Toemen Liza, de Jonge Layla L, Gishti Olta, van Osch-Gevers Lennie, Taal H Rob, Steegers Eric A P, Hofman Albert, Helbing Willem A, Jaddoe Vincent W V
aGeneration R Study Group bDepartment of Epidemiology cDepartment of Pediatrics dDepartment of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
J Hypertens. 2016 Jul;34(7):1396-406. doi: 10.1097/HJH.0000000000000947.
Low birth weight is associated with cardiovascular disease. We examined the effects of fetal and infant growth patterns on cardiovascular outcomes in children.
In a population-based prospective cohort study among 6239 children, we estimated fetal-femur length and weight by 20 and 30 weeks ultrasound, and child length and weight at birth, 0.5, 1, 2 and 6 years. We measured blood pressure (BP), carotid-femoral pulse wave velocity, aortic root diameter, left ventricular mass and fractional shortening at 6 years. We used regression analyses to identify longitudinal growth patterns associated with height-standardized vascular outcomes and body-surface-area-standardized cardiac outcomes.
Younger gestational age and lower birth weight were associated with higher BP, smaller aortic root diameter and lower left ventricular mass in childhood (all P values <0.05). Children with decelerated or normal fetal growth followed by accelerated infant growth had higher BP, whereas those with decelerated growth during both fetal life and infancy had a relatively larger left ventricular mass. Longitudinal growth analyses showed that children with increased BP tended to be smaller during third trimester of fetal life, but of normal size during infancy, than children with normal BP. Children with increased aortic root diameter or left ventricular mass tended to be larger during fetal life, but of similar size during infancy.
Specific fetal and infant growth patterns are associated with different cardiovascular outcomes in children. Further studies are needed to identify the underlying mechanisms and the long-term cardiovascular consequences.
低出生体重与心血管疾病相关。我们研究了胎儿和婴儿生长模式对儿童心血管结局的影响。
在一项针对6239名儿童的基于人群的前瞻性队列研究中，我们通过20周和30周超声估计胎儿股骨长度和体重，以及出生时、0.5岁、1岁、2岁和6岁时儿童的身长和体重。我们在6岁时测量血压（BP）、颈股脉搏波速度、主动脉根部直径、左心室质量和缩短分数。我们使用回归分析来确定与身高标准化血管结局和体表面积标准化心脏结局相关的纵向生长模式。
较年轻的孕周和较低的出生体重与儿童期较高的血压、较小的主动脉根部直径和较低的左心室质量相关（所有P值<0.05）。胎儿生长减速或正常随后婴儿期生长加速的儿童血压较高，而胎儿期和婴儿期生长均减速的儿童左心室质量相对较大。纵向生长分析表明，与血压正常的儿童相比，血压升高的儿童在胎儿期第三个月往往较小，但在婴儿期大小正常。主动脉根部直径或左心室质量增加的儿童在胎儿期往往较大，但在婴儿期大小相似。
特定的胎儿和婴儿生长模式与儿童不同的心血管结局相关。需要进一步研究以确定潜在机制和长期心血管后果。
