Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-06T10:53:37.973Z Has data issue: false hasContentIssue false
  • English
  • Français

Influence of intrauterine growth status on aortic intima-media thickness and aortic diameter in near-term fetuses: a comparative cross-sectional study

Published online by Cambridge University Press:  15 June 2021

Zohaib Akhter Open the ORCID record for Zohaib Akhter [Opens in a new window] ,
Rozina Nuruddin ,
Iqbal Azam ,
Ayesha Malik  and
Nuruddin Mohammed Open the ORCID record for Nuruddin Mohammed [Opens in a new window]
Zohaib Akhter
Affiliation:
York Trials Unit, Department of Health Sciences, University of York, UK
Rozina Nuruddin
Affiliation:
Department of Community Health Sciences, Aga Khan University, Pakistan
Iqbal Azam
Affiliation:
Department of Community Health Sciences, Aga Khan University, Pakistan
Ayesha Malik
Affiliation:
Maternal Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Aga Khan University, Pakistan
Nuruddin Mohammed*
Affiliation:
Maternal Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Aga Khan University, Pakistan
*
Address for correspondence: Dr. Nuruddin Mohammed, Associate Professor and Consultant Fetal Medicine, Director Maternal and Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Karachi, Pakistan. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Intrauterine undernutrition may lead to fetal vascular programming. We compared abdominal aortic intima-media thickness (aIMT) and aortic diameter (aD) between appropriate for gestational age (AGA) and growth-restricted fetuses (GRF). We recruited 136 singleton fetuses at 34–37 weeks of gestation from Fetal Medicine Unit of Aga Khan University Hospital, Karachi (January–November 2017). Subjects were classified as AGA (n = 102) and GRF (n = 34) using INTER-GROWTH 21st growth reference and standard ultrasound protocol. Their far- and near-wall aIMT and aD were compared after adjustment of maternal age, first-trimester body mass index, fetal gender, hypertension and hyperglycemia in pregnancy. As the severity of growth restriction increased in GRF, aIMT and aD showed an increasing and a decreasing trend, respectively. Both far- and near-wall aIMT in GRF [(adj. β = 0.082, 95% confidence interval [CI] 0.042–0.123) and (adj. β = 0.049, 95% CI 0.010–0.089)] were significantly greater with reference to AGA fetuses. GRF subgroup analysis into small for gestational age (SGA) fetuses and intrauterine growth restricted (IUGR) revealed highly significant difference between AGA and IUGR for far (0.142 mm, P-value < 0.001) and near-wall aIMT (0.115 mm, P-value < 0.001) and marginally significant aD difference (0.51 mm, P-value 0.05). These findings suggest that the extent of fetal aortic remodelling is influenced by the severity of growth restriction. Hence, the targeted interventions for the cardiovascular health promotion of IUGR and SGA born neonates are desirable during early childhood, particularly in set ups with high prevalence of low birth weight babies.

Keywords

Intima-media thicknessfetal growth restrictionvascular remodellinglate preterm fetuses
Type
Original Article
Information
Journal of Developmental Origins of Health and Disease , Volume 13 , Issue 2 , April 2022 , pp. 212 - 219
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press in association with International Society for Developmental Origins of Health and Disease

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Both authors have equally contributed to the manuscript writing and can be interchangeably reported as the first authors.

