Influence of birth weight on fetal cardiac indices at 35–37weeks' gestation

ObjectiveEchocardiographic studies have reported that fetuses with low birth weight, compared to those with normal birth weight, have globular hearts and reduced cardiac function. Dichotomizing continuous variables, such as birth weight, may be helpful in describing pathology in small studies but ca...

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Published in:Ultrasound in obstetrics & gynecology 2021-02, Vol.57 (2), p.266-272
Main Authors: Semmler, J, S Abdel‐Azim, Anzoategui, S, Zhang, H, Nicolaides, K H, Charakida, M
Format: Article
Language:English
Subjects:
Birth weight
Cardiac function
Childbirth & labor
Continuity (mathematics)
Diabetes mellitus
Eclampsia
Fetuses
Gestation
Gestational diabetes
Gynecology
Heart
Hypertension
Low-birth-weight
Morphology
Obstetrics
Oxygenation
Perfusion
Physiological responses
Physiology
Placenta
Population studies
Pregnancy
Regression analysis
Regression models
Ultrasonic imaging
Ultrasound
Uterus
Veins & arteries
Ventricle
Weight
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container_start_page 266
container_title Ultrasound in obstetrics & gynecology
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creator Semmler, J
S Abdel‐Azim
Anzoategui, S
Zhang, H
Nicolaides, K H
Charakida, M
description ObjectiveEchocardiographic studies have reported that fetuses with low birth weight, compared to those with normal birth weight, have globular hearts and reduced cardiac function. Dichotomizing continuous variables, such as birth weight, may be helpful in describing pathology in small studies but can prevent us from identifying physiological responses in relation to change in size. The aim of this study was to explore associations between fetal cardiac morphology and function and birth weight, as a continuous variable, as well as uterine artery (UtA) pulsatility index (PI), as an indirect measure of placental perfusion, and the cerebroplacental ratio (CPR), as an indirect measure of fetal oxygenation.MethodsThis was a prospective study of 1498 women with singleton pregnancy undergoing routine ultrasound examination at 35 + 0 to 36 + 6 weeks' gestation. Pregnancies complicated by pregestational or gestational diabetes mellitus, chronic hypertension, pregnancy‐induced hypertension or pre‐eclampsia were excluded from the analysis. Conventional and more advanced echocardiographic modalities, such as speckle tracking, were used to assess fetal cardiac function in the right and left ventricles. The morphology of the fetal heart was assessed by calculating the right and left sphericity indices. In addition, the PI of the UtA, umbilical artery (UA) and fetal middle cerebral artery (MCA) was determined and the CPR was calculated by dividing MCA‐PI by UA‐PI. Multiple linear regression models were used to assess determinants of fetal echocardiographic parameters.ResultsThe study population included 146 (9.7%) small‐for‐gestational‐age (SGA) fetuses with birth weight
doi_str_mv 10.1002/uog.23522
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Dichotomizing continuous variables, such as birth weight, may be helpful in describing pathology in small studies but can prevent us from identifying physiological responses in relation to change in size. The aim of this study was to explore associations between fetal cardiac morphology and function and birth weight, as a continuous variable, as well as uterine artery (UtA) pulsatility index (PI), as an indirect measure of placental perfusion, and the cerebroplacental ratio (CPR), as an indirect measure of fetal oxygenation.MethodsThis was a prospective study of 1498 women with singleton pregnancy undergoing routine ultrasound examination at 35 + 0 to 36 + 6 weeks' gestation. Pregnancies complicated by pregestational or gestational diabetes mellitus, chronic hypertension, pregnancy‐induced hypertension or pre‐eclampsia were excluded from the analysis. Conventional and more advanced echocardiographic modalities, such as speckle tracking, were used to assess fetal cardiac function in the right and left ventricles. The morphology of the fetal heart was assessed by calculating the right and left sphericity indices. In addition, the PI of the UtA, umbilical artery (UA) and fetal middle cerebral artery (MCA) was determined and the CPR was calculated by dividing MCA‐PI by UA‐PI. Multiple linear regression models were used to assess determinants