Can fetal vascular morphology at 30 weeks of gestation have impact on cardiovascular outcomes in childhood?

摘要

Many studies demonstrate an association between low birth weight and intrauterine growth retar-dation, cardiovascular abnormalities, and an increase in blood pressure later in life [1]. Although the initial hypothesis that intrauterine development is a dominant determinant of later blood pressure development and metabolic disorders has been slightly modified [2,3], the developmental origin of adult diseases is a continuing area of research. The question of whether there might be a particular period during fetal development when growth disturbances are of special importance for later cardiovascular outcome has not been thoroughly investigated. The study of fetal hemodynamics in normal-weight, uncomplicated pregnancies and its association with later cardiovascular outcome in childhood is important and might give us additional clues into the origins of the human cardiovascular disease hypothesis. Although reduced umbilical artery resistance has been associated with SBP and left-ventricular mass, low birth weight alone had little effect on childhood blood pressure [4]. In this issue of Journal of'Hypertension, Kooijman et al. [5] investigated fetal haemodynamics in fetuses from 917 pregnant women at gestational week 30 and related these findings to the cardiovascular outcomes of offspring at 6 years of age. They examined fetal growth, arterial hemodynamics, and cardiac hemodynamics in developing fetuses by echocardiography. At 6 years, blood pressure measurement, carotid-femoral pulse wave velocity, and an echocardiogram were performed investigating left cardiac structures and function. The only robust correlation was observed between aorta ascend ens diameter during fetal development and aortic root diameter measurements at 6 years of age (P< 0.01). In addition, fetal cardiac output correlated with childhood aortic root diameter and fetal left-ventricular filling patterns correlated with aortic root diameter. No consistent associations were observed between fetal vascular resistance variables and cardiovascular function at follow-up. Thus, their study shows only weak associations between fetal cardiac dynamics in normally grown fetuses at approximately 30 gestational weeks (range 28.8-32.3 gestational weeks) with cardiac structural findings at 6 years of age. Neither do fetal vascular resistance variables during the same period correlate with, or have an influence on, blood pressure or arterial stiffness at 6 years of age.