References

Bateson, P, Barker, D, Clutton-Brock, T, et al. Developmental plasticity and human health. Nature. 2004; 430(6998), 419–421.CrossRefGoogle ScholarPubMed
Painter, RC, Osmond, C, Gluckman, P, et al. Transgenerational effects of prenatal exposure to the Dutch famine on neonatal adiposity and health in later life. BJOG. 2008; 115(10), 1243–1249.CrossRefGoogle Scholar
Strufaldi, MWL, Silva, EM, Franco, MC, et al. Blood pressure levels in childhood: probing the relative importance of birth weight and current size. Eur J Pediatr. 2009; 168(5), 619.CrossRefGoogle ScholarPubMed
Kaijser, M, Bonamy, A, Akre, O, et al. Perinatal risk factors for ischemic heart disease. Circulation. 2008; 117(3), 405–410.10.1161/CIRCULATIONAHA.107.710715CrossRefGoogle ScholarPubMed
Figueras, F, Eixarch, E, Gratacos, E, et al. Predictiveness of antenatal umbilical artery Doppler for adverse pregnancy outcome in small-for-gestational-age babies according to customised birthweight centiles: population-based study. BJOG. 2008; 115(5), 590–594.CrossRefGoogle ScholarPubMed
Sehgal, A, Doctor, T, Menahem, S. Cardiac function and arterial biophysical properties in small for gestational age infants: postnatal manifestations of fetal programming. J Pediatr. 2013; 163(5), 1296–1300.CrossRefGoogle ScholarPubMed
Cruz-Lemini, M, Crispi, F, Valenzuela-Alcaraz, B, et al. A fetal cardiovascular score to predict infant hypertension and arterial remodeling in intrauterine growth restriction. Am J Obstet Gynecol. 2014; 210(6), 552.e1–552.e22.CrossRefGoogle ScholarPubMed
Crispi, F, Bijnens, B, Figueras, F, et al. Fetal growth restriction results in remodeled and less efficient hearts in children. Circulation. 2010; 121, 2427–2436.CrossRefGoogle ScholarPubMed
Sarvari, SI, Rodriguez-Lopez, M, Nuñez-Garcia, M, et al. Persistence of cardiac remodeling in preadolescents with fetal growth restriction. Circ Cardiovasc Imaging. 2017; 10(1), e005270.CrossRefGoogle ScholarPubMed
McGill, HC Jr, McMahan, CA, Herderick, EE, et al. Effects of coronary heart disease risk factors on atherosclerosis of selected regions of the aorta and right coronary artery. Arterioscler Thromb Vasc Biol. 2000; 20(3), 836–845.CrossRefGoogle ScholarPubMed
Skilton, MR, Evans, N, Griffiths, KA, et al. Aortic wall thickness in newborns with intrauterine growth restriction. Lancet. 2005; 365(9469), 1484–1486.CrossRefGoogle ScholarPubMed
Koklu, E, Kurtoglu, S, Akcakus, M, et al. Increased aortic intima-media thickness is related to lipid profile in newborns with intrauterine growth restriction. Horm Res. 2006; 65(6), 269–275.Google ScholarPubMed
Koklu, E, Ozturk, MA, Kurtoglu, S, et al. Aortic intima-media thickness, serum IGF-I, IGFBP-3, and leptin levels in intrauterine growth-restricted newborns of healthy mothers. Pediatr Res. 2007; 62(6), 704–709.CrossRefGoogle ScholarPubMed
Cosmi, E, Visentin, S, Fanelli, T, et al. Aortic intima media thickness in intrauterine growth restricted fetuses and infants: a longitudinal prospective study. Obstet Gynecol. 2009; 114, 1109–1114.CrossRefGoogle Scholar
Gomez-Roig, MD, Mazarico, E, Valladares, E, et al. Aortic intima-media thickness and aortic diameter in small for gestational age and growth restricted fetuses. PLoS One. 2015; 10(5), e0126842.CrossRefGoogle ScholarPubMed
Skilton, MR, Celermajer, DS, Cosmi, E, et al. Natural history of atherosclerosis and abdominal aortic intima-media thickness: rationale, evidence, and best practice for detection of atherosclerosis in the young. J Clin Med. 2019; 8(8), 1201.CrossRefGoogle Scholar
Diabetes IAo, Panel PSGC. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010; 33(3), 676–682.CrossRefGoogle Scholar
Brown, MA, Magee, LA, Kenny, LC, et al. Hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international practice. Hypertension. 2018; 72(1), 24–43.CrossRefGoogle ScholarPubMed
Stirnemann, J, Villar, J, Salomon, L, et al. International estimated fetal weight standards of the INTERGROWTH-21st Project. Ultrasound Obstet Gynecol. 2017; 49(4), 478–486.CrossRefGoogle ScholarPubMed
Villar, J, Ismail, LC, Victora, CG, et al. International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project. Lancet. 2014; 384(9946), 857–868.CrossRefGoogle ScholarPubMed
Figueras, F, Gratacos, E. Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol. Fetal Diagn Ther. 2014; 36(2), 86–98.CrossRefGoogle ScholarPubMed
Koklu, E, Kurtoglu, S, Akcakus, M, et al. Intima-media thickness of the abdominal aorta of neonate with different gestational ages. J Clin Ultrasound. 2007; 35(9), 491–497.10.1002/jcu.20335CrossRefGoogle ScholarPubMed
Visentin, S, Londero, AP, Bellamio, B, et al. Fetal endothelial remodeling in late-onset gestational hypertension. Am J Hypertens. 2015; 29(2), 273–279.CrossRefGoogle ScholarPubMed
Wong, M, Edelstein, J, Wollman, J, et al. Ultrasonic-pathological comparison of the human arterial wall. Verification of intima-media thickness. Arterioscler Thromb Vasc Biol. 1993; 13(4), 482–486.CrossRefGoogle ScholarPubMed
Visentin, S, Londero, AP, Calanducci, M, et al. Fetal abdominal aorta: doppler and structural evaluation of endothelial function in intrauterine growth restriction and controls. Ultraschall Med. 2019; 40(01), 55–63.Google ScholarPubMed
Stergiotou, I, Crispi, F, Valenzuela-Alcaraz, B, et al. Aortic and carotid intima–media thickness in term small-for-gestational-age newborns and relationship with prenatal signs of severity. Ultrasound Obstet Gynecol. 2014; 43(6), 625–631.CrossRefGoogle ScholarPubMed