of fetal echocardiographic parameters.ResultsThe study population included 146 (9.7%) small‐for‐gestational‐age (SGA) fetuses with birth weight &lt; 10th percentile and 68 (4.5%) with fetal growth restriction (FGR). In the SGA and FGR groups, compared to the non‐SGA and non‐FGR fetuses, respectively, there was a more globular right ventricle and reduced left and right ventricular systolic function, and, from the left ventricular diastolic functional indices, the E/A ratio was increased. There was a linear association of right ventricular sphericity index, indices of left and right ventricular systolic function and E/A ratio with birth‐weight Z‐score. There were no significant associations between cardiac morphological and functional indices and UtA‐PI Z‐score or CPR Z‐score.ConclusionsThis screening study at 35–37 weeks' gestation has demonstrated that birth weight is a determinant of fetal cardiac morphologyand function but UtA‐PI and CPR, as indirect measures of placental perfusion and fetal oxygenation, are not. This suggests that the differences in fetal cardiac indices between small and appropriately grown fetuses may be part of a normal physiological response to change in fetal size rather than part of a pathological adaptation to abnormal placental perfusion and fetal oxygenation. © 2020 International Society of Ultrasound in Obstetrics and Gynecology</description><identifier>ISSN: 0960-7692</identifier><identifier>EISSN: 1469-0705</identifier><identifier>DOI: 10.1002/uog.23522</identifier><language>eng</language><publisher>London: Wiley Subscription Services, Inc</publisher><subject>Birth weight ; Cardiac function ; Childbirth &amp; labor ; Continuity (mathematics) ; Diabetes mellitus ; Eclampsia ; Fetuses ; Gestation ; Gestational diabetes ; Gynecology ; Heart ; Hypertension ; Low-birth-weight ; Morphology ; Obstetrics ; Oxygenation ; Perfusion ; Physiological responses ; Physiology ; Placenta ; Population studies ; Pregnancy ; Regression analysis ; Regression models ; Ultrasonic imaging ; Ultrasound ; Uterus ; Veins &amp; arteries ; Ventricle ; Weight</subject><ispartof>Ultrasound in obstetrics &amp; gynecology, 2021-02, Vol.57 (2), p.266-272</ispartof><rights>Copyright © 2021 ISUOG. Published by John Wiley &amp; Sons Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids></links><search><creatorcontrib>Semmler, J</creatorcontrib><creatorcontrib>S Abdel‐Azim</creatorcontrib><creatorcontrib>Anzoategui, S</creatorcontrib><creatorcontrib>Zhang, H</creatorcontrib><creatorcontrib>Nicolaides, K H</creatorcontrib><creatorcontrib>Charakida, M</creatorcontrib><title>Influence of birth weight on fetal cardiac indices at 35–37weeks' gestation</title><title>Ultrasound in obstetrics &amp; gynecology</title><description>ObjectiveEchocardiographic studies have reported that fetuses with low birth weight, compared to those with normal birth weight, have globular hearts and reduced cardiac function. Dichotomizing continuous variables, such as birth weight, may be helpful in describing pathology in small studies but can prevent us from identifying physiological responses in relation to change in size. The aim of this study was to explore associations between fetal cardiac morphology and function and birth weight, as a continuous variable, as well as uterine artery (UtA) pulsatility index (PI), as an indirect measure of placental perfusion, and the cerebroplacental ratio (CPR), as an indirect measure of fetal oxygenation.MethodsThis was a prospective study of 1498 women with singleton pregnancy undergoing routine ultrasound examination at 35 + 0 to 36 + 6 weeks' gestation. Pregnancies complicated by pregestational or gestational diabetes mellitus, chronic hypertension, pregnancy‐induced hypertension or pre‐eclampsia were excluded from the analysis. Conventional and more advanced echocardiographic modalities, such as speckle tracking, were used to assess fetal cardiac function in the right and left ventricles. The morphology of the fetal heart was assessed by calculating the right and left sphericity indices. In addition, the PI of the UtA, umbilical artery (UA) and fetal middle cerebral artery (MCA) was determined and the CPR was calculated by dividing MCA‐PI by UA‐PI. Multiple linear regression models were used to assess determinants of fetal echocardiographic parameters.ResultsThe study population included 146 (9.7%) small‐for‐gestational‐age (SGA) fetuses with birth weight &lt; 10th percentile and 