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Published on: May 5, 2018
Maternal smoking during pregnancy, fetal arterial resistance adaptations and cardiovascular function in childhood
J J M Geelhoed1, H El Marroun, B O Verburg
1The Generation R Study Group Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands. j.geelhoed@erasmusmc.nl
Insights
Maternal smoking during pregnancy, especially heavy smoking, increases fetal arterial resistance. This may link smoking to low birthweight and later cardiovascular issues in children.
Area of Science:
- Cardiovascular development
- Maternal-fetal medicine
- Pediatric cardiology
Background:
- Low birthweight is linked to adult cardiovascular disease.
- Mechanisms connecting maternal smoking to offspring cardiovascular health require elucidation.
Purpose of the Study:
- To investigate if maternal smoking during pregnancy causes fetal arterial resistance adaptations.
- To determine if these adaptations lead to fetal growth restriction and altered postnatal cardiovascular development.
Main Methods:
- Prospective cohort study of 1120 children from fetal life to 2 years.
- Maternal smoking assessed by questionnaire.
- Fetal arterial resistance, growth, and postnatal cardiovascular parameters measured via ultrasound, Doppler, and physical examinations.
Main Results:
- Continued smoking (≥ 5 cigarettes/day) associated with increased uterine, umbilical, and middle cerebral artery resistance.
- Heavy smoking linked to reduced ascending aorta flow and diameter.
- Fetal arterial resistance correlated with aortic root and left atrial diameters at 2 years.
Conclusions:
- Fetal arterial resistance adaptations may mediate the link between maternal smoking and low birthweight.
- These adaptations could contribute to cardiovascular developmental changes in offspring exposed to smoking in utero.
Objective:
To unravel the mechanisms underlying the previously demonstrated associations between low birthweight and cardiovascular disease in adulthood, we examined whether maternal smoking during pregnancy leads to fetal arterial resistance adaptations, and subsequently to fetal growth retardation and changes in postnatal blood pressure and cardiac development.
Design:
Prospective cohort study from early fetal life onwards.
Setting:
Academic hospital.
Population:
Analyses were based on 1120 children aged 2 years.
Methods:
Maternal smoking during pregnancy [non-smoking, first trimester smoking, continued smoking (< 5 and ≥ 5 cigarettes/day)] was assessed by questionnaire.
Main Outcome Measures:
Third trimester placental and fetal arterial resistance indices and fetal growth were assessed by ultrasound and Doppler measurements. Postnatal blood pressure and cardiac structures (aortic root diameter, left atrial diameter, left ventricular mass) were measured at 2 years of age.
Results:
First trimester smoking was not associated with third trimester placental and fetal blood flow adaptations. Continued smoking of ≥ 5 cigarettes/day was associated with an increased resistance in uterine, umbilical and middle cerebral arteries, and with a decreased flow and diameter of the ascending aorta. Among mothers who continued to smoke, the third trimester estimated fetal weights and birthweights were most affected in children with the highest umbilical artery resistance. Fetal arterial resistance indices were also associated with aortic root diameter and left atrial diameter.
Conclusions:
Fetal arterial resistance adaptations may be involved in the pathways leading from maternal smoking during pregnancy to low birthweight and cardiovascular developmental changes in childhood in the offspring.
