Second-trimester cardiovascular biometry in growth-restricted fetuses; a multicenter cohort study

Area of Science:

• Cardiology
• Fetal Medicine
• Neonatal Health

Background:

• Intrauterine growth restriction (IUGR) is associated with neonatal cardiovascular changes, but the underlying fetal pathways remain unclear.
• Early detection of fetal cardiac dysfunction is crucial for understanding long-term cardiovascular risks.

Purpose of the Study:

• To investigate fetal cardiac dimensions in the second trimester among fetuses classified as small for gestational age (SGA) and IUGR postnatally.
• To compare these dimensions with those of appropriate for gestational age (AGA) fetuses.

Main Methods:

• A prospective, multicenter cohort study (The Copenhagen Baby Heart Study) involving 8278 fetuses.
• Second-trimester fetal cardiac biometry assessed from ultrasound images, with postnatal classification of SGA and IUGR.
• Statistical analysis included adjusted mean differences, z-scores, Bonferroni correction, and receiver operating characteristic (ROC) curve analysis.

Main Results:

• Both SGA and IUGR fetuses exhibited smaller heart biometry, including aortic and pulmonary valve diameters.
• IUGR fetuses showed significantly smaller heart dimensions (length, width, ventricles) even after adjusting for abdominal circumference.
• An ROC curve incorporating various parameters achieved an area under the curve of 0.91 for predicting IUGR.

Conclusions:

• IUGR fetuses present with smaller prenatal cardiovascular biometry, suggesting altered cardiac growth early in gestation.
• Fetal heart biometry shows potential as a screening tool for IUGR, especially when combined with other clinical factors.
• These findings highlight the early impact of growth restriction on fetal cardiovascular development.