68 (4.5%) with fetal growth restriction (FGR). In the SGA and FGR groups, compared to the non‐SGA and non‐FGR fetuses, respectively, there was a more globular right ventricle and reduced left and right ventricular systolic function, and, from the left ventricular diastolic functional indices, the E/A ratio was increased. There was a linear association of right ventricular sphericity index, indices of left and right ventricular systolic function and E/A ratio with birth‐weight Z‐score. There were no significant associations between cardiac morphological and functional indices and UtA‐PI Z‐score or CPR Z‐score.ConclusionsThis screening study at 35–37 weeks' gestation has demonstrated that birth weight is a determinant of fetal cardiac morphologyand function but UtA‐PI and CPR, as indirect measures of placental perfusion and fetal oxygenation, are not. This suggests that the differences in fetal cardiac indices between small and appropriately grown fetuses may be part of a normal physiological response to change in fetal size rather than part of a pathological adaptation to abnormal placental perfusion and fetal oxygenation. © 2020 International Society of Ultrasound in Obstetrics and Gynecology</description><subject>Birth weight</subject><subject>Cardiac function</subject><subject>Childbirth &amp; labor</subject><subject>Continuity (mathematics)</subject><subject>Diabetes mellitus</subject><subject>Eclampsia</subject><subject>Fetuses</subject><subject>Gestation</subject><subject>Gestational diabetes</subject><subject>Gynecology</subject><subject>Heart</subject><subject>Hypertension</subject><subject>Low-birth-weight</subject><subject>Morphology</subject><subject>Obstetrics</subject><subject>Oxygenation</subject><subject>Perfusion</subject><subject>Physiological responses</subject><subject>Physiology</subject><subject>Placenta</subject><subject>Population studies</subject><subject>Pregnancy</subject><subject>Regression analysis</subject><subject>Regression models</subject><subject>Ultrasonic imaging</subject><subject>Ultrasound</subject><subject>Uterus</subject><subject>Veins &amp; arteries</subject><subject>Ventricle</subject><subject>Weight</subject><issn>0960-7692</issn><issn>1469-0705</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNqNyj9uwjAUgHELgUT4M3CDJ3VgSnixEwfPqAiGbt2RCS-JQ2S3sSPW3oEb9iQwcACmb_h-jK1STFJEvhlcnXCRcz5iUZpJFWOB-ZhFqCTGhVR8ymbet4goMyEj9nW0VTeQLQlcBWfThwZuZOomgLNQUdAdlLq_GF2CsRdTkgcdQOT_f3dR3Iiufg01-aCDcXbBJpXuPC1fnbOP_ef37hD_9O53eKpT64bePteJZ9uMq62SuXhPPQDxZEMl</recordid><startdate>20210201</startdate><enddate>20210201</enddate><creator>Semmler, J</creator><creator>S Abdel‐Azim</creator><creator>Anzoategui, S</creator><creator>Zhang, H</creator><creator>Nicolaides, K H</creator><creator>Charakida, M</creator><general>Wiley Subscription Services, Inc</general><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope></search><sort><creationdate>20210201</creationdate><title>Influence of birth weight on fetal cardiac indices at 35–37weeks' gestation</title><author>Semmler, J ; S Abdel‐Azim ; Anzoategui, S ; Zhang, H ; Nicolaides, K H ; Charakida, M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-proquest_journals_24842989653</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Birth weight</topic><topic>Cardiac function</topic><topic>Childbirth &amp; labor</topic><topic>Continuity (mathematics)</topic><topic>Diabetes mellitus</topic><topic>Eclampsia</topic><topic>Fetuses</topic><topic>Gestation</topic><topic>Gestational diabetes</topic><topic>Gynecology</topic><topic>Heart</topic><topic>Hypertension</topic><topic>Low-birth-weight</topic><topic>Morphology</topic><topic>Obstetrics</topic><topic>Oxygenation</topic><topic>Perfusion</topic><topic>Physiological responses</topic><topic>Physiology</topic><topic>Placenta</topic><topic>Population studies</topic><topic>Pregnancy</topic><topic>Regression analysis</topic><topic>Regression models</topic><topic>Ultrasonic imaging</topic><topic>Ultrasound</topic><topic>Uterus</topic><topic>Veins &amp; arteries</topic><topic>Ventricle</topic><topic>Weight</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Semmler, J</creatorcontrib><creatorcontrib>S Abdel‐Azim</creatorcontrib><creatorcontrib>Anzoategui, S</creatorcontrib><creatorcontrib>Zhang, H</creatorcontrib><creatorcontrib>Nicolaides, K H</creatorcontrib><creatorcontrib>Charakida, M</creatorcontrib><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><jtitle>Ultrasound