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Updated: Apr 2, 2026
Fetal Echocardiography and Pulsed-wave Doppler Ultrasound in a Rabbit Model of Intrauterine Growth Restriction
Published on: June 29, 2013
Fetal cardiovascular remodeling persists at 6 months in infants with intrauterine growth restriction
M Cruz-Lemini1, F Crispi1, B Valenzuela-Alcaraz1
1BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
Insights
Cardiovascular changes are evident in fetuses with small-for-gestational-age (SGA) and persist postnatally, indicating early remodeling. This remodeling pathway may explain the increased cardiovascular risk in SGA individuals later in life.
Area of Science:
- Cardiovascular physiology
- Fetal development
- Pediatric cardiology
Background:
- Intrauterine growth restriction (IUGR) is linked to later cardiovascular disease.
- The specific mechanisms connecting fetal development to postnatal cardiovascular risk are not fully understood.
- Small-for-gestational-age (SGA) fetuses represent a significant portion of IUGR cases.
Purpose of the Study:
- To longitudinally assess cardiovascular remodeling in small-for-gestational-age (SGA) fetuses and infants at 6 months of age.
- To investigate the association between fetal cardiovascular changes and postnatal outcomes.
- To explore potential mechanistic links between SGA and future cardiovascular risk.
Main Methods:
- A cohort study comparing 80 SGA fetuses/infants with 80 controls.
- Cardiovascular evaluation using comprehensive echocardiography in fetuses and 6-month-old infants.
- Postnatal assessment included blood pressure and aortic intima-media thickness (aIMT) measurements.
- Statistical analysis adjusted for relevant confounding factors.
Main Results:
- SGA fetuses and infants exhibited altered cardiac shape and impaired systolic and diastolic function compared to controls.
- Infants in the SGA group presented with elevated mean blood pressure and increased aortic intima-media thickness (aIMT).
- These cardiovascular alterations were present prenatally and persisted at 6 months of corrected age.
Conclusions:
- Significant cardiovascular remodeling occurs in SGA fetuses and continues into infancy.
- Prenatal cardiovascular changes in SGA fetuses are a key factor in the increased long-term cardiovascular risk.
- These findings highlight the importance of early detection and intervention for SGA individuals.
Objectives:
Intrauterine growth restriction is associated with increased cardiovascular risk later in life but the link between fetal disease and postnatal risk is not well-documented. We evaluated longitudinally the association between cardiovascular remodeling in small-for-gestational-age (SGA) fetuses and at 6 months of age.
Methods:
A cohort of 80 SGA fetuses (defined by estimated fetal and birth weights < 10(th) centile) delivered > 34 weeks' gestation was compared with 80 normally grown age-matched control fetuses, with follow-up at 6 months of corrected age (i.e. 6 months from estimated date of delivery according to first-trimester crown-rump length). Cardiovascular evaluation included a comprehensive echocardiographic assessment in both fetuses and infants and blood pressure and aortic intima-media thickness (aIMT) measurement in infants. Parameters were adjusted by linear regression analysis for gender, gestational age at delivery, pre-eclampsia, prenatal glucocorticoid exposure, Cesarean delivery, admission to neonatal intensive care unit and body surface area.
Results:
Both pre- and postnatally, when compared with controls, the SGA group showed a more globular cardiac shape (left sphericity index: controls 2.06 vs SGA 1.87 (P = 0.022) prenatally and 1.92 vs 1.67 (P = 0.007) postnatally), as well as signs of systolic longitudinal dysfunction (systolic annular peak velocity (S'): 7.2 vs 6.3 cm/s (P = 0.003) prenatally and 7.9 vs 6.4 cm/s (P < 0.001) postnatally; tricuspid annular plane systolic excursion: 7.2 vs 6.8 mm (P = 0.015) prenatally and 16.0 vs 14.2 mm (P < 0.001) postnatally) and diastolic dysfunction (left isovolumetric relaxation time: 46 vs 52 ms (P < 0.001) prenatally and 50 vs 57 ms (P = 0.034) postnatally). In addition, infants in the SGA group had increased mean blood pressure (mean: 61 vs 70 mmHg, P < 0.001) and maximum aIMT (0.57 vs 0.66 mm; P < 0.001).
Conclusions:
Primary cardiovascular changes are already present in the SGA fetus and persist at 6 months of age. These data support prenatal cardiovascular remodeling as a mechanistic pathway of increased risk later in life in cases of SGA, regardless of Doppler abnormalities. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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