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Fetal cardiovascular function in a late-onset SGA and FGR cohort: CURIOSA study
Silvia M Lobmaier1, Oliver Graupner1, Christina Franke1
1Technical University of Munich, School of Medicine and Health, Klinikum rechts der Isar, Deparment of Obstetrics and Gynecology, Munich, Germany.
Insights
Fetal cardiovascular function parameters are altered in fetuses with late-onset small for gestational age (SGA), even before birth. These findings highlight potential early indicators for fetal programming in prenatal diagnostics.
Area of Science:
- Obstetrics and Gynecology
- Fetal Medicine
- Cardiovascular Physiology
Background:
- Fetal cardiovascular function measurement is not established in prenatal diagnostics.
- Fetal programming research is growing in importance.
- Cardiovascular changes are noted in early/severe fetal growth restriction (FGR).
Purpose of the Study:
- To investigate functional echocardiographic parameters in fetuses with late-onset small for gestational age (SGA) and FGR.
- To identify potential prenatal diagnostic markers for fetal programming.
Main Methods:
- Prospective cohort study of SGA fetuses (including FGR) and controls (32 weeks to term).
- Collected echocardiographic parameters of systolic, diastolic, and global cardiac function.
- Measured morphometry and fetal abdominal aorta parameters.
Main Results:
- SGA fetuses showed increased relative ventricular wall thickness, left E/A ratio, isovolumetric contraction time, and left myocardial performance index.
- Reduced MAPSE, TAPSE, ejection time, cardiac output, and aortic distensibility were observed in SGA fetuses.
- Changes were more pronounced in the FGR subgroup.
Conclusions:
- Echocardiographic parameters are altered in fetuses with late-onset SGA/FGR.
- These findings suggest potential for early detection of fetal programming issues.
- Functional echocardiography may offer new insights into fetal cardiovascular health.
Abstract:
The measurement of fetal cardiovascular function parameters is not yet established in prenatal diagnostics. Now that the research field of fetal programming is becoming increasingly important, this might change. Fetal cardiovascular changes have been described above all in early/severe fetal growth restriction (FGR). The aim of this study was to investigate functional echocardiographic parameters in fetuses with late-onset small for gestational age (SGA)/FGR.A prospective cohort of SGA fetuses (including FGR) and a control group with similar distribution of gestational age were studied. Parameters of systolic, diastolic, and global cardiac function, morphometry and measurements of the fetal abdominal aorta were collected.A total of 149 SGA fetuses and 143 control fetuses were included from 32 weeks until term. The total SGA group was further divided into SGA 3rd-10th (fetuses between the 3rd and 10th weight percentile) and FGR subgroups. In the total SGA group, relative right and left ventricular wall thickness, left E/A ratio, isovolumetric contraction time and left myocardial performance index were significantly increased compared to controls after adjustment for gestational age. MAPSE, TAPSE, ejection time, left cardiac output, and abdominal aortic distensibility were significantly lower. The changes were more pronounced in the FGR subgroup.Even in a group of late-onset SGA/FGR, echocardiographic parameters are already altered in utero.