in obstetrics &amp; gynecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Semmler, J</au><au>S Abdel‐Azim</au><au>Anzoategui, S</au><au>Zhang, H</au><au>Nicolaides, K H</au><au>Charakida, M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Influence of birth weight on fetal cardiac indices at 35–37weeks' gestation</atitle><jtitle>Ultrasound in obstetrics &amp; gynecology</jtitle><date>2021-02-01</date><risdate>2021</risdate><volume>57</volume><issue>2</issue><spage>266</spage><epage>272</epage><pages>266-272</pages><issn>0960-7692</issn><eissn>1469-0705</eissn><abstract>ObjectiveEchocardiographic studies have reported that fetuses with low birth weight, compared to those with normal birth weight, have globular hearts and reduced cardiac function. Dichotomizing continuous variables, such as birth weight, may be helpful in describing pathology in small studies but can prevent us from identifying physiological responses in relation to change in size. The aim of this study was to explore associations between fetal cardiac morphology and function and birth weight, as a continuous variable, as well as uterine artery (UtA) pulsatility index (PI), as an indirect measure of placental perfusion, and the cerebroplacental ratio (CPR), as an indirect measure of fetal oxygenation.MethodsThis was a prospective study of 1498 women with singleton pregnancy undergoing routine ultrasound examination at 35 + 0 to 36 + 6 weeks' gestation. Pregnancies complicated by pregestational or gestational diabetes mellitus, chronic hypertension, pregnancy‐induced hypertension or pre‐eclampsia were excluded from the analysis. Conventional and more advanced echocardiographic modalities, such as speckle tracking, were used to assess fetal cardiac function in the right and left ventricles. The morphology of the fetal heart was assessed by calculating the right and left sphericity indices. In addition, the PI of the UtA, umbilical artery (UA) and fetal middle cerebral artery (MCA) was determined and the CPR was calculated by dividing MCA‐PI by UA‐PI. Multiple linear regression models were used to assess determinants of fetal echocardiographic parameters.ResultsThe study population included 146 (9.7%) small‐for‐gestational‐age (SGA) fetuses with birth weight &lt; 10th percentile and 68 (4.5%) with fetal growth restriction (FGR). In the SGA and FGR groups, compared to the non‐SGA and non‐FGR fetuses, respectively, there was a more globular right ventricle and reduced left and right ventricular systolic function, and, from the left ventricular diastolic functional indices, the E/A ratio was increased. There was a linear association of right ventricular sphericity index, indices of left and right ventricular systolic function and E/A ratio with birth‐weight Z‐score. There were no significant associations between cardiac morphological and functional indices and UtA‐PI Z‐score or CPR Z‐score.ConclusionsThis screening study at 35–37 weeks' gestation has demonstrated that birth weight is a determinant of fetal cardiac morphologyand function but UtA‐PI and CPR, as indirect measures of placental perfusion and fetal oxygenation, are not. This suggests that the differences in fetal cardiac indices between small and appropriately grown fetuses may be part of a normal physiological response to change in fetal size rather than part of a pathological adaptation to abnormal placental perfusion and fetal oxygenation. © 2020 International Society of Ultrasound in Obstetrics and Gynecology</abstract><cop>London</cop><pub>Wiley Subscription Services, Inc</pub><doi>10.1002/uog.23522</doi></addata></record>
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ispartof Ultrasound in obstetrics & gynecology, 2021-02, Vol.57 (2), p.266-272
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1469-0705
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source Wiley-Blackwell Read & Publish Collection
subjects Birth weight
Cardiac function
Childbirth & labor
Continuity (mathematics)
Diabetes mellitus
Eclampsia
Fetuses
Gestation
Gestational diabetes
Gynecology
Heart
Hypertension
Low-birth-weight
Morphology
Obstetrics
Oxygenation
Perfusion
Physiological responses
Physiology
Placenta
Population studies
Pregnancy
Regression analysis
Regression models
Ultrasonic imaging
Ultrasound
Uterus
Veins & arteries
Ventricle
Weight
title Influence of birth weight on fetal cardiac indices at 35–37weeks' gestation
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