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Published on: June 29, 2013
Fetal hemodynamic adaptive changes related to intrauterine growth: the Generation R Study
Bero O Verburg1, Vincent W V Jaddoe, Juriy W Wladimiroff
1Department of Epidemiology and Biostatistics, Erasmus Medical Center, Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Insights
Reduced fetal growth is linked to cardiovascular changes in fetuses, including altered cardiac output and increased afterload. These early adaptations may increase the risk of adult cardiovascular disease.
Area of Science:
- Perinatal Medicine
- Cardiovascular Physiology
- Developmental Biology
Background:
- Adverse fetal environments may predispose individuals to adult hypertension and cardiovascular disease.
- Suboptimal in utero development of the heart and major arteries, or adaptive cardiovascular changes due to reduced fetal growth, are potential mechanisms.
- The study investigates the association between reduced fetal growth and fetal circulatory alterations and cardiac dysfunction.
Purpose of the Study:
- To evaluate the association between reduced fetal growth and fetal circulatory changes.
- To assess cardiac dysfunction in fetuses with reduced growth.
- To understand early markers of cardiovascular risk.
Main Methods:
- Prospective, population-based cohort study.
- Ultrasound and Doppler examinations in 1215 healthy women.
- Assessment of fetal growth, placental resistance, cerebral resistance, cardiac output, outflow tract velocities, cardiac compliance, and intraventricular pressure in relation to estimated fetal weight.
Main Results:
- Higher placental resistance indices strongly correlated with decreased fetal growth.
- Cerebral resistance showed a gradual decline with reduced fetal growth.
- Cardiac output, peak systolic velocity, and cardiac compliance decreased, while intraventricular pressure increased with diminished fetal growth.
Conclusions:
- Decreased fetal growth is associated with adaptive fetal cardiovascular changes, including cardiac remodeling and altered cardiac output.
- These changes suggest increased afterload and compromised arterial compliance, occurring before clinical fetal growth restriction.
- These prenatal adaptations may contribute to an elevated risk of cardiovascular disease later in life.
Background:
It has been suggested that an adverse fetal environment increases susceptibility to hypertension and cardiovascular disease in adult life. This increased risk may result from suboptimal development of the heart and main arteries in utero and from adaptive cardiovascular changes in conditions of reduced fetal growth. The aim of the present study was to evaluate whether reduced fetal growth is associated with fetal circulatory changes and cardiac dysfunction.
Methods And Results:
This study was embedded in a population-based, prospective cohort study starting in early fetal life. Fetal growth characteristics and fetal circulation variables were assessed with ultrasound and Doppler examinations in 1215 healthy women. The fetal circulation was examined in relation to estimated fetal weight. Higher placental resistance indices were strongly associated with decreased fetal growth. Cerebral resistance showed a gradual decline with reduced fetal growth. Cardiac output, peak systolic velocity of the outflow tracts, and cardiac compliance showed a gradual reduction with diminished fetal growth, whereas intraventricular pressure gradually increased.
Conclusions:
Decreased fetal growth is associated with adaptive fetal cardiovascular changes. Cardiac remodeling and cardiac output changes are consistent with a gradual increase in afterload and compromised arterial compliance in conditions of decreased fetal growth. These changes have already begun to occur before the stage of clinically apparent fetal growth restriction and may contribute to the increased risk of cardiovascular disease in later life.
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