title: Fetal cardiac function in late-onset intrauterine growth restriction vs small-for-gestational age, as defined by estimated fetal weight, cerebroplacental ratio and uterine artery Doppler.
abstract: OBJECTIVE
  Among late-onset small fetuses, a combination of estimated fetal weight (EFW), cerebroplacental ratio (CPR) and mean uterine artery (UtA) pulsatility index (PI) can predict a subgroup of fetuses with poor perinatal outcome; however, the association of these criteria with fetal cardiac structure and function is unknown. Our aim was to determine the presence and severity of signs indicating cardiac dysfunction in small fetuses, classified as intrauterine growth-restricted (IUGR) or small-for-gestational age (SGA), according to EFW, CPR and UtA-PI.
  
  
  METHODS
  A cohort of 209 late-onset small fetuses that were delivered > 34 weeks of gestation was divided in two categories: SGA (n = 59) if EFW was between the 3(rd) and 9(th) centiles with normal CPR and UtA-PI; and IUGR (n = 150) if EFW was < 3(rd) centile, or < 10(th) centile with a CPR < 5(th) centile and/or UtA-PI > 95(th) centile. The small population was compared with 150 appropriately grown fetuses (controls). Fetal cardiac morphometry and function were assessed by echocardiography using two-dimensional M-mode, conventional and tissue Doppler.
  
  
  RESULTS
  Compared with controls, both IUGR and SGA fetuses showed larger and more globular hearts (mean left sphericity index ± SD: controls, 1.8 ± 0.3; SGA, 1.5 ± 0.2; and IUGR, 1.6 ± 0.3; P < 0.01) and showed signs of systolic and diastolic dysfunction, including decreased tricuspid annular plane systolic excursion (mean ± SD: controls, 8.2 ± 1.1; SGA, 7.4 ± 1.2; and IUGR, 6.9 ± 1.1; P < 0.001) and increased left myocardial performance index (mean ± SD: controls, 0.45 ± 0.14; SGA, 0.51 ± 0.08; and IUGR, 0.57 ± 0.1; P < 0.001).
  
  
  CONCLUSIONS
  Despite a perinatal outcome comparable to that of normal fetuses, the population of so-defined SGA fetuses showed signs of prenatal cardiac dysfunction. This supports the concept that at least a proportion of them are not 'constitutionally small' and that further research is needed.
authors.affiliation: BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Pérez-Cruz
authors.affiliation: BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Cruz-Lemini
authors.affiliation: BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.
authors.forename: M T
authors.initials: MT
authors.lastname: Fernández
authors.affiliation: BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.
authors.forename: J A
authors.initials: JA
authors.lastname: Parra
authors.affiliation: Department of Paediatric Cardiology, Hospital Sant Joan de Déu, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Bartrons
authors.affiliation: BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.|Spanish Maternal & Child Health Network Retic SAMID, Barcelona, Spain.
authors.forename: M D
authors.initials: MD
authors.lastname: Gómez-Roig
authors.affiliation: BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.|IDIBAPS and Center for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Crispi
authors.affiliation: BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.|IDIBAPS and Center for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Gratacós
mesh_terms: D000328:Adult; D004452:Echocardiography / Q000379:methods; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005318:Fetal Heart / Q000000981:diagnostic imaging / Q000502:physiology*; D020567:Fetal Weight / Q000502:physiology; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age / Q000254:growth & development / Q000502:physiology*; D008297:Male; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging; D011247:Pregnancy; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third / Q000502:physiology; D011673:Pulsatile Flow / Q000502:physiology; D012720:Severity of Illness Index; D018617:Ultrasonography, Doppler, Pulsed / Q000379:methods; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000000981:diagnostic imaging; D055988:Uterine Artery / Q000000981:diagnostic imaging*
keywords: fetal cardiac function; fetal echocardiography; intrauterine growth restriction; myocardial performance index; small-for-gestational age; tissue Doppler