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Published on: June 29, 2013
Cardiovascular programming in children born small for gestational age and relationship with prenatal signs of
Fatima Crispi1, Francesc Figueras, Monica Cruz-Lemini
1Department of Maternal-Fetal Medicine, Institut Clinic de Ginecologia, Obstetricia, i Neonatologia, Hospital Clinic, Barcelona, Spain.
Insights
Children born small-for-gestational-age (SGA) exhibit altered cardiovascular function and increased vascular risk factors in childhood. These findings suggest fetal programming impacts long-term cardiovascular health, regardless of specific growth restriction markers.
Area of Science:
- Pediatric Cardiology
- Fetal Medicine
- Developmental Biology
Background:
- Small-for-gestational-age (SGA) is associated with adverse health outcomes.
- Intrauterine growth restriction (IUGR) is a common cause of SGA.
- Cardiovascular development may be affected by fetal growth restriction.
Purpose of the Study:
- To assess cardiovascular function in children born as small-for-gestational-age (SGA) fetuses.
- To compare cardiovascular outcomes in SGA with and without intrauterine growth restriction (IUGR).
- To investigate the impact of fetal growth parameters on postnatal cardiovascular health.
Main Methods:
- Prospective study of 50 SGA children and 100 controls, evaluated at 3-6 years.
- SGA children categorized by IUGR (defined by weight centile <3 or abnormal Doppler).
- Cardiovascular assessment included echocardiography, blood pressure, and carotid intima-media thickness.
Main Results:
- SGA and IUGR groups showed globular hearts, impaired longitudinal motion, and increased radial function.
- Elevated blood pressure and carotid intima-media thickness were observed in both SGA and IUGR groups.
- A trend towards worse cardiovascular outcomes was noted in IUGR compared to SGA.
Conclusions:
- Fetal cardiovascular programming is evident in SGA children, irrespective of Doppler findings or weight centiles.
- These results challenge the notion of 'constitutionally small' SGA infants.
- Further research is needed to identify predictors of cardiovascular risk in SGA populations.
Objective:
The objective of the study was to evaluate cardiovascular function in children who were small-for-gestational-age (SGA) fetuses.
Study Design:
This was a prospective study including 100 controls and 50 children diagnosed in utero as SGA after 34 weeks subdivided into the following categories: SGA and intrauterine growth restriction (IUGR) according to the absence or presence, respectively, of weight centile less than 3 or abnormal cerebroplacental Doppler. Postnatal cardiovascular outcome was evaluated at 3-6 years of age by echocardiography, blood pressure, and carotid ultrasound.
Results:
Both SGA and IUGR presented in childhood more globular hearts, reduced longitudinal motion, and impaired relaxation with an increase in radial function. Both groups showed increased blood pressure and carotid intima-media thickness. There was a linear tendency to worse cardiovascular results in IUGR as compared with SGA.
Conclusion:
Fetal cardiovascular programming occurs in SGA, regardless of Doppler and weight centile. These findings challenge the concept of constitutionally small and warrant further investigation to identify predictors of cardiovascular outcome in SGA.
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