TY - JOUR
T1 - Long-term cardiovascular outcome following fetal anaemia and intrauterine transfusion
T2 - A cohort study
AU - Wallace, Alexandra H.
AU - Dalziel, Stuart R.
AU - Cowan, Brett R.
AU - Young, Alistair A.
AU - Thornburg, Kent L.
AU - Harding, Jane E.
N1 - Funding Information:
We thank all the participants of this study; the staff of the University of Auckland's Centre for Advanced MRI and Auckland MRI Research Group, particularly Anna-Marie Lydon, Benjamin Wen and Agustin Okamura, who assisted with data acquisition and analysis; Beau Pontr? and Sunay Gotla of the Department of Anatomy with Radiology, University of Auckland, who analysed the MBF data; Michael Jerosch-Herold, Brigham and Women's Hospital, Boston, who assisted with design of the MRI protocol and analysis of MBF data; Craig Broberg, Oregon Health and Sciences University, Portland, who assisted with study design and data interpretation, and members of the Liggins Institute's LifePath Research Group, who assisted with administrative tasks, data collection and analysis: Chris McKinlay, Greg Gamble and Coila Bevan. Health Research Council of New Zealand (grant number: 09/095A) and the New Zealand Lottery Grant Board (grant numbers: 265071, 362747).
Publisher Copyright:
© 2017, BMJ Publishing Group. All rights reserved.
PY - 2017/1
Y1 - 2017/1
N2 - Objective: To compare long-term cardiovascular outcomes in survivors of fetal anaemia and intrauterine transfusion with those of non-anaemic siblings. Design: Retrospective cohort study. Setting: Auckland, New Zealand. Participants: Adults who received intrauterine transfusion for anaemia due to rhesus disease (exposed) and their unexposed sibling(s). Exposure: Fetal anaemia requiring intrauterine transfusion. Main outcome measures: Anthropometry, blood pressure, lipids, heart rate variability and cardiac MRI, including myocardial perfusion. Results: Exposed participants (n=95) were younger than unexposed (n=92, mean±SD 33.7±9.3 vs 40.1 ±10.9 years) and born at earlier gestation (34.3±1.7 vs 39.5±2.1 weeks). Exposed participants had smaller left ventricular volumes (end-diastolic volume/body surface area, difference between adjusted means -6.1, 95% CI -9.7 to -2.4 mL/m2), increased relative left ventricular wall thickness (difference between adjusted means 0.007, 95% CI 0.001 to 0.012 mm.m2/mL) and decreased myocardial perfusion at rest (ratio of geometric means 0.86, 95% CI 0.80 to 0.94). Exposed participants also had increased low frequency-to-high frequency ratio on assessment of heart rate variability (ratio of geometric means 1.53, 95% CI 1.04 to 2.25) and reduced high-density lipoprotein concentration (difference between adjusted means -0.12, 95% CI -0.24 to 0.00 mmol/L). Conclusions: This study provides the first evidence in humans that cardiovascular development is altered following exposure to fetal anaemia and intrauterine transfusion, with persistence of these changes into adulthood potentially indicating increased risk of cardiovascular disease. These findings are relevant to the long-term health of intrauterine transfusion recipients, and may potentially also have implications for adults born preterm who were exposed to anaemia at a similar postconceptual age.
AB - Objective: To compare long-term cardiovascular outcomes in survivors of fetal anaemia and intrauterine transfusion with those of non-anaemic siblings. Design: Retrospective cohort study. Setting: Auckland, New Zealand. Participants: Adults who received intrauterine transfusion for anaemia due to rhesus disease (exposed) and their unexposed sibling(s). Exposure: Fetal anaemia requiring intrauterine transfusion. Main outcome measures: Anthropometry, blood pressure, lipids, heart rate variability and cardiac MRI, including myocardial perfusion. Results: Exposed participants (n=95) were younger than unexposed (n=92, mean±SD 33.7±9.3 vs 40.1 ±10.9 years) and born at earlier gestation (34.3±1.7 vs 39.5±2.1 weeks). Exposed participants had smaller left ventricular volumes (end-diastolic volume/body surface area, difference between adjusted means -6.1, 95% CI -9.7 to -2.4 mL/m2), increased relative left ventricular wall thickness (difference between adjusted means 0.007, 95% CI 0.001 to 0.012 mm.m2/mL) and decreased myocardial perfusion at rest (ratio of geometric means 0.86, 95% CI 0.80 to 0.94). Exposed participants also had increased low frequency-to-high frequency ratio on assessment of heart rate variability (ratio of geometric means 1.53, 95% CI 1.04 to 2.25) and reduced high-density lipoprotein concentration (difference between adjusted means -0.12, 95% CI -0.24 to 0.00 mmol/L). Conclusions: This study provides the first evidence in humans that cardiovascular development is altered following exposure to fetal anaemia and intrauterine transfusion, with persistence of these changes into adulthood potentially indicating increased risk of cardiovascular disease. These findings are relevant to the long-term health of intrauterine transfusion recipients, and may potentially also have implications for adults born preterm who were exposed to anaemia at a similar postconceptual age.
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U2 - 10.1136/archdischild-2016-310984
DO - 10.1136/archdischild-2016-310984
M3 - Article
C2 - 27664264
AN - SCOPUS:84988683834
VL - 102
SP - 40
EP - 45
JO - Archives of Disease in Childhood
JF - Archives of Disease in Childhood
SN - 0003-9888
IS - 1
ER -