Meeting paper
SMFM paper
Cardiac dysfunction and cell damage across clinical stages of severity in growth-restricted fetuses

This research was presented at the 28th Annual Meeting of the Society for Maternal–Fetal Medicine, Dallas, TX, Jan. 28-Feb. 2, 2008.
https://doi.org/10.1016/j.ajog.2008.06.056Get rights and content

Objective

The purpose of this study was to assess cardiac function and cell damage in intrauterine growth-restricted (IUGR) fetuses across clinical Doppler stages of deterioration.

Study Design

One hundred twenty appropriate-for-gestational-age and 81 IUGR fetuses were classified in stages 1/2/3 according umbilical artery present/absent/reversed end-diastolic blood flow, respectively. Cardiac function was assessed by modified-myocardial performance index, early-to-late diastolic filling ratios, cardiac output, and cord blood B-type natriuretic peptide; myocardial cell damage was assessed by heart fatty acid–binding protein, troponin-I, and high-sensitivity C-reactive protein.

Results

Modified-myocardial performance index, blood B-type natriuretic peptide, and early-to-late diastolic filling ratios were increased in a stage-dependent manner in IUGR fetuses, compared with appropriate-for-gestational-age fetuses. Heart fatty acid–binding protein levels were higher in IUGR fetuses at stage 3, compared with control fetuses. Cardiac output, troponin-I, and high-sensitivity C-reactive protein did not increase in IUGR fetuses at any stage.

Conclusion

IUGR fetuses showed signs of cardiac dysfunction from early stages. Cardiac dysfunction deteriorates further with the progression of fetal compromise, together with the appearance of biochemical signs of cell damage.

Section snippets

Study populations

Eligible cases were singleton pregnancies that were selected from women who attended the Maternal-Fetal Medicine Department at Hospital Clinic and at Harris Birthright Research Centre for Fetal Medicine. The study protocol was approved by the Ethics Committee at each participating institution, and patients provided written informed consent.

IUGR was defined as an estimated fetal weight below the 10th percentile according to local reference curves18 together with a Doppler pulsatility index in

Characteristics of the study populations

Clinical and perinatal data are shown in TABLE 1, TABLE 2. IUGR fetuses from severity stages 2 and 3 showed lower 5-minute Apgar scores and umbilical artery pH values and higher rates of adverse perinatal outcome, compared with AGA fetuses.

Fetal echocardiography

A total of 62, 65, and 47 ultrasound explorations were performed in IUGR-stages 1, 2, and 3, respectively. Values of echocardiographic parameters in term AGA and in IUGR fetuses are shown in Figure 1. Mod-MPI was significantly higher in stage 1 and showed a

Comment

This study documents the evolution of cardiac dysfunction and cell damage in fetal growth restriction in relation with Doppler stages of severity that are used widely in clinical practice. It provides evidence that subclinical cardiac dysfunction is an early and progressive event in severe IUGR. Echocardiographic parameters and cord blood levels of BNP indicate that cardiac dysfunction increased progressively across the stages of fetal compromise. Advanced fetal Doppler deterioration was

References (37)

  • K. Niewiadomska-Jarosik et al.

    Assessment of cardiac function in fetuses with intrauterine growth retardation using the Tei index

    Med Wieku Rozwoj

    (2005)
  • A. Girsen et al.

    Cardiovascular hemodynamics and umbilical artery N-terminal peptide of proB-type natriuretic peptide in human fetuses with growth restriction

    Ultrasound Obstet Gynecol

    (2007)
  • A.A. Baschat et al.

    Venous Doppler in the assessment of fetal cardiovascular status

    Curr Opin Obstet Gynecol

    (2006)
  • D.J. Barker et al.

    Growth in utero, blood pressure in childhood and adult life, and mortality from cardiovascular disease

    BMJ

    (1989)
  • P.M. Vuguin

    Animal models for small for gestational age and fetal programming of adult disease

    Horm Res

    (2007)
  • A.A. Baschat et al.

    Predictors of neonatal outcome in early-onset placental dysfunction

    Obstet Gynecol

    (2007)
  • T. Chaiworapongsa et al.

    Subclinical myocardial injury in small-for-gestational-age neonates

    J Matern Fetal Neonatal Med

    (2002)
  • N. Iacovidou et al.

    Perinatal changes of cardiac troponin-I in normal and intrauterine growth restricted pregnancies

    Mediators Inflamm

    (2007)
  • Cited by (0)

    Cite this article as: Crispi F, Hernandez-Andrade E, Pelsers MMAL, et al. Cardiac dysfunction and cell damage across clinical stages of severity in growth-restricted fetuses. Am J Obstet Gynecol 2008;199:254.e1-254.e8.

    Supported by grants from the Fondo the Investigación Sanitaria (PI0600347); Cerebra Foundation for the Brain Injured Child, Carmarthen, Wales, UK; Thrasher Research Fund (Salt Lake City, UT); and the Medical Research Council (grants G0601295 and G0700288 [A.A.; E.G.]).

    View full text