bogalusa Heart StudyAmerican Journal of Epidemiology, 2007
- Tissue Doppler imaging identifies myocardial dysfunction in adults with marfan syndromeClinical Cardiology, 2007
- NATURAL HISTORY AND RISK FACTORS OF ATHEROSCLEROSIS IN CHILDREN AND YOUTH: THE PDAY STUDYPediatric Pathology & Molecular Medicine, 2002
- Ventriculovascular physiology of the growth-restricted fetusUltrasound in Obstetrics & Gynecology, 2001
- Association of Increased Cardiothoracic Ratio and Intrauterine Growth RetardationAmerican Journal of Perinatology, 1991
- Growth in utero, blood pressure in childhood and adult life, and mortality from cardiovascular disease.BMJ, 1989