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IUGR Infants May Be at Risk for Atherosclerosis


 

Major Finding: Abdominal aortic intima media thickness was significantly greater in infants with IUGR than in controls, as was blood pressure, in one small study. In a second study of 59 IUGR fetuses, fetal ultrasonographic cardiovascular indices were significantly worse in the fetuses that died compared with survivors.

Data Source: The first study involved 25 infants with IUGR and 25 controls, while the second included 59 IUGR fetuses, in which the 8 fetuses that died were compared with survivors.

Disclosures: None reported.

HAMBURG, GERMANY — The environment experienced in utero was found in two small studies to influence the development of later cardiovascular disease and even perinatal death.

“We found that in fetuses and neonates with intrauterine growth restriction, aortic intima media wall thickness is increased with respect to controls, suggesting that it may represent an in utero marker of potential atherosclerosis development,” lead author Dr. Erich Cosmi said at the World Congress on Ultrasound in Obstetrics and Gynecology.

Doppler ultrasound revealed that maximum abdominal aortic intima media thickness (aIMT) was significantly increased in 25 infants with intrauterine growth restriction (IUGR), compared with 25 controls, at a mean gestational age of 32 weeks (2.05 mm vs. 1.05 mm) and at a mean of 18 months after birth (2.3 mm vs. 1.06 mm).

Blood pressure values were also significantly correlated with prenatal and postnatal aIMT values, reported Dr. Cosmi of the department of obstetrics and gynecology, University of Padua (Italy). Systolic blood pressure was 123 mm Hg in IUGR infants and 104 mm Hg in controls, which was significantly different at a P value of .0004.

When asked by the audience if any of the infants were on hypertension medication at the time of evaluation, Dr. Cosmi responded, “No, but they are now. We didn't know they would have hypertension. It was surprising for us.”

The researchers also assessed renal function after birth, as previous research in animal models suggests a renal contribution to developmentally programmed hypertension.

Compared with controls, IUGR infants had significantly higher urinary microalbumin (4.4 mg/L vs. 10.7 mg/L) and sodium (56 mmol/L vs. 122 mmol/L) levels and albumin/creatinine ratios (14.7 mg/g vs. 26.9 mg/g). All are markers of glomerular function.

Kidney length and volume were similar, as were levels of lysozyme, a marker of tubular function.

“The clinical implications of this study are that fetuses that were IUGR necessitate follow-up after birth, as they are at risk for cardiovascular disease,” Dr. Cosmi said in an interview.

Fetuses were classified as IUGR if their estimated fetal weight was below the 10th percentile with Doppler velocimetry greater than 2 standard deviations.

In a separate study presented during the same session, Dr. Elisenda Eixarchof the University of Barcelona reported that perinatal death in preterm IUGR fetuses is associated with the presence of markedly abnormal myocardial function before delivery and biomarkers of myocardial cell damage in cord blood.

Among 59 IUGR fetuses, the 8 fetuses who died as compared with survivors had significantly worse myocardial performance index z scores (2.5 vs. 1.7), left E/A (ratio of peak velocity during early diastolic filling to peak velocity during atrial contraction) z scores (2.4 vs. 0.8), and right E/A z scores (2.3 vs. 1). Only cardiac output was not significantly different at 816 mL/min per kilogram in those who died and 750 mL/min per kilogram in survivors.

Significant increases were also observed in fetuses who died versus survivors in B-type natriuretic peptide (350 pg/mL vs. 64 pg/mL), heart-type fatty acid–binding protein (23 mcg/L vs. 11 mcg/L), and troponin I levels (0.07 ng/mL vs. 0.02 ng/mL).

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