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Published on: June 29, 2013
First trimester fetal growth restriction and cardiovascular risk factors in school age children: population based
Vincent W V Jaddoe1, Layla L de Jonge, Albert Hofman
1The Generation R Study Group, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, Netherlands.
Insights
Impaired first trimester fetal growth is linked to higher cardiovascular risk in children. Early fetal development may be crucial for long-term heart health.
Area of Science:
- Developmental origins of health and disease (DOHaD)
- Pediatric cardiovascular health
- Fetal growth and development
Background:
- Cardiovascular risk factors often track from childhood into adulthood.
- Early life factors, including fetal growth, may influence later cardiovascular health.
Purpose of the Study:
- To investigate the association between first trimester fetal growth restriction and childhood cardiovascular outcomes.
- To determine if early fetal development impacts the risk profile for cardiovascular disease in later childhood.
Main Methods:
- Population-based prospective cohort study in Rotterdam, Netherlands.
- Included 1184 children with first trimester fetal crown-rump length measurements.
- Assessed cardiovascular risk factors at a median age of 6.0 years.
Main Results:
- Smaller first trimester fetal crown-rump length was associated with adverse cardiovascular risk profiles in childhood.
- Associations included higher body mass index, unfavorable fat distribution, and increased clustering of cardiovascular risk factors.
- Childhood body mass index mediated the relationship between early fetal growth and fat mass.
Conclusions:
- Impaired first trimester fetal growth is associated with an adverse cardiovascular risk profile in school-aged children.
- Early fetal development appears to be a critical period influencing long-term cardiovascular health.
Objective:
To examine whether first trimester fetal growth restriction correlates with cardiovascular outcomes in childhood.
Design:
Population based prospective cohort study.
Setting:
City of Rotterdam, the Netherlands.
Participants:
1184 children with first trimester fetal crown to rump length measurements, whose mothers had a reliable first day of their last menstrual period and a regular menstrual cycle.
Main Outcomes Measures:
Body mass index, total and abdominal fat distribution, blood pressure, and blood concentrations of cholesterol, triglycerides, insulin, and C peptide at the median age of 6.0 (90% range 5.7-6.8) years. Clustering of cardiovascular risk factors was defined as having three or more of: high android fat mass; high systolic or diastolic blood pressure; low high density lipoprotein cholesterol or high triglycerides concentrations; and high insulin concentrations.
Results:
One standard deviation score greater first trimester fetal crown to rump length was associated with a lower total fat mass (-0.30%, 95% confidence interval -0.57% to -0.03%), android fat mass (-0.07%, -0.12% to -0.02%), android/gynoid fat mass ratio (-0.53, -0.89 to -0.17), diastolic blood pressure (-0.43, -0.84 to -0.01, mm Hg), total cholesterol (-0.05, -0.10 to 0, mmol/L), low density lipoprotein cholesterol (-0.04, -0.09 to 0, mmol/L), and risk of clustering of cardiovascular risk factors (relative risk 0.81, 0.66 to 1.00) in childhood. Additional adjustment for gestational age and weight at birth changed these effect estimates only slightly. Childhood body mass index fully explained the associations of first trimester fetal crown to rump length with childhood total fat mass. First trimester fetal growth was not associated with other cardiovascular outcomes. Longitudinal growth analyses showed that compared with school age children without clustering of cardiovascular risk factors, those with clustering had a smaller first trimester fetal crown to rump length and lower second and third trimester estimated fetal weight but higher weight growth from the age of 6 months onwards.
Conclusions:
Impaired first trimester fetal growth is associated with an adverse cardiovascular risk profile in school age children. Early fetal life might be a critical period for cardiovascular health in later life.
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