title: Influence of fetal blood flow redistribution on fetal and childhood growth and fat distribution: the Generation R Study.
abstract: A suboptimal intrauterine environment leads to fetal blood flow redistribution and fetal growth restriction. Not much is known about childhood growth consequences. We examined the associations of fetal blood flow redistribution with birth outcomes, and repeatedly measured fetal and childhood growth and fat mass measures.
  
  
  
  Prospective cohort study.
  
  
  
  Population-based.
  
  
  
  One thousand one hundred and ninety-five pregnant women and their children.
  
  
  
  We measured umbilical and cerebral artery blood flow at a gestational age of 30.3 weeks (95% range, 28.5-32.6 weeks). A higher umbilical/cerebral (U/C) pulsatility index ratio is an indicator of preferential blood flow to the brain cerebral circulation at the expense of the lower body parts.
  
  
  
  Fetal and childhood growth were repeatedly measured from the third trimester until childhood. We measured the total body fat mass, lean fat mass and android/gynoid fat mass ratio by dual-energy X-ray absorptiometry and preperitoneal fat by ultrasound at 6 years.
  
  
  
  A higher fetal U/C ratio was associated with increased risks of preterm birth and small size for gestational age at birth [odds ratios, 1.41 (95% confidence interval, 1.08-1.85) and 1.63 (95% confidence interval, 1.21-2.19), respectively, per SDS increase in U/C ratio]. Longitudinal growth analyses showed that a higher fetal U/C ratio was associated with persistently lower head circumference, length and weight from third trimester fetal life until childhood (all P < 0.05). The fetal U/C ratio was not associated with total body and abdominal fat measures at 6 years.
  
  
  
  Our results suggest that fetal blood flow redistribution affects fetal development and has persistent consequences for childhood growth.
  
  
  
  Fetal blood flow redistribution affects fetal development and has persistent consequences for childhood growth.
authors.affiliation: The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.|Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.|Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
authors.forename: M N
authors.initials: MN
authors.lastname: Kooijman
authors.affiliation: The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.|Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.|Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Gaillard
authors.affiliation: Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
authors.forename: Ikm
authors.initials: I
authors.lastname: Reiss
authors.affiliation: Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Hofman
authors.affiliation: Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
authors.forename: Eap
authors.initials: E
authors.lastname: Steegers
authors.affiliation: The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.|Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.|Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
authors.forename: Vwv
authors.initials: V
authors.lastname: Jaddoe
mesh_terms: D005312:Fetal Blood; D047109:Fetal Development; D005317:Fetal Growth Retardation; D005333:Fetus / Q000098:blood supply*; D006801:Humans; D011446:Prospective Studies
keywords: Adiposity; Doppler ultrasound; childhood growth; epidemiology; fetal and placental circulation; fetal haemodynamics