title: Third trimester fetal hemodynamics and cardiovascular outcomes in childhood: the Generation R study.
abstract: OBJECTIVE
  Low birth weight is associated with cardiovascular disease in adulthood. Hemodynamic adaptations related to fetal growth restriction may underlie these associations, through persistent influences on cardiovascular development. We examined the associations of third trimester fetal hemodynamics with cardiovascular outcomes in childhood.
  
  
  METHODS
  In a prospective cohort study among 917 pregnant women and their children, we measured fetal growth, and fetal arterial and cardiac hemodynamic variables with ultrasound and Doppler examinations at a gestational age of 30.3 (95% range 28.8-32.3) weeks. At the age of 6 years, we measured blood pressure, carotid-femoral pulse wave velocity, and left cardiac structures and function.
  
  
  RESULTS
  We observed that fetal hemodynamics were not associated with childhood blood pressure and carotid-femoral pulse wave velocity. The fetal aorta ascendens diameter and left cardiac output were positively associated with childhood aortic root diameter [0.14 standard deviation score (SDS), 95% confidence interval (CI) 0.07-0.22 and 0.08 SDS, 95% CI 0.01-0.15 per SDS change in diameter and output, respectively]. Fetal left ventricular diastolic filling pattern was inversely associated with aortic root diameter (-0.07 SDS, 95% CI -0.13 to 0.00 per SDS change in E/A ratio) at 6 years. Analyses adjusted and stratified for estimated fetal weight showed no differences in results.
  
  
  CONCLUSIONS
  Our results suggest that third trimester fetal vascular resistance parameters do not affect blood pressure or arterial stiffness in childhood. Fetal cardiac functional and structural measures are associated with cardiac outcomes in childhood. Whether these early adaptations lead to greater risks of cardiovascular disease should be further studied.
authors.affiliation: aThe Generation R Study Group bDepartment of Epidemiology cDepartment of Pediatrics dDepartment of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Marjolein N
authors.initials: MN
authors.lastname: Kooijman
authors.forename: Layla L
authors.initials: LL
authors.lastname: de Jonge
authors.forename: Eric A P
authors.initials: EA
authors.lastname: Steegers
authors.forename: Lennie
authors.initials: L
authors.lastname: van Osch-Gevers
authors.forename: Bero O
authors.initials: BO
authors.lastname: Verburg
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.forename: Willem A
authors.initials: WA
authors.lastname: Helbing
authors.forename: Vincent W V
authors.initials: VW
authors.lastname: Jaddoe
mesh_terms: D000328:Adult; D001011:Aorta / Q000000981:diagnostic imaging / Q000196:embryology*; D001724:Birth Weight; D001794:Blood Pressure; D002319:Cardiovascular System / Q000503:physiopathology*; D002339:Carotid Arteries / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005263:Femoral Artery / Q000473:pathology; D047109:Fetal Development / Q000502:physiology; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000196:embryology*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D011446:Prospective Studies; D063177:Pulse Wave Analysis; D016216:Ultrasonography, Prenatal; D014655:Vascular Resistance; D059289:Vascular Stiffness