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Placental vascular dysfunction, fetal and childhood growth, and cardiovascular development: the generation R study

Romy Gaillard1, Eric A P Steegers, Henning Tiemeier

  • 1Generation R Study Group (R.G., V.W.V.J.) and the Departments of Epidemiology (R.G., H.T., A.H., V.W.V.J.), Paediatrics (R.G., V.W.V.J.), Obstetrics and Gynaecology (E.A.P.S.), and Child and Adolescent Psychiatry (H.T.), Erasmus Medical Center, Rotterdam, The Netherlands.

Circulation
|October 19, 2013
PubMed

Insights

Suboptimal fetal nutrition, indicated by higher umbilical artery resistance, is linked to slower fetal growth and altered childhood cardiovascular development. These effects persist into childhood, impacting body composition and blood pressure.

Area of Science:

  • Perinatology
  • Developmental Biology
  • Cardiovascular Physiology

Background:

  • Suboptimal fetal nutrition can impact early growth and cardiovascular development.
  • Feto-placental and utero-placental vascular function are key indicators of fetal well-being.

Purpose of the Study:

  • To investigate the association between umbilical and uterine artery resistance indices and fetal/childhood growth and cardiovascular development.
  • To determine if vascular resistance in the third trimester predicts long-term growth and cardiovascular outcomes.

Main Methods:

  • A population-based prospective cohort study of 6716 mothers and children.
  • Third-trimester measurements of umbilical artery pulsatility index, uterine artery resistance index, and fetal growth.
  • Repeated assessments of childhood growth, body fat distribution, left ventricular mass, and blood pressure up to age 6.

Main Results:

  • Higher third-trimester umbilical and uterine artery vascular resistance correlated with lower fetal growth and smaller birth size.
  • These growth differences persisted, though diminished, up to age 6.
  • Elevated umbilical artery resistance (not uterine) was associated with higher childhood BMI, body fat, systolic blood pressure, and lower left ventricular mass, independent of birth weight.

Conclusions:

  • Increased feto-placental vascular resistance in the third trimester is associated with reduced fetal growth rates.
  • Higher feto-placental vascular resistance predicts adverse cardiovascular adaptations in childhood.
  • Utero-placental vascular resistance did not show similar associations with childhood cardiovascular outcomes.
Abstract

Keywords:
blood supplycardiovascular diseasesepidemiologypediatricspregnancy

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