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Fetal and Infant Growth and the Cardiovascular Stress Response in Adolescence: A Cardiovascular Magnetic Resonance
Arwen S J Kamphuis1,2, Alexander Hirsch3,4, Dimitris Rizopoulos5
1The Generation R Study Group Erasmus MC, University Medical Center Rotterdam The Netherlands.
Insights
Lower gestational age is linked to altered systolic blood pressure response during exercise in adolescents. Fetal and infant growth did not significantly impact cardiovascular stress responses in this healthy cohort.
Area of Science:
- Cardiovascular physiology
- Pediatric health
- Developmental origins of health and disease
Background:
- Abnormal birth weight and infant growth are risk factors for cardiovascular diseases (CVDs).
- Mechanisms linking early growth to CVD risk remain unclear.
- Exercise testing reveals cardiovascular function differences not apparent at rest.
Purpose of the Study:
- To investigate the association between fetal and infant growth and the adolescent cardiovascular stress response.
- To determine if early life growth influences cardiovascular reactivity to exercise.
Main Methods:
- Prospective cohort study of 207 children from fetal life to 16 years.
- Assessment of fetal and infant growth (2nd trimester to 2 years).
- Isometric handgrip exercise test at 16 years with heart rate, blood pressure monitoring, and cardiovascular magnetic resonance imaging.
Main Results:
- Higher gestational age correlated with lower systolic blood pressure during exercise and recovery.
- No significant associations found between birth weight or infant growth and cardiovascular stress response.
- Heart rate and cardiovascular magnetic resonance imaging outcomes were not associated with gestational age, birth weight, or infant growth.
Conclusions:
- Lower gestational age is associated with altered systolic blood pressure response to exercise in adolescence.
- Fetal or infant growth does not appear to influence cardiovascular response to exercise-induced stress in this population.
- Early identification and prevention of CVD in preterm infants are crucial.
Background:
Abnormal birth weight and infant weight gain are recognized as risk factors for cardiovascular diseases. Underlying mechanisms remain unclear. Exercise testing can detect subtle differences in cardiovascular function not present at rest. We examined associations of fetal and infant growth with the cardiovascular stress response in adolescence.
Methods:
We examined a subsample of 207 children from a population-based prospective cohort from fetal life onwards. Fetal and infant growth were assessed from the second trimester to 2 years. At 16 years, participants performed an isometric handgrip exercise with continuous heart rate and blood pressure monitoring and cardiovascular magnetic resonance imaging.
Results:
Children showed a clear peak in heart rate and systolic and diastolic blood pressure during exercise, followed by a decrease below baseline after exercise cessation, before stabilizing. Higher gestational age was associated with lower systolic blood pressure throughout the exercise (differences per SD score increase in gestational age: rest, -2.24 mm Hg [95% CI, -4.23 to -0.25 mm Hg], peak exercise (-2.37 mm Hg [95% CI, -4.70 to -0.04 mm Hg]), recovery (-2.57 mm Hg [95% CI, -4.72 to -0.42 mm Hg])) but not with heart rate or CMR outcomes. No consistent associations were present for birth weight or infant growth with the cardiovascular stress response.
Conclusions:
A lower gestational age at birth is associated with an altered response to exercise in systolic blood pressure. Fetal or infant growth is not associated with differences in cardiovascular response to exercise-induced stress in adolescence in a relatively healthy population. Follow-up of children born preterm is important to enable early identification and prevention of cardiovascular disease development.
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