Cruz-Lemini M, Crispi F, Valenzuela-Alcaraz B, Figueras F, Sitges M, Bijnens B, Gratacós E
BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
Department of Cardiology (Institut Clínic del Tòrax), Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain.
Ultrasound Obstet Gynecol. 2016 Sep;48(3):349-56. doi: 10.1002/uog.15767.
Intrauterine growth restriction is associated with increased cardiovascular risk later in life but the link between fetal disease and postnatal risk is not well-documented. We evaluated longitudinally the association between cardiovascular remodeling in small-for-gestational-age (SGA) fetuses and at 6 months of age.
A cohort of 80 SGA fetuses (defined by estimated fetal and birth weights < 10(th) centile) delivered > 34 weeks' gestation was compared with 80 normally grown age-matched control fetuses, with follow-up at 6 months of corrected age (i.e. 6 months from estimated date of delivery according to first-trimester crown-rump length). Cardiovascular evaluation included a comprehensive echocardiographic assessment in both fetuses and infants and blood pressure and aortic intima-media thickness (aIMT) measurement in infants. Parameters were adjusted by linear regression analysis for gender, gestational age at delivery, pre-eclampsia, prenatal glucocorticoid exposure, Cesarean delivery, admission to neonatal intensive care unit and body surface area.
Both pre- and postnatally, when compared with controls, the SGA group showed a more globular cardiac shape (left sphericity index: controls 2.06 vs SGA 1.87 (P = 0.022) prenatally and 1.92 vs 1.67 (P = 0.007) postnatally), as well as signs of systolic longitudinal dysfunction (systolic annular peak velocity (S'): 7.2 vs 6.3 cm/s (P = 0.003) prenatally and 7.9 vs 6.4 cm/s (P < 0.001) postnatally; tricuspid annular plane systolic excursion: 7.2 vs 6.8 mm (P = 0.015) prenatally and 16.0 vs 14.2 mm (P < 0.001) postnatally) and diastolic dysfunction (left isovolumetric relaxation time: 46 vs 52 ms (P < 0.001) prenatally and 50 vs 57 ms (P = 0.034) postnatally). In addition, infants in the SGA group had increased mean blood pressure (mean: 61 vs 70 mmHg, P < 0.001) and maximum aIMT (0.57 vs 0.66 mm; P < 0.001).
Primary cardiovascular changes are already present in the SGA fetus and persist at 6 months of age. These data support prenatal cardiovascular remodeling as a mechanistic pathway of increased risk later in life in cases of SGA, regardless of Doppler abnormalities. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
胎儿生长受限与成年后心血管疾病风险增加相关，但胎儿疾病与出生后风险之间的联系尚无充分文献记载。我们纵向评估了小于胎龄（SGA）胎儿与6月龄时心血管重塑之间的关联。
将80例孕龄>34周分娩的SGA胎儿（根据估计胎儿体重和出生体重<第10百分位数定义）与80例年龄匹配的正常生长对照胎儿进行比较，并在矫正年龄6个月时（即根据孕早期头臀长度估计的分娩日期起6个月）进行随访。心血管评估包括对胎儿和婴儿进行全面的超声心动图评估，以及对婴儿进行血压和主动脉内膜中层厚度（aIMT）测量。通过线性回归分析对性别、分娩时的孕周、子痫前期、产前糖皮质激素暴露、剖宫产、入住新生儿重症监护病房和体表面积等参数进行校正。
与对照组相比，SGA组在产前和产后均表现出更球形的心脏形状（左球形指数：产前对照组为2.06，SGA组为1.87（P = 0.022），产后为1.92对1.67（P = 0.007）），以及收缩期纵向功能障碍的体征（收缩期环向峰值速度（S'）：产前7.2对6.3 cm/s（P = 0.003），产后7.9对6.4 cm/s（P < 0.001）；三尖瓣环平面收缩期位移：产前7.2对6.8 mm（P = 0.015），产后16.0对14.2 mm（P < 0.001））和舒张功能障碍（左等容舒张时间：产前46对52 ms（P < 0.001），产后50对57 ms（P = 0.034））。此外，SGA组婴儿的平均血压升高（平均值：61对70 mmHg，P < 0.001）和最大aIMT增加（0.57对0.66 mm；P < 0.001）。
SGA胎儿已出现原发性心血管改变，并在6月龄时持续存在。这些数据支持产前心血管重塑是SGA病例成年后风险增加的一种机制途径，与多普勒异常无关。版权所有©2015 ISUOG。由John Wiley & Sons Ltd出版。
