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Published on: June 29, 2013
Cardiovascular function in children born very preterm after intrauterine growth restriction with severely abnormal
Eva Morsing1, Petru Liuba2, Vineta Fellman2
1Lund University, Lund, Sweden eva.morsing@med.lu.se.
Insights
Children born very preterm with intrauterine growth restriction (IUGR) show arterial wall changes and higher blood pressure. Preterm birth, not IUGR, was linked to elevated blood pressure in this study.
Area of Science:
- Cardiology
- Neonatology
- Pediatric Cardiovascular Health
Background:
- Low birthweight is a known risk factor for adult cardiovascular disease.
- Intrauterine growth restriction (IUGR) with abnormal fetal blood flow may impact long-term cardiovascular health.
- Very preterm birth is associated with increased risks of adverse health outcomes, including cardiovascular issues.
Purpose of the Study:
- To evaluate the cardiovascular outcomes in children born very preterm with IUGR.
- To assess arterial structure, function, and blood pressure in relation to preterm birth and IUGR.
- To compare cardiovascular parameters between preterm infants with and without IUGR, and term-born controls.
Main Methods:
- Non-invasive assessment of blood pressure, cardiac function, arterial diameters, distensibility, and stiffness in 7-year-old children.
- Measurements included abdominal aorta, carotid, and popliteal arteries, endothelial function, and carotid intima-media thickness.
- Comparison between three groups: preterm-IUGR (n=32), preterm-appropriate-for-gestational-age (AGA) (n=32), and term-AGA (n=32).
Main Results:
- Preterm-IUGR children exhibited lower microvascular response, lower aortic stiffness, and higher distensibility compared to preterm-AGA children.
- Preterm-born children (both IUGR and AGA) had higher height-adjusted systolic blood pressure than term-AGA children.
- Lower carotid intima-media thickness was observed in preterm-IUGR children compared to term-AGA children; no differences in cardiac size or function were found.
Conclusions:
- Intrauterine growth restriction (IUGR) and preterm birth are associated with structural arterial wall changes.
- Preterm birth, independent of IUGR, appears to be linked to elevated blood pressure in childhood.
- Conventional echocardiography did not reveal effects of IUGR on cardiac size and function in this cohort.
Aims:
Low birthweight has been linked to increased cardiovascular risk in adulthood. We evaluated the effect on cardiovascular outcome of intrauterine growth restriction (IUGR) with abnormal fetal blood flow in children born very preterm.
Methods:
Blood pressure, cardiac function and size, diameters, distensibility, and stiffness of the abdominal aorta, carotid, and popliteal arteries, and endothelial function were assessed non-invasively in 7-year-old children (n = 32) born very preterm with IUGR, with birthweight (median, range) 650 g (395-976 g) and gestational age 27 weeks (24-29 weeks). In addition, intima-media thickness was measured in the carotid artery. Controls were matched for gender and age and had birthweight appropriate-for-gestational-age (AGA). The study included 32 preterm-AGA children with birthweight 1010 g (660-1790) g and 32 term-AGA children with birthweight 3530 g (3000-4390) g.
Results:
Preterm-IUGR children had lower microvascular response to acetylcholine, lower aortic stiffness, and higher distensibility compared with the preterm-AGA group (p = 0.019, p = 0.001, and p < 0.001, respectively) and lower carotid intima-media thickness compared with the term-AGA group (p = 0.047). The highest aortic β and lowest distensibility were found in the preterm-AGA group. Height-adjusted systolic blood pressure was higher in the preterm groups than in the term-AGA group (p = 0.018). Cardiac function and size did not differ between the groups.
Conclusion:
IUGR and preterm birth appear to be associated with structural changes in the arterial wall, whereas preterm birth seems to be associated with higher blood pressure. Using conventional echocardiography, we observed no effect of IUGR on cardiac size and function.
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