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Third trimester fetal hemodynamics and cardiovascular outcomes in childhood: the Generation R study
Marjolein N Kooijman1, Layla L de Jonge, Eric A P Steegers
1aThe Generation R Study Group bDepartment of Epidemiology cDepartment of Pediatrics dDepartment of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, the Netherlands.
Insights
Fetal cardiac function in the third trimester, not vascular resistance, influences childhood heart structure. Early cardiac adaptations may impact long-term cardiovascular health, warranting further investigation into disease risks.
Area of Science:
- Perinatal Medicine
- Cardiovascular Physiology
- Developmental Biology
Background:
- Low birth weight is linked to adult cardiovascular disease.
- Fetal growth restriction may influence cardiovascular development and outcomes.
- Understanding early hemodynamic adaptations is crucial for predicting future cardiovascular health.
Purpose of the Study:
- To investigate the association between third-trimester fetal hemodynamics and cardiovascular outcomes in childhood.
- To determine if fetal cardiac and arterial measures predict childhood blood pressure, arterial stiffness, and cardiac structure.
Main Methods:
- Prospective cohort study of 917 pregnant women and their children.
- Ultrasound and Doppler examinations assessed fetal hemodynamics at ~30 weeks gestation.
- Childhood cardiovascular outcomes (blood pressure, pulse wave velocity, cardiac structure/function) assessed at age 6.
Main Results:
- Third-trimester fetal hemodynamics were not associated with childhood blood pressure or arterial stiffness.
- Fetal aorta diameter and cardiac output correlated with childhood aortic root diameter.
- Fetal cardiac diastolic filling patterns were inversely associated with childhood aortic root diameter.
Conclusions:
- Third-trimester fetal vascular resistance does not appear to impact childhood blood pressure or arterial stiffness.
- Fetal cardiac structure and function in the third trimester are associated with cardiac outcomes in childhood.
- Further research is needed to determine if these early adaptations increase future cardiovascular disease risk.
Objective:
Low birth weight is associated with cardiovascular disease in adulthood. Hemodynamic adaptations related to fetal growth restriction may underlie these associations, through persistent influences on cardiovascular development. We examined the associations of third trimester fetal hemodynamics with cardiovascular outcomes in childhood.
Methods:
In a prospective cohort study among 917 pregnant women and their children, we measured fetal growth, and fetal arterial and cardiac hemodynamic variables with ultrasound and Doppler examinations at a gestational age of 30.3 (95% range 28.8-32.3) weeks. At the age of 6 years, we measured blood pressure, carotid-femoral pulse wave velocity, and left cardiac structures and function.
Results:
We observed that fetal hemodynamics were not associated with childhood blood pressure and carotid-femoral pulse wave velocity. The fetal aorta ascendens diameter and left cardiac output were positively associated with childhood aortic root diameter [0.14 standard deviation score (SDS), 95% confidence interval (CI) 0.07-0.22 and 0.08 SDS, 95% CI 0.01-0.15 per SDS change in diameter and output, respectively]. Fetal left ventricular diastolic filling pattern was inversely associated with aortic root diameter (-0.07 SDS, 95% CI -0.13 to 0.00 per SDS change in E/A ratio) at 6 years. Analyses adjusted and stratified for estimated fetal weight showed no differences in results.
Conclusion:
Our results suggest that third trimester fetal vascular resistance parameters do not affect blood pressure or arterial stiffness in childhood. Fetal cardiac functional and structural measures are associated with cardiac outcomes in childhood. Whether these early adaptations lead to greater risks of cardiovascular disease should be further studied.
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