Aortic Intima Media Thickness in Fetuses and Children With Intrauterine Growth Restriction

OBJECTIVE: To measure aortic intima media thickness and diameter by ultrasonography in fetuses with intrauterine growth restriction (IUGR) and in appropriate for gestational age (AGA) fetuses and in the same children after a mean follow-up of 18 months. METHODS: This was a prospective study performed between January 2006 and August 2008. Fetuses were classified as having IUGR if the estimated fetal weight was below the 10th percentile and umbilical artery pulsatility index was greater than 2 standard deviations; they were classified as AGA if the estimated fetal weight was between the 10th and 90th percentiles. Abdominal aortic intima media thickness and diameter were measured in each fetus with IUGR and in each AGA fetus at a mean gestational age of 32 weeks. The same measurements were taken in the children after a mean follow-up of 18 months. RESULTS: Thirty-eight fetuses with IUGR and 32 AGA fetuses were enrolled in the study. Aortic intima media thickness median values were significantly higher in IUGR than in AGA both in utero (1.9 mm compared with 1.15 mm; P<.001) and after birth (2.4 mm compared with 1.03 mm; P<.001) and were significantly correlated (P=.018, r=0.48). At 32 weeks of gestation, aortic intima media thickness in fetuses with IUGR was inversely correlated with estimated fetal weight (P<.003; r=−0.58). Median diameter of the abdominal aorta and blood-flow velocity at 32 weeks of gestation were significantly higher in fetuses with IUGR compared with AGA fetuses (median diameter 4.5 mm compared with 3.6 mm, P<.001, blood-flow velocity 42.5 cm/s compared with 23.3 cm/s, P<.001). At follow-up, in 25 children who had had IUGR and 25 children who had been AGA, there was no significant difference in median diameter of the abdominal aorta (6.8 mm compared with 7.5 mm, P=.21). CONCLUSION: Aortic wall thickening in fetuses and children with IUGR shows differences with respect to those who were AGA. This may reflect a correlation between impaired growth in utero, Doppler abnormalities, low birth weight, and early signs of vascular dysfunction. LEVEL OF EVIDENCE: II

[1]  D. Barker.  In utero programming of cardiovascular disease. , 2000, Theriogenology.

[2]  C Osmond,et al.  Fetal, infant, and childhood growth are predictors of coronary heart disease, diabetes, and hypertension in adult men and women. , 2000, Environmental health perspectives.

[3]  B. Walker,et al.  Adult cardiovascular risk factors in premature babies , 2000, The Lancet.

[4]  J. Strong,et al.  Effects of coronary heart disease risk factors on atherosclerosis of selected regions of the aorta and right coronary artery. PDAY Research Group. Pathobiological Determinants of Atherosclerosis in Youth. , 2000, Arteriosclerosis, thrombosis, and vascular biology.

[5]  A. Evangelou,et al.  Adult cardiovascular risk factors in premature babies , 2000, The Lancet.

[6]  Olli T. Raitakari,et al.  Increased Aortic Intima-Media Thickness: A Marker of Preclinical Atherosclerosis in High-Risk Children , 2001, Circulation.

[7]  Peter Gluckman,et al.  Developmental plasticity and human health , 2004, Nature.

[8]  A. Iliadou,et al.  Risk of High Blood Pressure Among Young Men Increases With the Degree of Immaturity at Birth , 2005, Circulation.

[9]  Nick Evans,et al.  Aortic wall thickness in newborns with intrauterine growth restriction , 2005, The Lancet.

[10]  Debbie A Lawlor,et al.  Birth Weight Is Inversely Associated With Incident Coronary Heart Disease and Stroke Among Individuals Born in the 1950s: Findings From the Aberdeen Children of the 1950s Prospective Cohort Study , 2005, Circulation.

[11]  S. Ajzen,et al.  Effects of Low Birth Weight in 8- to 13-Year-Old Children: Implications in Endothelial Function and Uric Acid Levels , 2006, Hypertension.

[12]  D. Barker,et al.  Adult Consequences of Fetal Growth Restriction , 2006, Clinical obstetrics and gynecology.

[13]  E. Pesonen,et al.  Is increased intima‐media thickness associated with preatherosclerotic changes in intrauterine growth restricted newborns?– Reply , 2007 .

[14]  J. Eriksson,et al.  Childhood Growth and Hypertension in Later Life , 2007, Hypertension.

[15]  J. Eriksson,et al.  Infant Growth and Stroke in Adult Life: The Helsinki Birth Cohort Study , 2007, Stroke.

[16]  D. Lawlor,et al.  Associations of Gestational Age and Intrauterine Growth With Systolic Blood Pressure in a Family-Based Study of 386 485 Men in 331 089 Families , 2007, Circulation.

[17]  S. Kurtoğlu,et al.  Is increased intima‐media thickness associated with preatherosclerotic changes in intrauterine growth restricted newborns? , 2007, Acta paediatrica.

[18]  Abdulhakim Coskun,et al.  Intima–media thickness of the abdominal aorta of neonate with different gestational ages , 2007, Journal of clinical ultrasound : JCU.

[19]  K. Nicolaides,et al.  Predictors of Neonatal Outcome in Early- Onset Placental Dysfunction , 2007, Obstetrics and gynecology.

[20]  M. Skilton.  Intrauterine Risk Factors for Precocious Atherosclerosis , 2008, Pediatrics.

[21]  M. Franco,et al.  Blood pressure levels in childhood: probing the relative importance of birth weight and current size , 2009, European Journal of Pediatrics.

[22]  Anna Niemirska,et al.  Intima–media thickness measurements in children with cardiovascular risk factors , 2009, Pediatric Nephrology.