title: Fetal hemodynamics and adverse outcome in primary school-aged children with fetal growth restriction: a prospective longitudinal study.
abstract: BACKGROUND
  Fetal growth restriction is associated with short-term and long-term mortality and morbidity. We hypothesized that adverse outcome in children with fetal growth restriction at primary school age is associated with fetoplacental circulatory abnormalities.
  
  
  METHODS
  Comprehensive ultrasonographic assessment of fetoplacental hemodynamics was performed in 72 growth-restricted fetuses prenatally, and short-term outcome data were collected. At the median age of 9 years, mortality and morbidity were determined using medical charts and questionnaires. The impact of abnormal fetoplacental hemodynamics on mortality and morbidity with significant developmental disorders or delay were studied.
  
  
  RESULTS
  Fetal growth restriction children with adverse long-term outcome were delivered earlier and with lower birthweights than were those with non-compromised outcome. Seventy percent of the fetal growth restriction group showed non-compromised long-term outcomes and participated in mainstream education at the appropriate age level. Absent/retrograde diastolic flow in the umbilical artery (p < 0.001), negative A-wave in the ductus venosus (p = 0.006), cardiomegaly (p = 0.02), hydrops (p = 0.006) and cardiovascular profile score <6 (p = 0.002) were associated with increased risk of adverse outcome. After adjustment for gestational age, these parameters demonstrated hazard ratios of 5.0-16.5 for adverse long-term outcome; increased systemic venous pulsatility and low cardiovascular profile score had the highest predictive power.
  
  
  CONCLUSIONS
  Absent or reversed end-diastolic flow in the umbilical artery, reversed A-wave in the ductus venosus, cardiomegaly, hydrops, and low cardiovascular profile score are associated with adverse outcomes at primary school age in fetal growth restriction children. These fetal parameters play a significant role in the prediction of long-term outcomes for fetal growth restriction children.
authors.affiliation: Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland.|PEDEGO Research Unit, University of Oulu, Oulu, Finland.
authors.forename: Noora
authors.initials: N
authors.lastname: Korkalainen
authors.affiliation: Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland.|PEDEGO Research Unit, University of Oulu, Oulu, Finland.|Department of Obstetrics and Gynecology, University Hospital of Helsinki and University of Helsinki, Helsinki, Finland.
authors.forename: Juha
authors.identifier: http://orcid.org/0000-0002-3868-5936
authors.initials: J
authors.lastname: Räsänen
authors.affiliation: PEDEGO Research Unit, University of Oulu, Oulu, Finland.|Department of Pediatrics, Oulu University Hospital, Oulu, Finland.
authors.forename: Tuula
authors.initials: T
authors.lastname: Kaukola
authors.affiliation: PEDEGO Research Unit, University of Oulu, Oulu, Finland.|Department of Pediatrics, Oulu University Hospital, Oulu, Finland.
authors.forename: Hanna
authors.initials: H
authors.lastname: Kallankari
authors.affiliation: PEDEGO Research Unit, University of Oulu, Oulu, Finland.|Department of Pediatrics, Oulu University Hospital, Oulu, Finland.
authors.forename: Mikko
authors.initials: M
authors.lastname: Hallman
authors.affiliation: Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland.|PEDEGO Research Unit, University of Oulu, Oulu, Finland.|Department of Obstetrics and Gynecology, University Hospital of Turku and University of Turku, Turku, Finland.
authors.forename: Kaarin
authors.initials: K
authors.lastname: Mäkikallio
mesh_terms: D001034:Apgar Score; D001724:Birth Weight / Q000502:physiology; D006332:Cardiomegaly / Q000000981:diagnostic imaging / Q000453:epidemiology; D002648:Child; D002658:Developmental Disabilities / Q000453:epidemiology; D003971:Diastole / Q000502:physiology; D005260:Female; D005317:Fetal Growth Retardation / Q000453:epidemiology* / Q000503:physiopathology*; D005387:Finland / Q000453:epidemiology; D006340:Heart Rate, Fetal / Q000502:physiology; D006801:Humans; D015160:Hydrops Fetalis / Q000000981:diagnostic imaging / Q000453:epidemiology; D008137:Longitudinal Studies; D021041:Placental Circulation / Q000502:physiology; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology; D011446:Prospective Studies; D011673:Pulsatile Flow / Q000502:physiology; D014469:Umbilical Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology; D014471:Umbilical Veins / Q000000981:diagnostic imaging / Q000503:physiopathology
keywords: Doppler; Fetal growth restriction; circulation; fetal monitoring; outcome; ultrasound