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Updated: Jan 28, 2026
Functional Transcranial Doppler Ultrasound for Monitoring Cerebral Blood Flow
Published on: March 15, 2021
Fetal umbilical, cerebral and pulmonary blood flow patterns in relation to lung function and asthma in childhood. The
Marjolein N Kooijman1,2, Evelien R van Meel1,2,3, Eric A P Steegers4
1The Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands.
Insights
Fetal blood flow patterns in the third trimester may influence childhood respiratory health. Specific patterns, like higher pulmonary artery resistance, are linked to increased wheezing risks.
Area of Science:
- Perinatal Medicine
- Pediatric Respiratory Medicine
- Fetal Physiology
Background:
- Fetal growth restriction is linked to increased childhood respiratory issues.
- Fetal blood flow adaptations may play a role in these associations.
- Understanding these links can inform early interventions.
Purpose of the Study:
- To investigate the relationship between fetal blood flow (umbilical, cerebral, pulmonary) and respiratory outcomes in childhood.
- To assess associations with wheezing patterns, lung function, and asthma development.
- To explore potential early markers of respiratory risk.
Main Methods:
- Population-based prospective cohort study of 903 children.
- Fetal blood flow measured using pulsed-wave Doppler at 30.3 weeks gestation.
- Childhood respiratory health assessed via questionnaires (wheezing, asthma) and spirometry (lung function) up to age 10.
Main Results:
- Higher umbilical artery pulsatility index and umbilical/cerebral artery PI ratio showed non-significant trends towards increased early wheezing risk.
- Elevated pulmonary artery time velocity integral (higher pulmonary vascular resistance) was associated with increased risk of late/persistent wheezing.
- Increased middle cerebral artery PI correlated with improved FEV1/FVC ratio, indicating better lung function.
Conclusions:
- Third-trimester fetal blood flow patterns may predict childhood respiratory health.
- Findings suggest fetal circulatory adaptations could influence post-natal respiratory outcomes.
- Further research is needed to confirm these hypothesis-generating findings.
Background:
Fetal growth restriction is associated with higher risks of childhood respiratory morbidity. Fetal blood flow adaptations might contribute to these associations. We examined the associations of fetal umbilical, cerebral, and pulmonary blood flow with wheezing patterns, lung function, and asthma in childhood.
Methods:
In a population-based prospective cohort study among 903 children, we measured fetal umbilical, cerebral, and pulmonary blood flow by pulsed-wave Doppler at a median gestational age of 30.3 (95% range 28.8-32.3) weeks. We obtained information about wheezing patterns until the age of 6 years by questionnaires. Lung function was measured by spirometry and information about current asthma was obtained by questionnaire at the age of 10 years.
Results:
Results showed a non-significant relationship between a higher umbilical artery pulsatility index (PI) and umbilical artery PI/cerebral artery PI ratio, indicating fetal blood flow redistribution at the expense of the trunk, with higher risks of early wheezing (OR [95% CI]: 2.07 (0.70-6.10) and 2.74 (0.60, 12.62) per unit increase, respectively). A higher pulmonary artery time velocity integral, indicating higher pulmonary vascular resistance, was associated with a higher risk of late/persistent wheezing (Z-score 1.14 [1.01-1.29]). A higher middle cerebral artery PI was associated with a higher FEV1 /FVC (Z-score [95% CI]: 0.21 [0.01-0.42]). Results did not materially change after additional adjustment for birth and growth characteristics.
Conclusion:
Third-trimester fetal blood flow patterns might be related to childhood respiratory health. These findings should be considered as hypothesis generating and need further replication.
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