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Updated: Jun 8, 2026
Fetal Echocardiography and Pulsed-wave Doppler Ultrasound in a Rabbit Model of Intrauterine Growth Restriction
Published on: June 29, 2013
Cardiac Function in Fetal Growth Restriction: A Systematic Review and Meta-Analysis
Alice D'Amico1, Francesco D'Antonio1, Lorenza Della Valle1
1Center for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, Italy.
Insights
Fetal growth restriction (FGR) is linked to altered fetal heart geometry and function. Fetuses with FGR showed smaller cardiac sphericity indices and reduced systolic function markers like MAPSE and TAPSE.
Area of Science:
- Cardiology
- Fetal Medicine
- Neonatology
Background:
- Fetal growth restriction (FGR) affects a significant number of pregnancies.
- Cardiac function assessment in fetuses with FGR is crucial for understanding long-term outcomes.
Purpose of the Study:
- To compare cardiac function in fetuses with and without fetal growth restriction (FGR).
- To analyze differences in cardiac geometry, systolic, diastolic, and global function between these groups.
Main Methods:
- A systematic literature search was conducted on Medline and Embase.
- Meta-analyses included 15 studies comparing pregnancies with and without FGR (Delphi criteria).
- Cardiovascular parameters assessed included sphericity index (SI), cardiac output (CO), atrioventricular plane displacement (MAPSE, TAPSE), E/A ratio, and myocardial performance index (MPI).
Main Results:
- Fetuses with FGR exhibited smaller right and left sphericity indices (SI).
- Reduced systolic function was observed, indicated by shorter MAPSE and TAPSE.
- Left myocardial performance index (MPI) was significantly higher in fetuses with FGR, suggesting impaired global function.
Conclusions:
- Fetal growth restriction is associated with significant alterations in fetal cardiac geometry.
- FGR impacts fetal cardiac systolic and global function, as evidenced by specific echocardiographic markers.
Objectives:
To compare cardiac function in fetuses with and without fetal growth restriction (FGR).
Methods:
Medline and Embase databases were searched. Inclusion criteria were pregnancies complicated compared to those non-complicated by FGR, defined according to the Delphi criteria. The following cardiovascular parameters were assessed. Markers of cardiac geometry and morphology, including the left and right sphericity index (SI). Markers primarily affecting the systolic function, including right (TAPSE) and left (MAPSE) cardiac output (CO), atrioventricular plane displacement, and peak systolic velocity of the aorta and pulmonary arteries. Markers primarily affecting the diastolic function, including the mitral and tricuspid E/A ratio. Markers of global cardiac function, including left and right isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT) ejection time (ET), and myocardial performance index (MPI). Random-effect meta-analyses were used to analyze the data.
Results:
Fifteen studies were included. Fetuses affected by FGR had a smaller right SI (MD -0.23, 95% CI 0.44 to -0.01; p: 0.04) and left (MD: -0.20, 95% CI -0.33 to -0.05) compared to those not affected. There was no difference in left (p = 0.179) and right (p = 0.068) CO between fetuses affected and those not affected by FGR. Fetuses with FGR had shorter MAPSE (MD: -0.91 mm, 95% CI: -1.25 to -0.57; p < 0.001) and TAPSE (MD: -1.09 mm, 95% CI: -1.23 to -0.96; p < 0.001), while there was no difference in mitral (p = 0.832) and tricuspid (p = 0.504) E/A ratio. Left MPI was higher (MD: 0.09, 95% CI 0.04 to 0.14; p < 0.001) in fetuses with FGR compared with controls.
Conclusion:
FGR is associated with significant changes in fetal cardiac geometry and function.
