A fetal cardiovascular score to predict infant hypertension and arterial remodeling in intrauterine growth restriction

作者：Cruz Lemini Monica; Crispi Fatima; Valenzuela Alcaraz Brenda; Figueras Francesc; Gomez Olga; Sitges Marta; Bijnens Bart; Gratacos Eduard^*

来源：American Journal of Obstetrics and Gynecology, 2014, 210(6): 552.e1.

DOI：10.1016/j.ajog.2013.12.031

• cardiovascular risk
• fetal echocardiography
• hypertension
• intrauterine growth restriction
• programming

OBJECTIVE: Intrauterine growth restricted (IUGR) fetuses experience cardiovascular remodeling that persists into infancy and has been related to cardiovascular outcomes in adulthood. Hypertension in infancy has been demonstrated to be a strong risk factor for later cardiovascular disease. Close monitoring together with dietary interventions have shown to improve cardiovascular health in hypertensive children; however, not all IUGR infants show increased blood pressure. We evaluated the potential of fetal echocardiography for predicting hypertension and arterial remodeling in 6-month-old IUGR infants. %26lt;br%26gt;STUDY DESIGN: One hundred consecutive IUGR and 100 control fetuses were observed into infancy. Fetal assessment included perinatal Doppler imaging, cardiac morphometry, ejection fraction, cardiac output, isovolumic relaxation time (IVRT), tricuspid annular-plane systolic excursion (TAPSE), and tissue Doppler imaging. Infant hypertension and arterial remodeling were defined as mean blood pressure of %26gt;95th percentile together with aortic intima-media thickness of %26gt;75th percentile at 6 months of age. Odds ratio were obtained for fetal parameters that were associated with infant outcomes. %26lt;br%26gt;RESULTS: Fetal TAPSE, right sphericity index, IVRT, and cerebroplacental ratio were the strongest predictors for postnatal vascular remodeling. A cardiovascular risk score that was based on fetal TAPSE, cerebroplacental ratio, right sphericity index, and IVRT was highly predictive of infant hypertension and arterial remodeling (area under the curve, 0.87; 95% confidence interval, 0.79-0.93; P %26lt; .001). %26lt;br%26gt;CONCLUSION: Fetal echocardiographic parameters identify a high-risk group within the IUGR fetuses who could be targeted for early screening of blood pressure and other cardiovascular risk factors and for promoting healthy diet and physical exercise.

• 出版日期2014-6