Cardiac function and arterial biophysical properties in small for gestational age infants: postnatal manifestations of fetal programming

Abstract

Objective: To investigate the differences in cardiac function and arterial biophysical properties between term-born appropriate for gestational age (AGA) infants and small for gestational age (SGA) infants. Our hypothesis was that adaptation to intrauterine growth restriction induces changes in cardiac and arterial indices.

Study design: This was a prospective observational echocardiographic evaluation of cardiac and arterial indices in SGA infants and AGA infants. Demographic and echocardiographic data were compared between 20 inborn term SGA infants with birth weight <3rd percentile for gestational age and 20 AGA infants.

Results: The Ponderal index was significantly lower and blood pressure was significantly higher in the SGA infants compared with the AGA infants. Left ventricular output was lower in the SGA infants (170 ± 31 mL/kg/min vs 197 ± 39 mL/kg/min). Diastolic dysfunction was greater in the SGA infants (ie, reduced E and A wave velocities, higher E/A ratio [1.08 ± 0.16 vs 0.85 ± 0.07], and prolonged isovolumic relaxation time [73 ± 6.2 ms vs 62.6 ± 3.6 ms]). Aortic intima-media thickness was significantly greater in the SGA infants (822 ± 105 μm vs 694 ± 52 μm), as were arterial wall stiffness index and input impedance.

Conclusion: Cardiac function and arterial biophysical properties were altered in the SGA infants. The findings complement the information on the association between in utero growth and cardiovascular morbidity in later life.

Keywords: AGA; Aortic intima-media thickness; Appropriate for gestational age; BP; Blood pressure; E wave deceleration time; EDT; IUGR; IVRT; Intrauterine growth restriction; Isovolumic relaxation time; LA:Ao; LVO; Left atrial:aortic root ratio; Left ventricular output; PWD; Pulsed wave Doppler; SGA; Small for gestational age; VTI; Velocity time integral; aIMT.