Antenatal hemodynamic findings and heart rate variability in early school-age children born with fetal growth restriction

Noora Korkalainen, Timo Mäkikallio, Juha Räsänen, Heikki Huikuri, Kaarin Mäkikallio

Research output: Contribution to journalArticle

Abstract

Background: According to epidemiological studies, impaired intrauterine growth increases the risk for cardiovascular morbidity and mortality in adulthood. Heart rate variability (HRV), which reflects the autonomic nervous system function, has been used for risk assessment in adults while its dysfunction has been linked to poor cardiovascular outcome. Objective: We hypothesized that children who were born with fetal growth restriction (FGR) and antenatal blood flow redistribution have decreased HRV at early school age compared to their gestational age matched peers with normal intrauterine growth. Study design: A prospectively collected cohort of children born with FGR (birth weight <10th percentile and/or abnormal umbilical artery flow, n = 28) underwent a 24-hour Holter monitoring at the mean age of 9 years and gestational age matched children with birth weight appropriate for gestational age (AGA, n = 19) served as controls. Time- and frequency domain HRV indices were measured and their associations with antenatal hemodynamic changes were analyzed. Results: Time- and frequency domain HRV parameters (standard deviation of R–R intervals, SDNN; low frequency, LF; high frequency, HF; LF/HF; very low frequency, VLF) did not differ significantly between FGR and AGA groups born between 24 and 40 weeks. Neither did they differ between children born with FGR and normal umbilical artery pulsatility or increased umbilical artery pulsatility. In total, 56% of the FGR children demonstrated blood flow redistribution (cerebroplacental ratio, CPR < −2 SD) during fetal life and their SDNN (p =.01), HF (p =.03) and VLF (p =.03) values were significantly lower than in FGR children with CPR ≥ −2SD. Conclusions: Early school age children born with FGR and intrauterine blood flow redistribution demonstrated altered heart rate variability. These prenatal and postnatal findings may be helpful in targeting preventive cardiovascular measures in FGR.

Original languageEnglish (US)
JournalJournal of Maternal-Fetal and Neonatal Medicine
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Fetal Development
Heart Rate
Hemodynamics
Umbilical Arteries
Gestational Age
Cardiopulmonary Resuscitation
Birth Weight
Ambulatory Electrocardiography
Autonomic Nervous System
Growth
Epidemiologic Studies
Morbidity
Mortality

Keywords

  • Catch-up growth
  • cerebroplacental ratio
  • heart rate variability
  • placental insufficiency
  • umbilical artery

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Antenatal hemodynamic findings and heart rate variability in early school-age children born with fetal growth restriction. / Korkalainen, Noora; Mäkikallio, Timo; Räsänen, Juha; Huikuri, Heikki; Mäkikallio, Kaarin.

In: Journal of Maternal-Fetal and Neonatal Medicine, 01.01.2019.

Research output: Contribution to journalArticle

Korkalainen, Noora ; Mäkikallio, Timo ; Räsänen, Juha ; Huikuri, Heikki ; Mäkikallio, Kaarin. / Antenatal hemodynamic findings and heart rate variability in early school-age children born with fetal growth restriction. In: Journal of Maternal-Fetal and Neonatal Medicine. 2019.
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AU - Mäkikallio, Timo

AU - Räsänen, Juha

AU - Huikuri, Heikki

AU - Mäkikallio, Kaarin

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N2 - Background: According to epidemiological studies, impaired intrauterine growth increases the risk for cardiovascular morbidity and mortality in adulthood. Heart rate variability (HRV), which reflects the autonomic nervous system function, has been used for risk assessment in adults while its dysfunction has been linked to poor cardiovascular outcome. Objective: We hypothesized that children who were born with fetal growth restriction (FGR) and antenatal blood flow redistribution have decreased HRV at early school age compared to their gestational age matched peers with normal intrauterine growth. Study design: A prospectively collected cohort of children born with FGR (birth weight <10th percentile and/or abnormal umbilical artery flow, n = 28) underwent a 24-hour Holter monitoring at the mean age of 9 years and gestational age matched children with birth weight appropriate for gestational age (AGA, n = 19) served as controls. Time- and frequency domain HRV indices were measured and their associations with antenatal hemodynamic changes were analyzed. Results: Time- and frequency domain HRV parameters (standard deviation of R–R intervals, SDNN; low frequency, LF; high frequency, HF; LF/HF; very low frequency, VLF) did not differ significantly between FGR and AGA groups born between 24 and 40 weeks. Neither did they differ between children born with FGR and normal umbilical artery pulsatility or increased umbilical artery pulsatility. In total, 56% of the FGR children demonstrated blood flow redistribution (cerebroplacental ratio, CPR < −2 SD) during fetal life and their SDNN (p =.01), HF (p =.03) and VLF (p =.03) values were significantly lower than in FGR children with CPR ≥ −2SD. Conclusions: Early school age children born with FGR and intrauterine blood flow redistribution demonstrated altered heart rate variability. These prenatal and postnatal findings may be helpful in targeting preventive cardiovascular measures in FGR.

AB - Background: According to epidemiological studies, impaired intrauterine growth increases the risk for cardiovascular morbidity and mortality in adulthood. Heart rate variability (HRV), which reflects the autonomic nervous system function, has been used for risk assessment in adults while its dysfunction has been linked to poor cardiovascular outcome. Objective: We hypothesized that children who were born with fetal growth restriction (FGR) and antenatal blood flow redistribution have decreased HRV at early school age compared to their gestational age matched peers with normal intrauterine growth. Study design: A prospectively collected cohort of children born with FGR (birth weight <10th percentile and/or abnormal umbilical artery flow, n = 28) underwent a 24-hour Holter monitoring at the mean age of 9 years and gestational age matched children with birth weight appropriate for gestational age (AGA, n = 19) served as controls. Time- and frequency domain HRV indices were measured and their associations with antenatal hemodynamic changes were analyzed. Results: Time- and frequency domain HRV parameters (standard deviation of R–R intervals, SDNN; low frequency, LF; high frequency, HF; LF/HF; very low frequency, VLF) did not differ significantly between FGR and AGA groups born between 24 and 40 weeks. Neither did they differ between children born with FGR and normal umbilical artery pulsatility or increased umbilical artery pulsatility. In total, 56% of the FGR children demonstrated blood flow redistribution (cerebroplacental ratio, CPR < −2 SD) during fetal life and their SDNN (p =.01), HF (p =.03) and VLF (p =.03) values were significantly lower than in FGR children with CPR ≥ −2SD. Conclusions: Early school age children born with FGR and intrauterine blood flow redistribution demonstrated altered heart rate variability. These prenatal and postnatal findings may be helpful in targeting preventive cardiovascular measures in FGR.

KW - Catch-up growth

KW - cerebroplacental ratio

KW - heart rate variability

KW - placental insufficiency

KW - umbilical artery

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